Detailed Information on the
Child Survival and Health - Population Assessment

Use the budget allocation model to rank countries globally rather than within regions for priority family planning and reproductive health funding. Present how the allocation model has impacted decisions in future Child Survival and Health budget requests to OMB.

Complete graduation criteria and design/implement graduation strategies for countries receiving family planning and reproductive health funding within reach of the criteria.

Continue to provide resources at the 2003 request level of $425 million.

Take steps to better align resource allocations with country needs through new performance budgeting efforts.

Measure: Percentage of married women of reproductive age who use modern contraceptives

Explanation:Percentage of in-union women of reproductive age (age 15-49) (WRA) using, or whose partner is using, a modern method of contraception at the time of the survey. Numerator: Number of in-union WRA using modern contraception. Denominator: Number of WRA in union. Data from the Uttar Pradesh State were used for India. The annual percent change between each data point (DHS and RHS) was calculated. The annual percent change was then used to estimate the results between survey years. The data presented here are based on countries that received at least $ 1 million in FY03 and had at least two data points in FY06 in each element (CS/MH and FP/RH). The lists of countries used for this PAR will remain unchanged until 2010. Only a 2013 target level was added for Spring 2008 PART submission.

Measure: Percentage of total demand for family planning satisfied by modern method use among married women of reproductive age.

Explanation:This outcome indicator is the proportion of total demand for family planning at a given point in time that is being satisfied by current modern contraceptive use. The indicator was revised in the Spring 2008 PART submission to more accurately describe the measure and remove country number. The definition of the indicator does not change from Fall 2007 PART submission. No data changes for the indicator for Spring 2008 PART submission.The 2009 and 2012 target levels are based on the 2007 actual level.

Measure: Percentage of first births to women under age 18.

Explanation:Proportion of women who had a first birth before age 18 years among women aged 18-24 at the time of the survey. Numerator: Number of women aged 18-24 at the time of the survey who had a first birth before the age of 18. Denominator: Number of women aged 18-24 at the time of the survey. The annual percent change between each data point (DHS and RHS) was calculated. The annual percent change was then used to estimate the results between survey years. The data presented here are based on countries that received at least $ 1 million in FY03 and had at least two data points in FY06 in each element (CS/MH and FP/RH). The lists of countries used for this PART will remain unchanged until 2010. 2007 actual level and 2009 target level was added for Spring 2008 PART submission.

Measure: Average cost per married woman of reproductive age receiving USAID-attributed modern contraceptives.

Explanation:The indicator was revised in the Spring 2008 PART submission to more accurately describe the measure and remove country number. The definition of the indicator does not change from Fall 2007 PART submission. No data changes for the indicator for Spring 2008 PART submission.

Measure: Percentage of Births Spaced Three or More Years Apart.

Explanation:Proportion of all closed birth intervals that are 36 months or longer. Numerator: Number of all closed birth intervals that are 36 months or longer in the five-year period preceding the survey. Denominator: Number of all closed birth intervals in the same period. The annual percent change between each data point (DHS and RHS) was calculated. The annual percent change between each data point (DHS and RHS) was calculated. The annual percent change was then used to estimate the results between survey years. Data from Uttar Pradesh State were used for India. The data presented here are based on countries that received at least $ 1 million in FY03 and had at least two data points in FY06 in each element (CS/MH and FP/RH). The lists of countries used for this PART will remain unchanged until 2010. 2005, 2007 actual level and 2009 target level was added for Spring 2008 PART submission.

Measure: Percentage of Births Parity 5 or Higher.

Explanation:Proportion of births in a given year or referenced period that are birth order 5 or higher. Numerator: Number of births in the two year period preceding the survey that are birth order 5 or higher. Denominator: Total number of births in the same period. The annual percent change between each data point (DHS and RHS) was calculated. The annual percent change was then used to estimate the results between survey years. The data presented here are based on countries that received at least $ 1 million in FY03 and had at least two data points in FY06 in each element (CS/MH and FP/RH). The lists of countries used for this PART will remain unchanged until 2010. 2005, 2007 actual level and 2009 target level was added for Spring 2008 PART submission.

