Detailed Information on the
United States-Mexico Border Health Commission Assessment

Continuing to develop additional targets for its annual measures.

The Commission will complete and publish a border health status report for the US-Mexico border region, which will be the first source of reliable morbidity and mortality data currently available on the US-Mexico border health.

The Commission will plan to work with an external evaluator to assess its impact and achievements.

Collect and report on mid-year performance data

Measure: The diabetes death rate on the United States side of the border (number of deaths per 100,000 inhabitants).

Explanation:Diabetes is a major health problem at the U.S.-Mexico border. Nearly 4,000 border residents die each year from diabetes, with about 1,500 of those fatalities occurring on the U.S. side of the border. The Commission works to reduce the diabetes death rate by raising awareness and stimulating interest in addressing border health issues among stakeholder organizations that can take actions to meet these targets. The data source is the CDC's National Vital Statistics System.

Measure: The incidence of HIV cases per 100,000 inhabitants on the U.S. side of the border.

Explanation:HIV/AIDS is a major cause of illness and death in the United States, and is growing rapidly in importance in Mexico. The measure remains as a ten-year measure because there is very limited HIV incidence data for the border region, which will require the development of a mechanism to collect the needed data. The Commission works to reduce the HIV incidence rate by raising awareness and stimulating interest in addressing border health issues among stakeholder organizations that can take actions to meet these targets. Data is collected from the four border state departments of health, except 2000 data only includes Arizona, New Mexico, and Texas (not California).

Measure: The incidence of tuberculosis cases per 100,000 inhabitants on the U.S. side of border.

Explanation:Tuberculosis represents one of the most important re-emerging infectious diseases in both the United States and Mexico. The difficulties in completing treatment of tuberculosis cases on the border, related to the ease of movement across the border, have contributed to the growth of drug-resistant tuberculosis in both countries. The Commission works to reduce the incidence rate of tuberculosis by raising awareness and stimulating interest in addressing border health issues among stakeholder organizations that can take actions to meet these targets. Data is collected from the four border state departments of health (Arizona, New Mexico, Texas, California).

Measure: The number of U.S. border residents who receive public health education or health care screenings during the annual Border Binational Health Week, to improve detection of chronic diseases.

Explanation:The goal of Border Binational Health Week is to promote sustainable partnerships throughout the U.S.-M??xico border region to address border health problems. This measure supports the program's population-level health outcome measures by influencing the provision of health education and health care services designed to improve the health of border residents. The Commission works to increase the quantity of health screenings and health education provided during the Commission's Border Binational Health Week by promoting the week's events and encouraging Federal, State and local public and private partners to fund health education and screenings. Public health education and health care screenings include: direct health education through classes, seminars, or forums, or direct health screenings or other medical encounters. Although the number of health care providers participating in Border Binational Health Week has increased, the number of screenings has declined; the program attributes this to decreased demand from patients, due to the increased availability of Community Health Centers and other public and private providers in the border region. Data is collected by the Commission using a standardized questionnaire completed by public and private agencies and organizations estimating the number of people served through public health education services or health care screenings provided during Border Binational Health Week.

Measure: The percentage of program funds spent on indirect costs (overhead).

Explanation:Direct costs are those costs that are traced directly to a program output, while indirect costs are overhead costs (e.g. rent, communications, utilities, supplies, materials and equipment). The lower the indirect costs, the higher the percentage of funds committed to direct program activities. The program believes the 2007 actual of 2.4% should be read as a lower range of what will probably be a fluctuating number; the Commission's indirect cost rate is expected to increase in 2008 since: (1) the BHC office in El Paso, TX is projecting to replace all computer and support equipment, since all existing equipment is original from the start-up of the office in 2001; and (2) the BHC El Paso, TX office just completed a relocation to a new location and the annual rental cost will increase during the next five years. Data is calculated by the program based on program financial data.

Measure: The cumulative number of health-related organizations that have adopted population-level health outcome objectives of the Border Health Commission's "Healthy Border 2010" strategy into their planning, programming or funding process.

