PROGRAM: REDSO/ESA
TITLE & NUMBER: Enhanced Regional Capacity to Improve Health Systems, 623-007
STATUS: New
PLANNED FY 2001 OBLIGATION AND ACCOUNT: $1,105,000 DA, $5,514,000 CSD
PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCE: $1,201,000 DA, $6,580,000 CSD
INITIAL OBLIGATION: FY 2001; ESTIMATED COMPLETION DATE: FY 2005

Summary: Enhanced capacity in the region is critical to ensure appropriate long-term response to health development issues. Moreover, given the transnational nature of health problems, particularly with infectious diseases such as HIV/AIDS, tuberculosis and malaria, approaches and solutions should increasingly recognize regional or multi-country realities-diseases do not respect national borders. Presently, however, there are limited numbers of African institutions with regional public health mandates and strategies in ESA. Those that exist lack adequate human, financial and institutional resources and capacity to effectively address health issues.

Additionally, cooperation and collaboration in program and resource planning among countries on public health issues remains limited and informal. Improving the technical and institutional capacity of African organizations and professionals to transfer information, skills and technologies regionally for strengthening health systems and to undertake policy advocacy and dialogue for sustaining improvements to these systems is a critical development need.

During FY 2001, Child Survival and Diseases (CSD) money will be used to fund: Child Survival (CHS) $1,940,000; HIV/AIDS $2,680,000 (to support HIV/AIDS regional activities which, if conditions allow, will include HIV/AIDS activities in Burundi); and Infectious Diseases (ID) $894,000 (of which $395,000 will be used for Malaria and $499,000 for Tuberculosis). These funds include all of the Greater Horn of Africa (GHAI) Child Survival funds and a small portion of the Economic Growth funds (EG $80,000) allocated to the GHAI.

Development Assistance resources (Population $1,025,000) will fund regional training for African partners to strengthen family planning systems. Family planning agreements under this notification will incorporate clauses that implement the President's recent directive reinstating the Mexico City Policy.

The activities initiated or planned in FY 2001 are expected to continue without major adjustments in FY 2002. CSD ($6,580,000) and DA ($1,201,000) resources will provide continuation without significant change to focus on four areas: improving the viability of regional institutions; broadening the technical resource base; expanding the utilization of critical information; and expanding the policy dialogue.

Key Results: Four Intermediate Results are required to achieve this activity: 1) improved viability of regional partner institutions; 2) broadened technical resource base; 3) expanded utilization of critical information; and 4) expanded policy dialogue.

Performance and Prospects: REDSO/ESA's work builds on program efforts underway since 1995 under the previous strategy and, accordingly, accomplishing this activity will involve continued assistance to African regional institutions and other regional partners in four key areas.

First, activities will aim to strengthen the institutional capacity and sustainability of regional partner institutions to expand African leadership in the sector. This will involve targeted human and institutional capacity development to establish and strengthen operational support systems and enhance skills in critical management areas such as planning, training and human resource development, health management information systems, logistics management, quality of health care improvement and assurance, supervision and monitoring, and sustainable financing strategies to reduce dependence on USAID as a primary donor. Strengthening partner institutional capacity in this manner should lead to better achievement by partners of planned results. Additionally, it should enable African partner institutions to play a more vital role in catalyzing partnerships and strategic coordination throughout the region. By the end of the strategy period, partners will be more mature regional organizations, with clearly defined mandates and organizational and management systems to support these mandates, and with financing strategies in place that will sustain regional activities.

Second, focus will be given to expand the base of human, technical and program resources available to improve systems throughout the region. Achieving this depends on the presence of a broad base of technical professionals and mechanisms that promote south-to-south networking and partnership approaches both within the health sector and across other sectors. Activities will support the expanded development of networking and partnership mechanisms; the establishment of systems for institutionalizing training, human resources, and consultant development to meet ongoing needs for Africans equipped to improve health systems throughout the region; and the design of approaches to furthering cross-sector coordination to maximize program and technical resources and impact. By the end of the strategy period, there will be increased utilization of African specialists and organizations in health sector networking and technical assistance support activities throughout the ESA region.

Third, efforts will be made to increase the analysis, dissemination and application of information to enhance sector programs. Improving regional health systems on a long-term basis requires the ongoing dissemination and adaptation of state-of-the-art technical knowledge and better practices by African institutions. Activities will thus support the development of regional capacity to keep technical knowledge current, to identify better practices from the region (including gender- differentiated approaches), to share information on these practices throughout the region, and to adapt and implement these practices at the country level. Focus will be given to the utilization of modern information technologies where appropriate. By the end of the strategy period, networks in key technical areas will be operational, with network members regularly sharing information, exchanging lessons learned, and supporting the application of better practices in countries throughout the region.

Finally, this activity seeks to enhance the policy environment by improving regional advocacy and dialogue on policy issues in key technical areas that include HIV/AIDS, maternal and child health and nutrition, reproductive health, infectious disease, and health care financing. Regional capacity to improve health systems requires a policy environment that not only enables the enhancement of health systems, but also promotes and sustains these systems. Accordingly, efforts will focus on promoting policy dialogue among health sector leaders and other key decision-makers on critical regional health issues. Activities will emphasize strengthening regional capacity to develop a regional policy agenda, conduct policy analysis that informs policy development, and undertake advocacy activities to support policy reform and development. By the end of the strategy period, there will be increased regional coordination to foster policy change. Regional organizations will be working collaboratively to identify institutional, programmatic, legal and regulatory constraints to the achievement of health objectives throughout the region and to advocate for regional and country policy formulation to address these constraints.

Achieving results under this activity will require close and continued collaboration with other REDSO/ESA teams, ESA USAID missions, and USAID/Washington's offices and bureaus. Cross-cutting activities in nutrition and food security were initiated under the earlier strategy. Under this activity, efforts will be made to strengthen and expand cross-activity coordination of this nature. Particular attention will be given to building synergies between PHN activities in HIV/AIDS and activities in food security, economic growth and conflict and democracy. Special focus will be given to involving non-presence countries in population, health, and nutrition regional networking and partnership activities

Possible Adjustments to Plans: The pressure of the continuing and accelerating spread of HIV/AIDS in the region compounds the already high rates of infant, child and maternal mortality and morbidity and overwhelms weak health systems. African government and donor attention to addressing the HIV/AIDS pandemic requires a comprehensive and sustained approach. At the same time, it will be critical to balance HIV/AIDs programs with sustainable activities in maternal and child health and nutrition, reproductive health, and infectious disease to enable regional institutions to effectively address the broad range of health issues confronting the ESA region.

Other Donor Programs: In implementing activities, REDSO/ESA and its partners will continue to collaborate on regional activities with a broad range of donors, including the UNFPA, UNICEF, Rockefeller Foundation, World Bank, International Planned Parenthood Federation, European Union, and Gates Foundation. African and cooperating agency partners will continue to focus on diversification and leveraging of funds for regional program activities.

Principal Contractors, Grantees or Agencies: Regional Center for Quality of Health Care, Centre for African Family Studies, Commonwealth Regional Health Community Secretariat, Training in Reproductive Health/Maternal and Neonatal Health Program/JHPIEGO, POLICY Project, CHANGE Project, Implementing AIDS Prevention and Control Activities, Health Policy and Systems Strengthening Project, Deliver, Rational Pharmaceutical Management Project, LINKAGES, Food and Nutrition Technical Assistance Project, and Tuberculosis Coalition.

Selected Performance Measures: This is a new Strategic Objective in FY 2001 and performance measures are being developed.