Is the program purpose clear?

Explanation: The purpose of the program is focused principally on reducing unintended pregnancy and improving reproductive health by increasing the use of voluntary family planning. The program also makes substantial contributions to reducing maternal mortality due to unintended pregnancy and abortion and to reducing infant and child mortality through birth spacing.

Evidence: Foreign Assistance Act, 1961 as amended, paragraph 104(b): "The President is authorized to furnish assistance, on such terms and conditions as he may determine for voluntary population planning."

Does the program address a specific interest, problem or need?

Explanation: The program addresses three broad problems found in many developing countries: (1) the high level of unmet need for family planning, resulting in couples' inability to determine the number and spacing of their children, disempowerment of women who are unable to complete their schooling or participate in the labor force, and, in some cases, elevated rates of population growth that may be inconsistent with economic growth and natural resource availability; (2) high levels of maternal mortality, in part due to unintended pregnancies and the abortions that result from them; and (3) high levels of infant and child mortality, in part due to births that are too closely spaced, born to women at very young ages and are of too high parity. [Unmet need is the percent of married, reproductive age women who state that they want either no more children or to delay their next birth but are not using family planning.]

Evidence: Unmet need for family planning in USAID-assisted countries, on average, is 18% compared to 13% in phase-out, 13% in E&E, and 11% in non-USAID assisted countries. In absolute terms, there are 86 million women with unmet need in USAID-assisted countries, represenenting over 80% of unmet need in all developing countries, excluding China. The maternal mortality ratio in USAID-assisted countries, on average, is 632 per 100,000 live births, compared to 270 in phase-out countries, 99 in E&E and 340 in non-USAID assisted countries. In absolute terms, there are 480,000 maternal deaths annually in USAID-assisted countries, which account for 85% of maternal deaths in all developing countries, excluding China. The infant mortality rate in USAID-assisted countries is 75 per 1,000 live births, compared to 53 in phase-out countries, 26 in E&E, and 54 in non-USAID assisted countries. In absolute terms, there are 5.7 million infant deaths annually in USAID-assisted countries, which account for over 80% of infant deaths in all developing countries, excluding China.

Is the program designed to have a significant impact in addressing the interest, problem or need?

Explanation: Studies have consistently shown that when quality, voluntary family planning/reproductive health services are made available, use of modern contraception increases, even in low resource environments, thereby reducing unintended pregnancy. Increased use of modern contraception also contributes to lower maternal mortality by reducing the number of women exposed to the risks of pregnancy and by reducing reliance on abortion. Finally, increased use of family planning reduces infant and child mortality by allowing women to avoid births that are associated with elevated risks of mortality for either the mother or child (e.g. too closely spaced, mother too young, high parity).

Evidence: USAID-supported FP/RH programs serve approximately 28 million women of reproductive age in USAID-assisted countries, or 22.6% of users of modern contraceptive methods in those countries. In addition to contributing directly to increased contraceptive use, USAID's population resources also help prevent 3,253,000 abortions, roughly 16,000 maternal deaths, and 275,000 infant deaths. Resources are focused on improving on-the-ground efforts to improve FP/RH information and services. FY2000 expenditure data reveal that over 70% of funds were focused on these activities, including training, management, communications, contraceptives and logistics.

Is the program designed to make a unique contribution in addressing the interest, problem or need (i.e., not needlessly redundant of any other Federal, state, local or private efforts)?

Explanation: USAID is the only U.S. government agency that receives funding expressly for implementing family planning and reproductive health programs in developing countries. USAID makes unique contributions to family planning and reproductive health programs in the following areas: biomedical research (including microbicides that provide protection from pregnancy and STIs, including HIV); operations research; surveys; contraceptive logistics; and behavior change communication. Unlike most other donors, USAID provides substantial support for service delivery through private channels, including through commercial, PVO and other non-governmental organizations. Cooperative agreement and grant mechanisms typically include a matching requirements of 10-25 percent -- some as high as 50% (CARE Endowment).