Explanation:This measure identifies the percentage of health-related organizations in the four border states that have adopted Healthy Border 2010 health outcome objectives into their planning, programming or funding process - meaning such an organization has made an explicit decision to work toward population-level health objectives in Healthy Border 2010 (such as by awarding grants to applicants that specifically target Healthy Border 2010 health objectives, like reducing deaths due to diabetes in the border region). The BHC promotes and encourages the use of Healthy Border 2010 through direct communication with a wide network of partners and publicizing information about Healthy Border 2010 on the BHC's website and through other communication instruments. Health-related organizations include: State and local health departments; community health centers; local or regional private not-for-profit organizations; coalitions; and foundations. The incorporation of the Healthy Border 2010 framework into more organizations' missions results in more resources being applied to achieving these objectives. The BHC collects this data through its partnership with U.S. and Mexican state departments of health, and other public and private organizations. The targets are intended to be a cumulative total, with a significant increase to be shown year to year. This measure supports the program's population-level health outcome measures (which are themselves health objectives taken from Healthy Border 2010) by increasing the number of organizations working to reduce the incidence rate of tuberculosis and HIV and the diabetes death rate in the border population. The denominator of this percentage is 102 organizations, and is a rough estimate based on the number of border health non-profits listed on WWW.GUIDESTAR.ORG plus the number of state and local health departments in the four border states; this denominator will be updated during the Fall of 2008 with a more accurate number.

Measure: The percentage of "Healthy Border 2010" population-level health outcome objectives with baseline data that have been achieved.

Explanation:The Healthy Border 2010 initiative is a program of health education and health promotion that established population-level health outcome objectives for the US-Mexico border region (e.g. "Reduce deaths due to diabetes in the border region by 10%"). It is modeled after the U.S. Healthy People 2010 initiative, and incorporates objectives of Mexico's National Health Indicators Program. As of the end of 2007, 14 of the 22 objectives had baseline data, and 12 of the 14 were progressing toward the 2010 goal. Of these, 2 have already surpassed the 2010 goal (reducing childhood injuries and hepatitis A incidence).

Is the program purpose clear?

Explanation: The United States-Mexico Border Health Commission Act authorized the United States to enter into an agreement with Mexico to form the United States-Mexico Border Health Commission (Commission). The U.S. and Mexico signed this agreement to create the Commission in July 2000. Article 1 of the Agreement sets out the purpose of the Commission, to identify and evaluate current and future health problems that affect the U.S.-Mexico border area, and to encourage and facilitate actions to address these problems. The Commission's leadership consists of the two Health Secretaries of the United States and Mexico as Commissioners, and 24 other members including, for the United States, the four chief health officials from the Border States of Texas, New Mexico, Arizona and California as well as eight individuals from those States named by the President.

Evidence: (1) Public Law 103-400. (2) Agreement between the Government of the U.S.A. and the Government of the United Mexico States to Establish a U.S.-Mexico Border Health Commission (Article 1).

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

Explanation: The Commission serves the area that extends 60 miles (100 kilometers) on either side of the 2,000 mile border between the United States and Mexico. Within that area, the Commission addresses major health problems and serves as the binational leader in promoting healthy behaviors and disease prevention. The federal government has designated 41 out of 44 border counties as medically underserved areas and nearly half of the forty-four as economically distressed areas. Statistics from the 2000 U.S. Census reveal that 25-30% of the border population is uninsured; inhabitants have less private health insurance (40%, average for U.S., versus 60%, average for border states); and the average yearly income is approximately $14,000, compared with the U.S. median household income in 2000 of $41,994. As the busiest crossing in the world, the region is vulnerable to the movement of pathogens, respiratory and gastrointestinal illnesses, HIV/AIDS, and tuberculosis, as well as a high prevalence of chronic illnesses such as diabetes and heart disease. Approximately 432,000 border residents in Texas and New Mexico live in colonias, or unincorporated and semi-rural communities characterized by substandard housing and unsafe public drinking water and/or wastewater systems.

Evidence: (1) 2000 U.S. Census. (2) Bruhn, John and Jeffrey Brandon, 1997, Border Health: Challenges for the United States and M??xico, Garland Publishing, Inc. New York. (3) HHS, 2000, Health on the U.S.-M??xico Border: Past, Present, and Future: A Preparatory Report to the Future U.S.-M??xico Border Health Commission.

Is the program designed so that it is not redundant or duplicative of any other Federal, state, local or private effort?