Evidence: USAID receives funding from other U.S. government agencies for biomedical research on new contraceptives, including funding from DHSS, NIH and CDC. In 2001, this funding totaled $1.5 million. In 2000, USAID's funding for family planning comprised 37% of all donor funding for this sector according to the UNFPA-sponsored "Financial Resource Flows for Population Activities in 2000". In the broader classification of "Cairo-defined" population activities that encompasses maternal health and HIV/AIDS, USAID's funding comprises 24% of all donor funding.

Is the program optimally designed to address the interest, problem or need?

Explanation: USAID's program is decentralized, placing most program design and funding decisions in the hands of technical experts based in-country in field missions, but also including programs designed, funded, and managed out of AID/W. Programming decisions are governed by guidelines on appropriate and optimal use of funds (developed for CSH funds) for acheiving impact in the sector. Most mission-based programs focus on direct provision of FP/RH services and information. Central programs focus on biomedical, operations, and social science research, commodity procurement and logistics, and technical leadership in critical areas such as policy, communications, and performance improvement. Missions have at their disposal, various options for implementing programs, including both mission-managed contracts and agreements and mechanisms managed centrally in Washington. Options include agreements with central governments, district-level governments, international organizations, private voluntary organizations, contracts with local NGOs, contracts with commercial sector organizations and loan programs.

Evidence: Field and central programs are complementary. They also seek to minimize management burdens on USAID staff and to maximize the reach of USAID resources by including cost-share requirements when appropriate. The Kenya program is a good example of these principles: it represents a combination of locally-awarded and AID/W-managed components; charges the insitutional contractor with coordinating training, technical assistance and monitoring and evaluation practices among the handful of Kenyan NGOs that actually provide fp/rh services; and meets the 15 percent cost share requirement for the project by leveraging assistance from other private and bilateral donors that complement the activities of the bilateral agreement.

Does the program have a limited number of specific, ambitious long-term performance goals that focus on outcomes and meaningfully reflect the purpose of the program?

Explanation: The Agency has three ten-year (1998-2007) performance goals that the population program contributes to: (1) reducing fertility by 20 percent, (2) reducing maternal mortality by 10 percent, and (3) reducing infant and child mortality by 25 percent. The population program is the principal intervention contribution to goal (1). It contributes jointly with the Agency's maternal health program to achieve goal (2) and with the child survival program to achieve goal (3).

Evidence: Section IV.1 of this PART contains the Agency's goals and targets for the population sector, as articulated in the 2003 APP. The evidence folder includes a chart summarizing long-term goals and performance indicators that relate thereto. Perforamance targets are articulated in performance monitoring plans at the global, regional, and mission levels.

Does the program have a limited number of annual performance goals that demonstrate progress toward achieving the long-term goals?

Explanation: The Agency maintains performance data tables that track progress in achieving annual targets for each of its indicators, both at the country level and at an aggregate level. Field missions report country program performance against annual goals using proxy measures in years when survey data are not available. For all operating units, field missions and central programs, a variety of "intermediate-level" results are also tracked.

Evidence: Key goals, performance targets, and progress to date are articulated in Section IV.2 of this PART. Two indicators are not included in that section because accurate data are available for too few countries to be included in GPRA reporting. 1. Unmet need for family planning reduced in countries where adult HIV prevalence is 8% or higher: data available for six such countries show unmet need reduced by over 13 points, on average, over a five-year period. 2. Abortions reduced through increased use of family planning: data available for five countries have documented success in both increasing family planning use and reducing abortions.

Do all partners (grantees, sub-grantees, contractors, etc.) support program planning efforts by committing to the annual and/or long-term goals of the program?

Explanation: Many partners have mission statements that are consistent with USAID's -- many partners provided input to USAID's "vision" for population programs -- partners are usually participants/provide comment to USAID designs in an open/transparent process -- partners have scopes of work that are in concert with USAID goals.

Evidence: In its cooperative agreement with USAID, one partner states: "AVSC is an organization that is fundamentally devoted to helping countries to introduce, expand, and improve services to enable individuals to carry out their reproductive intentions. The results framework for the cooperative agreement mirrors AVSC's overall strategy for working in partnership with USAID and its country partners to maximize access to and quality of services."

Does the program collaborate and coordinate effectively with related programs that share similar goals and objectives?

Explanation: Internal coordination across different categories of health programs is faciliated by the broad responsibilities of most Mission PHN officers for health, HIV and fp/rh activities. The small size of missions also facilitates coordination across sectors. USAID Missions coordinate their fp/rh assistance with the national government and in-country offices of bilateral and multilateral donors. Specific mechanisms exist to foster internal coordination in the Global Bureau also. Global contracts and agreements are often cross-cutting and various working groups and committees exist for coordination. Global assistance with external donors is coordinated through technical meetings, e.g. USAID participation in international technical advisory boards, in executive boards for multilateral and private donors, and through shared initiatives such as the contraceptive security initiative. As the largest bilateral donor, USAID retains an important "seat at the table" in donor fora, espcially on technical matters related to international fp/rh.

Evidence: Evidence of internal coordination by USAID Missions includes the recent Uganda RFA which was designed with input from the health, fp/rh and education experts in the Mission. Within the Global Bureau internal coordination occurs through global working groups on HIV/FP integration, population and environment, and reproductive health commodities. External coordination by Missions has led to the alignment of project cycles with other donors [e.g. with UNFPA in Nepal]. Globally and in the field the common agenda has involved joint project design missions with representatives from USAID and Japan, for example in Tanzania and Zambia.

Are independent and quality evaluations of sufficient scope conducted on a regular basis or as needed to fill gaps in performance information to support program improvements and evaluate effectiveness?

Explanation: Independent program-wide evaluations have not been done in recent years because family planning programs over the last two decades have demonstrated their effectiveness in meeting unmet need and reducing total fertility rates. Where they have demonstrated success, interventions that were initiatied as operations research experiments have been scaled-up to the national level and implemented worldwide. Although evaluations are not program-wide, the Agency does regularly evaluate most of its activities. However, because it has a system for annual results reviews and reports, evaluations are no longer required for every project. As a consequence, evaluations are often broader in scope, encompassing multiple, related projects/activities.

Evidence: Through the Evaluation Project, USAID has conducted case-control studies measuring key outcomes in project and non-project areas in Bangladesh and Uganda. USAID has also used operations research to test new modes of service delivery, such as community-based distribution and social marketing, which are now widely implemented at the national level. Independent qualitative evaluations of global and bilateral projects are conducted through the Poptech Project. Poptech evaluations also focus on thematic or cross-cutting initiatives, for example the recent assessment of USAID's post-abortion care activities. Such assessments or evaluations focus on the questions of whether the activities and approach of the project or initiative are the appropriate ones and the quality of implementation.

Is the program budget aligned with the program goals in such a way that the impact of funding, policy, and legislative changes on performance is readily known?

Explanation: Agency budget allocations are often not aligned with need but rather are driven by geopolitical and historical considerations more than by health priorities.

Evidence: Nigeria, the country with the greatest need for FP/RH assistance based on both magnitude and severity of unmet need, is ranked 7th in terms of population funding. The country receiving the most population funds in FY2001 was Bangladesh, which ranks 17th in terms of need. Of the countries ranked 1-10 on the basis of need, only two (Nigeria and India) rank in the top ten for FY2001 funding.

Has the program taken meaningful steps to address its strategic planning deficiencies?

Explanation: The Global Bureau has conducted analyses to identify allocations of resources that would better serve the Agency's population goals. However, to date, the information has not significantly affected Agency budget allocations. Allocations are further distorted by the decision to fund fp/rh projects from specialized accounts (e.g., ESF, SEED) in countries where unmet need is limited to help meet overall congressional earmarks for fp/rh programs. These specialized accounts comprise an increasing percentage of the Agency's population budget, circumscribing the ability to direct funds to countries with the greatest need.