Explanation: The Commission is the only public international organization located in the border region that has a binational regional focus on health and is committed to enhancing and consolidating the resources and talents of both countries by building partnerships and consensus across Federal, border state and local organizations. No other organization is chartered with identification, evaluation, and provision of solutions for current and prospective health problems for a combined population of 13 million people. The Commission is specifically constituted to be distinct from the other U.S.-Mexico border commissions because of its health focus.

Evidence: As stated in the Agreement between the Government of the U.S.A. and the Government of the United Mexico States to Establish a U.S.-Mexico Border Health Commission (Article 10), the Commission's activities are distinct from and not overlapping with the function of the other Boundary organizations, including the International Boundary and Water Commission (IBWC), the Border Environment Cooperation Commission (BECC) and the North American Development Bank (NAD Bank).

Is the program design free of major flaws that would limit the program's effectiveness or efficiency?

Explanation: The Commission is a well-designed and fully operational organization that targets its resources to improve health on the U.S.-M??xico border and to the intended border recipients. Public Law 103-400 and the Commission Agreement established the Commission, its organization and structure. The Commission is comprised of the Federal secretaries of health of both nations or their designees, and both the U.S. and Mexico section have 12 other members consisting of chief health officials and community health professionals from the border States. The U.S.-M??xico Border Health Commission supplemented the language of Public Law 103-400 and the Commission Agreement by establishing Bylaws that detail policies, procedures and controls. The Bylaws explicitly describe the activities of the Commission, its roles, and responsibilities of the members and Section staff.

Evidence: (1) Public Law 103-400. (2) Agreement between the Government of the USA and the Government of the United Mexico States to Establish a US-Mexico Border Health Commission. (3) U.S.-Mexico Border Health Commission Bylaws.

Is the program design effectively targeted so that resources will address the program's purpose directly and will reach intended beneficiaries?

Explanation: The Commission's function is to improve the health of the border population; either by defining the overall need, conducting specific promotion and prevention activities, or leading coordination and collaboration among agencies, state, local, and international, that are active in the area (according to Article 3 of the Agreement). These activities include: (1) conducting public health needs assessments in the border area and conducting or supporting investigations, research or studies designed to identify and monitor health problems; (2) providing financial, technical or administrative support to assist the efforts of public and private non-profit entities to prevent and resolve health problems; (3) conducting or supporting health promotion and disease-prevention activities in the border area; (4) conducting or supporting the establishment of an extensive and coordinated system that uses advanced technologies to gather health-related data and monitor health problems at the border; and (5) collaborating with non-governmental and other entities in public health on the border.

Evidence: (1) As a first step, the Commission, in concert with local, State and Federal partners, crafted the Healthy Border 2010 agenda that documents the health needs of the U.S.-Mexico border and established 20 objectives with 10-year targets. With the Healthy Border 2010 agenda in place, the Commission and its partners structured programs and projects around the 20 objectives. For example, the Commission collaborated with HHS and Mexico in a Binational Tuberculosis Referral and Case Management Project that provides wallet-sized cards to tuberculosis patients to ensure continuity and quality of care on both sides of the border. (2) Agreement between the Government of the USA and the Government of the United Mexico States to Establish a U.S.-Mexico Border Health Commission (Article 3).

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

Explanation: The U.S.-Mexico Border Health Commission crafted the first binational health promotion agenda to improve health at the border, the Healthy Border 2010 Program. The Healthy Border 2010 Program establishes 20 10-year objectives for binational health promotion and disease prevention at the U.S.-Mexico border. These 20 objectives are long-term performance measures that focus on improving the health outcomes of border populations, and will be measured in 2010 for impact.

Evidence: HHS/OHGA has selected three long-term objectives from the Healthy Border 2010 Program to track which are of particular importance to the U.S. side of the border: (1) reduce diabetes death rate on the U.S. side of the border by 10%, (2) reduce the incidence of tuberculosis cases on the U.S. side of the border by 50%, and (3) reduce the incidence of HIV cases on the U.S. side of the border by 50%. These measures will be incorporated into the HHS/OGHA FY 2007 budget submission.

Does the program have ambitious targets and timeframes for its long-term measures?