Evidence: Analyses have been undertaken to rank countries on the basis of 1) unmet need for family planning, both in terms of magnitude of need (# of births in excess of 2.6 per woman) and severity (total fertility rate) and 2) FY2001 funding allocations. As noted in the evidence for question II.5 above, there is a poor match between need and funding for many countries.

Does the agency regularly collect timely and credible performance information, including information from key program partners, and use it to manage the program and improve performance?

Explanation: (a) The agency-wide mechanism for reviewing regional and country funding allocations is not sufficiently robust to assure that resource flows reflect primarily the programmatic needs and performance arising from the family planning program's strategic objectives. (b) Central programs rely on management reviews; results reviews (which feed into annual reports); and evaluations -- each of which is aimed at improving performance. Some contracts are performance-based, where the award fee is adjusted based on performance against a range of criteria. Funding decisions are based in part on performance, including field support funds that missions direct to those partners that are most needed to support country programs and objectives. (c) Missions use performance information to review progress with partners and to make adjustments in their programs (Kenya: quarterly meetings with partners to report and review performance/identify problems; Bangladesh: use of surveys in areas where project is and is not working to compare performance).

Evidence: Annual performance is tracked at multiple levels. PPC tracks, aggregates and reports key indicators of performance (e.g., TFR, CPR, IMR) across roughly 50 countries receiving population and health assistance using three-year weighted averages based on most the recent data from DHS and CDC surveys and interopolation. Aggregated information is updated on a rolling cycle as new survey data become available. However, the Agency has not yet translated the information on need and performance into reallocating funds (see Section II.6). GH tracks a larger set of indicators aggregated across countries on an annual basis, including desired family size, # of new or improved contraceptive at various stages of devlopment, and # of policies in place. Individual missions report annually on their performance against mission-set goals, often using CPR or CYP and other performance measures. GH and missions also collect information from program partners for ongoing monitoring of program performance and annual budget allocation purposes.

Are Federal managers and program partners (grantees, subgrantees, contractors, etc.) held accountable for cost, schedule and performance results?

Explanation: In the Agency personnel evaluation process, project managers are evaluated for effective management of agreements; staff who serve as point-persons for country programs (called Country Coordinators) are assessed against their contributions to a mission team. Input is sought from supervisors, peers, and clients on performance against these criteria as part of the annual evaluation process. Partners are rewarded for performance either directly through award fees (POLICY & CMS) or through budget allocation by GH and missions.

Evidence: Work objectives in employee work plans are tied to the employee's role in the organzation. Among other areas, project managers are evaluated against the quality of technical guidance provided to contractors and grantees and their management of financial and human resources. Country coordinators are assessed against criteria appropriate to the stage of the country program; for example, contribution to a new country strategy or assistance in ensuring that country resources are appropriately allocated to agreements managed by AID/W if the mission chooses to program its funds that way. Award-fee contracts reward performance with additional fee for exemplary performance in categories such as results, quality, timeliness, management, cost control, and collaboration. Project pipelines factor into annual budget decisions. For example, in FY2001, the Office of Population obligated no core funds to its PASA with CDC because of CDC's sizeable unspent pipeline.

Are all funds (Federal and partners') obligated in a timely manner and spent for the intended purpose?

Explanation: (a) The Agency has obligated nearly all its population funds in the same year the funds were made available; it has issued guidance on the use of population funds to help ensure that funds are spent for their intended purpose; (b) the Agency regularly audits contracts and grants to assure the funds are spent for the object class, but does not systematically review expenditures for appropriate use of funds for meeting objectives. Because they can visit service sites and training sessions, it is easier for mission staff than for AID/W staff to assess whether funds are being spend for the intended purpose.

Evidence: The Agency has successfully obligated its population funds in the same year as appropriated, with rare exceptions (e.g., in 2000 only funds that were on hold for the CARE endowment ($2.7m) was carried forward into FY01 and in 2001 only ESF funds for Cambodia ($750k) was carried forward. Across these two years, less than $4m was carried forward out of a total of $797.5m available for population programs (about 1/2 of one percent). The Agency issued guidance on the use of population funds to help ensure that funds are spent for their intended purpose.