Explanation: The Healthy Border 2010 Program outlines a 10-year bilateral agenda that provides year 2000 baseline data and year 2010 targets. The 20 objectives have ambitious quantitative targets given the health status of the U.S.-Mexico border population. These objectives incorporate input form a broad cross-section of people from the U.S.-Mexico border as well as allies of border health. Scientific experts from the United States' National Center for Health Statistics, Centers for Disease Control and Prevention, U.S. State Outreach offices, Mexico's Direccion General de Epidemiologia, and epidemiologists from the border states' Secretaria de Salud worked in partnership to finalize this document. All outcomes of the objectives will improve health at the U.S.-Mexico border.

Evidence: Tuberculosis represents one of the most important re-emerging infectious diseases in both the U.S. and Mexico. The difficulties in completing treatment of tuberculosis cases on the border, related to the ease of movement across the border, have contributed to the growth of drug resistant tuberculosis in both countries. On the U.S. side of the border, the incidence of tuberculosis has declined over the past decade to 10.0 per 100,000 inhabitants in 2000, but still remains about 70 percent above the national rate. Therefore, the long-term goal of decreasing the incidence of tuberculosis on the U.S. of the border by 50 percent by 2010 is very ambitious.

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

Explanation: In order to achieve the three long-term measures which are of particular significance to the health of individuals on the U.S. side of the border, three annual goals have been developed which highlight the HHS/OGHA activities tied to the achievement of these long-term measures. For example, the first annual goal to increase the number of patients at the U.S.-Mexico border using the tuberculosis card is tied to the long-term measure to reduce the incidence of tuberculosis, the second annual goal to increase the number of health screenings provided to U.S.-Mexico border health residents during the Border Binational Health Week to improve detection of chronic diseases will help to reduce the diabetes death rate (long-term measure), and the third annual measure to increase the distribution of health cards (18 cards on topics ranging from HIV, Diabetes, immunizations, etc.) to health care providers is tied to all achievement of all three long-term measures. These measures will be included in the HHS/OGHA FY 2007 budget submission.

Evidence: Tuberculosis is one of the most important re-emerging infectious diseases in the border region. Therefore, the Commission has initiated a U.S.-M??xico Binational Tuberculosis Referral and Case Management Project, part of which is the creation of a TB card (this card contains a unique ID number, toll-free telephone number to ask for information in the U.S and Mexico, site where the patient first received TB care, treatment start date, treatment regimen, and whether the patient received directly observed therapy). The HHS/OGHA annual measure is to increase the number of patients at the U.S. border using the TB card. The utilization of the TB card by individuals who inhabit the border region will lead to effective case detection and case management, and cost-effective follow-up along the border; and ultimately to the reduction of the incidence of TB in the U.S. side of the border (long-term measure).

Does the program have baselines and ambitious targets for its annual measures?

Explanation: HHS/OGHA has established baselines and targets for all three of its annual measures which highlight the results of programmatic activities. The targets reflect substantial increases in the number of health screenings to be delivered during Border Binational Health Week, participants using the Tuberculosis card, and number of health cards distributed to providers.

Evidence: In the Border Binational Health Week: Families in Action for Health Report, data were collected to determine the scope and magnitude of the activities that took place during Border Binational Health Week. This information was then used to set an ambitious target of a 25% increase from 2004 to 2005 for the annual measure - the number of health screenings provided to U.S.-Mexico border health residents during Border Binational Health Week to improve detection of chronic diseases. In addition, from 2004 to 2005, the Commission expects to increase the number of participants using the Tuberculosis card by 15% and number of health cards distributed to providers by 25%.

Do all partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) commit to and work toward the annual and/or long-term goals of the program?

Explanation: Through MOUs with the Commission, the U.S. State Outreach Offices target their annual work to reflect and incorporate the Healthy Border 2010 objectives. In the Commission's Progress Report, States specifically identify which Healthy Border 2010 topic areas their activities are focused on. In the annual reports, U.S. State Outreach Offices describe the projects they have undertaken which address health concerns identified in the Healthy Border 2010 objectives. In addition, the Commission has signed a similar agreement with the Pan American Health Organization, and works with other existing organizations, like the U.S.-Mexico Border 2012 Program on the environment to assure their efforts are linked to the overall Healthy Border 2010 objectives.