Does the program have incentives and procedures (e.g., competitive sourcing/cost comparisons, IT improvements) to measure and achieve efficiencies and cost effectiveness in program execution?

Explanation: The Agency has not identified systematic approaches through U.S. based contracts and grants that ensure maximum use of indigenous organizations and experts to implement programs in a sustainable manner. Efficiency and productivity gains are not generally part of contracts and grant agreements. However, the Agency implements much of its program through competitively-awarded mechanims, and usually makes awards on the basis of "best value" to the government; has empowered its frontline managers to make program decisions; has pursued increased efficiencies by consolidating projects (fewer/more easily managed) that work across health sectors; has focused on improving use of info technology through IT & Materials Working Group that places a premium on information/technology sharing & transfer (subject of upcoming CAs meetings).

Evidence: Close to 60% of the Agency's $450M population budget flows through contracts and grants administered through the Bureau for Global Health. Of this total, 71% was obligated into competitively-awarded contracts and cooperative agreements. Non-competitive awards tend to be those for activities with other government agencies (i.e., CDC, BuCen) and biomedical research. With the exception of support to governments, the majority of bilateral awards are also competitive.

Does the agency estimate and budget for the full annual costs of operating the program (including all administrative costs and allocated overhead) so that program performance changes are identified with changes in funding levels?

Explanation: Although the agency has made progress in the allocation of administrative costs, they are still unable to fully account for headquarters costs or allocate down to the individual program level. In addition, to date, the information has simply been used to highlight missions with either extraordinarily high or low operating expense to program ratios rather than as a direct factor in decisions regarding program funding.

Evidence: Status Report on Operating Expenses, Managerial Cost Accounting Report

Does the program use strong financial management practices?

Explanation: Although the agency has made progress in achieving a qualified financial audit opinion for FY 2001, it continues to not meet basic Federal financial management requirements. In addition, it has not yet implemented a compliant financial management system for its field missions.

Evidence: USAID Inspector General's audit report for FY 2001.

Has the program taken meaningful steps to address its management deficiencies?

Explanation: The Agency has centralized its budget function in PPC and is reviewing its approach to country allocations; it has only recently issued guidance on appropriate uses of population funds and programs have yet to be audited systematically; it has begun to explore ways of rewarding sustainability within its agreements. This has not yet resulted in a significant shift of funds to countries with the greatest deficits in the three long-term goal areas.

Evidence: Reorganization Memo #1 moves the Agency's budget function from the Management Bureau to PPC. Analyses of the relationship between need and funding levels have been undertaken and are being discussed with the Administrator as part of the Bureau Budget and Program Submission (BPBS) process.

Are grant applications independently reviewed based on clear criteria (rather than earmarked) and are awards made based on results of the peer review process?

Explanation: With very few exceptions, USAID awards are competitively procured with awards made on the basis of a technical panel's evaluation of proposals based on clear selection criteria, included in the request for proposals. Most awards are judged against the following broad criteria: program design and performance monitoring, institutional capacity and past performance, personnel capability and experience. Bidders are informed of the relative weight of each category and the elements within it towards the total score. Bidders' cost proposals are separately evaluated by USAID's Office of Procurement. In the population sector, most RFAs/RFPs state how much money the Agency plans to obligate for the activity being competed, effectively eliminating "low-ball" bids and allowing the technical panel to assess cost-effectiveness.

Evidence: Examples of specific criteria from a recent competitively-awarded cooperative agreement include: "Does the proposal reflect understanding of USAID and the needs of the Bureau for Global Health sector? Does the proposal provide adequate evidence of innovation and understanding of the evidence/science base of health communication including field experience and data? Does the proposal suggest credible and realistic performance results? What evidence is there that the applicant and this/these organization(s) have managed and implemented a large global project int he PHN or related development sector, and performed well? The personnel capability will include examination of the multidisciplinary technical expertise in health communication, population, health sciences and development..."

Does the grant competition encourage the participation of new/first-time grantees through a fair and open application process?