Evidence: For example, the California State Outreach Office Report for FY 03-04 identified HIV/AIDS as one of the Health Border 2010 topic areas their activities are focused on. The three main events listed under HIV/AIDS activities are as follows: (1) held the first binational conference in San Diego that reached around 120 participaints; (2) lead a binational tour to governmental and non-governmental HIV/AIDS/STI agencies with 40 participants; and (3) held the 4th Annual Binational Conference HIV/AIDS/STI in Tijiuana with a total of 435 participants that included promotoras, students from universities and high schools, health professionals, and homemakers. These HIV/AIDS activities undertaken by the California State Outreach office will assist the Commission in achieving their long-term goal to reduce the incidence of HIV cases on the U.S. side of the border by 50%.

Are independent evaluations of sufficient scope and quality conducted on a regular basis or as needed to support program improvements and evaluate effectiveness and relevance to the problem, interest, or need?

Explanation: To date, the evaluation efforts undertaken by HHS/OGHA have not been of sufficient scope to evaluate the effectiveness of the Commission. The evaluation activities of the Comission have been more targeted to specific activities, such as an evaluation of the U.S.-Mexico Binational TB Referral and Case Management Project. HHS/OGHA has plans to undertake more comprehensive and rigorous evaluation efforts in the future. HHS/OGHS will begin to develop a schedule to ensure that independent evaluations of the Commission's activities are of sufficient scope, quality, and frequency.

Evidence: (1) U.S.-Mexico Binational TB Referral and Case Management Project: Evaluation Findings, El, Paso, April 4, 2005.

Are Budget requests explicitly tied to accomplishment of the annual and long-term performance goals, and are the resource needs presented in a complete and transparent manner in the program's budget?

Explanation: HHS/OGHA's FY 2006 budget does not provide a presentation that clearly ties the impact of funding decisions to the accomplishment of annual and long-term performance goals, or explain why the requested resources are appropriate. In the FY 2007, HHS/OGHA will incorporate the annual and long-term performance goals of the U.S.-Mexico Border Health Commission into their budget submission. The Commission will participate in a binational strategic planning process this fall, in order to build a framework for this information. This process will be planned and facilitated by an external contractor or consultant that is agreed to by both the United States and Mexico. Planning will be initiated after the Washington, D.C. meeting in July 2005.

Evidence: FY 2006 Congressional Justification.

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

Explanation: This year, the Commission members agreed to pursue a binational strategic planning effort and revisit goals and objectives. In July 2004, the initial steps of working binationally on a strategic plan took place in Ensenada, M??xico when all Commission members agreed upon and signed a vision statement. Further strategic planning will take place later in 2005.

Evidence: Ensenada Declaration (August 20, 2004)

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: Information is collected from the State Outreach Offices on a regular basis and is used effectively to improve program performance. The Commission's central office in El Paso collects quarterly and annual reports from U.S. State Outreach Offices. The reports include narratives on activity progress and financial reporting. The Central office receives the reports, reviews them, and posts them on the web page. In addition, the Commission meets on a quarterly basis to review the reports submited by the U.S. State Outreach Offices and to ensure the offices are adhering to their pre-determied workplans. If the States do not follow their pre-determined workplans, then the Commission will follow-up with the States to resolve any differences. The reports are also provided to the Work Plan and Budget Committee and to the full Commission at the annual meetings. HHS/OGHA currently has plans to improve the information collected from the State Outreach Offices to better manage the program performance. The Commission has developed a performance measure matrix to enhance the reporting for all programs and services. The Commission staff and the U.S. State Outreach Offices have started to use the performance matrix to monitor program performance. The matrix consists of reporting on program targets, inputs, outputs, measures and outcomes.

Evidence: (1) Arizona Department of Health Services and U.S. Mexico Border Health Commission Report FY 2004. (2) U.S. Mexico Border Health Commission California Outreach Office Report FY 2004 (October 1, 2003-September 31, 2004). (3) U.S. Mexico Border Health Commission Texas Outreach Office - Progress Report for Reporting Period: October 2003-September 30, 2004 - Cumulative. (4) New Mexico Outreach Office Activities July 2003-June 2004. (5) U.S.-Mexico Border Health Commission FY 06 Performance Measure Matrix (Draft 4/11/05). (6) Border Health Officers and Commission Outreach Directors/Coordinators Binational Meeting - Draft Recommendations/Outcomes (May 4, 2005).

Are Federal managers and program partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) held accountable for cost, schedule and performance results?

Explanation: Commission grantees or contractors are held accountable for their cost schedules and performance results. Each grantee must submit an application of intent or work plan. Once the Work Plan and Budget Committee and the central office approve the application, the Commission can award funds. Thirty days after the program or service has ended, the grantee/contractor must submit a final financial report of all costs derived from the grant or award and a progress report to indicate performance results and impact at the community, State and border levels. These requirements are made explicit before the grantee/contractor can receive funds. Payment to the grantee/contractor is contingent upon meeting project targets and schedules.

Evidence: For example, prior to the receipt of funds, each State Outreach Office submits to the Commission an outreach work plan, which highlights the planned activities (objectives, expected outcomes, and evaluations), Health Border2010 focus themes, and proposed budget for the next fiscal year. The Work Plan and Budget Committee covenes before the beginning of the fiscal year to approve/disapprove activities in the inital work plan. The State Outreach Offices also submit annual and quarterly reports, and the Commission also meets on a quarterly basis to monitor adherence of the State Outreach Offices with the previously approved work plans.

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

Explanation: To track actual expenditures, the program uses the CORE accounting system. Actual spending as documented in CORE matches the appropriated funds closely. For example, Congress appropriated the $3,752,957 to the U.S.-Mexico Border Health Commission in FY 2004, and CORE showed that 99 percent of the funds were obligated accordingly. In addition, the Commission submits to the HHS Office of Global Health Affairs financial status reports on a quarterly basis. This documentation includes the overall budget, expected expenditures, expected milestones, and projected expenditures. For contracts, the Executive Director of the Border Health Commission reviews monthly invoices submitted by the contractors to ensure funds are spent for the intended purpose.

Evidence: (1) FY 04 Obligations Report from CORE Accounting System. (2) GovNet report.

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

Explanation: HHS/OGHA is in the process of developing an efficiency measure to evaluate the effectiveness of the U.S.-Mexico Border Health Commission. HHS/OHGA has fiscal and administrative procedures in place, but at this time is unable to measure efficiencies and cost effectiveness. Based on the U.S.-Mexico Border Health Commission Policies and Procedures Manual, the Commission has mechanisms to do procurement, contracts, purchase professional services, and identify best costs. The Commission follows purchase guidelines that are similar to those of the HHS Office of Global Health Affairs.

Evidence: For example, three reliable quotes must accompany all purchase requisitions over $1500. Once the Commission staff determines the source of the most cost-effective and efficient execution of the program, the Executive Director can issue a purchase order. (To come to this conclusion a panel of Commission members and OGHA representative may be asked to evaluate the sources for best cost and quality.)

Does the program collaborate and coordinate effectively with related programs?

Explanation: As one of its functions (according to the Commission Agreement), the Commission facilitates and encourages collaborative actions to address health problems at the U.S.-Mexico border. The Commission also has strong partnerships with all the U.S. and Mexico Border States through MOUs that cite the Healthy Border 2010 goals. The Commission central office holds quarterly work meetings with the U.S. State Outreach Office directors to present progress, identify challenges, and communicate needed outputs and program outcomes. The HHS Office of Global Health Affairs, in partnership with the Commission, co-chairs the Inter-Agency Action Team on Border Health, comprised of multiple Federal agencies. The Commission also works to build other border health alliances. For example, the Commission recently signed a communiqu?? for collaborative work with the Pan American Health Organization (PAHO) and signed a letter of intent with Environmental Protection Agency (EPA) Border 2012 and the Comisi??n Federal para la Protecci??n contra Riesgos Sanitarios (COFEPRIS) in M??xico to collaborate on environmental health work. In addition, the Commission works with Ten against Tuberculosis to control the spread of tuberculosis and assist in providing continued care to tuberculosis patients who cross the border.

Evidence: "(1) Agreement between the Government of the USA and the Government of the United Mexico States to Establish a US-Mexico Border Health Commission (Article 3). (2) Communiqu?? between the US-Mexico Border Health Commission and the Pan American Health Organization (March 17, 2005). (3) Letter of Intent to Establish an Alliance between the US Mexico Border 2012 Program and the USMBHC. (4) Strategic Plan 2005-2010 for the Ten Against TB. "

Does the program use strong financial management practices?