Explanation: USAID requests for proposals are open and announced on the Agency website in addition to the CBD announcement.

Evidence: While competition is open, few first-time bidders win awards as primes, because of the size of the awards; first-time awardees are more prominent in smaller procurements; trend has been toward larger procurements given the management efficiencies.

Does the program have oversight practices that provide sufficient knowledge of grantee activities?

Explanation: USAID provides close monitoring of its agreements, through annual workplan reviews, management reviews, site visits, briefings, results reporting and financial reviews.

Evidence: USAID's Automated Directive System (ADS) requires Cognizant Technical Officers (CTOs) of cooperative agreements to "monitor and evaluate the recipient's performance [through site visits, reviewing and analyzing performance, assuring compliance with the terms and conditions of the award...]; evaluate...program effectiveness at the end of the program; and perform other duties as may be requested or as delegated by the Agreement Officer." CTO responsibilities for contract oversight are articulated in each contract.

Does the program collect performance data on an annual basis and make it available to the public in a transparent and meaningful manner?

Explanation: USAID collects performance data from partners on at least an annual basis and uses it to assess impact and manage its programs. While the information it collects is not shared publicly, its cooperating agencies [CAs] make the results of their USAID-assisted activities widely available through the web and other channels.

Evidence: All CAs maintain websites highlighting their project activities and accomplishments. Many CAs, particularly those undertaking biomedical and operations research, publish their work in peer-reviewed journals, and USAID supports the Johns Hopkins media center to serve as a repository of communication tools and media materials. All of these formats are accessible to the public. CAs are also required to submit copies of all publications to USAID's Clearinghouse for Development Information and Experience (CDIE).

Has the program demonstrated adequate progress in achieving its long-term outcome goal(s)?

Explanation: USAID's population program has demonstrated marked progress in meeting its goals.

Evidence: Evidence is from USAID mission and GH Annual Reports and from the Annual Performance Plan, which responds to GPRA.

Does the program (including program partners) achieve its annual performance goals?

Explanation: USAID's population program has achieved its annual performance goals for the most recent reporting period.

Evidence: Evidence is from USAID mission and GH Annual Reports and from the Annual Performance Plan, which responds to GPRA.

Does the program demonstrate improved efficiencies and cost effectiveness in achieving program goals each year?

Explanation: Commodity procurement has benefited from competition; for other parts of the population program, unit costs are more difficult to measure and compare across various organizations and service delivery systems and components.

Evidence: USAID receives low commodity prices through Agency-wide, pooled procurement and through competition. Condom procurement has has benefited from competitive sourcing and economies of scale as evidenced by the recently procured price of 3.5 cents per condom, down from a high of over 7 cents.

Does the performance of this program compare favorably to other programs with similar purpose and goals?

Explanation: There are no other US government programs that work in this field.

Evidence:  

Do independent and quality evaluations of this program indicate that the program is effective and achieving results?

Explanation: Independent evaluations of USAID's family planning programs at the country level have demonstrated their impact and effectiveness. Although, as noted in Part II.Q5, evaluations are not program-wide, the Agency does regularly evaluate most of its activities. Because it has a system for annual results reviews and reports, evaluations are no longer required for every project. Rather, evaluations now more often encompass multiple related projects/activities and provide a more comprehensive picture of program accomplishments than earlier project-by-project evaluations provided.

Evidence: Recent evaluations have examined the impact of USAID family planning (FP) assistance in Morocco over 30 years, Turkey over 12 years, and Brazil over eight years. The Morocco evaluation notes that "the collaboration between the MOH and USAID led to important results in FP indicators. [CPR]...rose from less than 20% in 1979-80 to 59% in 1997. [TFR] decreased dramatically from 7.0 children in 1979-80 to 3.1 children in 1997." (p.iv) The Turkey assessment notes accomplishments ranging from developing strategies for women's health and FP to securing contraceptives to strengthening training systems, to improving access and method choice, to monitoring and evaluation. The Brazil assessment notes that "USAID's program produced a number of significant achievements, many of which warrant replication throughout the country." (p.20)