Explanation: The Commission uses stringent fiscal and financial management practices, policies, procedures and controls. Commission conducts an audit once a year by using an external audit firm. Audit reports are included in the Commission Annual Report. In 2004, the Commission received a clean audit with no material weaknesses identified. The Commission executes budgetary control such that all financial obligations enter into general ledger based on a work plan approved by the Commission.

Evidence: According to the US-Mexico Border Health Commission Policies and Procedures Manual (Chapter 6), for payments over $1500, one of two designated Commission members must sign a check and confirm the issuance of funds. Otherwise, the Executive Director may execute payments under $1500.

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

Explanation: The Commission takes a pro-active approach to reviewing and addressing management deficiencies on an annual basis. Effective in 2004, the Commission put in place organizational administrative and management structures in a Policies and Procedures Manual to assist the Commission in saving time, reducing costs and becoming more fiscally and financially responsive. Additionally, the Commission's Work Plan and Budget Committee meet quarterly to review financial activities and correct any deficiencies.

Evidence: For example, the U.S. and Mexican Governments are pursuing changes to the Agreement to allow the Commission to accept funding from non-federal sources and facilitate the cross-border work of Commission staff. The U.S. Government has recognized the Commission as a public international organization for certain purposes, notably the concession of special visas for Commission employees.

Has the program demonstrated adequate progress in achieving its long-term performance goals?

Explanation: There are no data available to date to demonstrate the progress the Commission has made in achieving its Healthy Border 2010 objectives. The Commission is preparing for a mid-term summit review of Healthy Border 2010 in the spring of 2006. The Commission will collect data to measure comprehensively the progress over the last five years on Healthy Border 2010 objectives compared with the 2000 baseline data.

Evidence:  

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

Explanation: To date, the Commission only has baseline data; therefore it is unable to measure the success of the program at achieving the annual targets at this time. Preliminary results indicate that the Commission is on target to achieve its ambitious annual performance goals for FY 2005. It is expected that this answer will change once the Commission has received data for its FY 2005 performance goals.

Evidence:  

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

Explanation: HHS/OGHA is in the process of developing an efficiency measure to evaluate the effectiveness of the U.S.-Mexico Border Health Commission. HHS/OHGA has fiscal and administrative procedures in place, but at this time is unable to measure efficiencies and cost effectiveness achieved by the U.S.-Mexico Border Health Commission.

Evidence:  

Does the performance of this program compare favorably to other programs, including government, private, etc., with similar purpose and goals?

Explanation: To date, there has been no formal or informal comparison made between the performance of the U.S.-Mexico Border Health Commission activities and similar programs. In the FY 20065 Commission Work Plan and Budget, the Commission plans to undertake an evaluation that will seek to compare the Commission with other programs, to guide resource allocation between operations and programmatic activities.

Evidence: U.S.-Mexico Border Health Commission FY 05 Implementation Work Plan.

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

Explanation: The evaluation efforts undertaken by HHS/OGHA have been more targeted to specific activities, which are not of sufficient scope to demonstrate the Commission is effective and achieving results. HHS/OGHA has plans to undertake more comprehensive and rigorous evaluation efforts in the future. HHS/OGHS will begin to develop a schedule to ensure that independent evaluations of the Commission's activities are of sufficient scope, quality, and frequency. The Commission has completed an evaluation of the U.S.-Mexico Binational TB Referral and Case Management Project, which is a small part of the activities undertaken by the Commission. This evaluation will contribute to the Commission's mid-term summit review of Healthy Border 2010 in the spring of 2006. The summit will also evaluate data collected over the last five years on Healthy Border 2010 objectives and measure them against the 2000 baseline data.

Evidence: In the U.S.-Mexico Binational TB Referral and Case Management Project: Evaluation Findings (April 2005), two main questions were evaluated: (1) is the referral system facilitating completion of therapy by patients traveling across the border and (2) is the model established through this initiative sufficiently effective and feasible to warrant continuations. Through this evaluation the workgroup was able to establish that the project made an important contribution to the continuity of care, it was built on binational projects already operating on the border, and that it has improved communication both across and along the border. Therefore it was determined that this project has both merit and worth, and the workgroup recommended expanding the project.