PROGRAM: Mali
TITLE AND NUMBER: Reproductive and Child Health, 688-XXX
STATUS: New
PLANNED FY 2001 OBLIGATION AND FUNDING SOURCE: N/A
PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCE: $2,321,000 DA, $5,967,000 CSD
INITIAL OBLIGATION: FY 2002 ESTIMATED COMPLETION DATE: FY 2012

Summary: The purpose of the responsible reproductive and child health strategic objective will be to increase the use of selected health services. Achieving this objective will require a strong commitment by the Government of the Republic of Mali and donor community.

The activity will: stabilize the HIV/AIDS epidemic in Mali; increase contraceptive use; and alleviate priority child health problems. Interventions that help ensure the availability of quality reproductive health and child survival services and products, and that consolidate USAID investment in family planning into a Mali-owned long-term strategy for contraceptive security, are central to the program. All vulnerable populations will be targeted, nationwide, unlike the current strategy. For reproductive health, this includes sexually transmitted infections, HIV/AIDS, and family planning interventions that will specifically target high-risk groups, and adolescents within the general population. Child survival activities will target the individuals and systems responsible for ensuring appropriate child health interventions.

The FY 2002 resources requested are for: Development Assistance (DA) Population ($2,321,000) to fund family planning activities and contraceptive procurements; Child Survival and Diseases (CSD) Child Survival ($2,900,000) for improving maternal/child health systems; and CSD HIV/AIDS ($3,067,000) to combat the spread of HIV/AIDS and enhance health care for those already inflicted. Agreements under this notification will incorporate clauses that implement the President's recent directive reinstating the Mexico City Policy.

Performance and Prospects: Priority activities for reproductive health are HIV/AIDS and family planning. For child survival, priorities are malaria prevention, immunizations, nutrition status improvement, and safe motherhood and prenatal care. These correspond with Ministry of Health priorities as embodied in the GRM's ten-year Health Program and with areas of USAID comparative advantage. Interventions will address policy dialogue, strengthening of service provision, and promotion in use of services.

USAID has a long history of investment in family planning in Mali. However, contraceptive prevalence remains low, and the GRM maintains a reactive role to USAID commodity supply and program efforts. As an important aspect of poverty reduction and long term economic stability, and a major contributor (via condom use) to HIV/AIDS prevention, family planning efforts will be continued and expanded in Mali. USAID needs to encourage and witness more proactive, high level political commitment from the Government of the Republic of Mali for family planning objectives, and for long-term efforts for ensuring contraceptive security in Mali. Food for Peace is interested in providing resources for mitigation activities, should they become available.

Efforts to stabilize the HIV/AIDS epidemic in Mali will require the availability of standardized test kits, voluntary counseling and testing center services, and standards for care and support for people living with HIV/AIDS, all of which are currently virtually nonexistent. As the nature of HIV/AIDS and its impact goes well beyond the health sector, a multi-sectoral approach must also be implemented that encourages the private sector to invest in public health interventions.

Community-based outreach programs in family planning will be expanded to include: availability of child survival products such as prenatal vitamins and iron, chloroquine and oral rehydration salts; and services such as information, education, and referrals. "Positive deviance" community programs for nutrition will be established. By developing the capabilities of service managers and providers for identifying needs and planning commodity procurement (essential drugs and rapid test kits), USAID will strengthen the essential drug provision program, including the contraceptives logistics system. To stimulate possible resource alternatives, USAID will encourage the private sector to invest in public health interventions and to form partnerships between the public and private sectors in health care delivery. We will also pursue long-term efforts to establish a supportive supervision system that addresses established norms and procedures in reproductive health and child health client counseling, diagnosis, treatment and referral.

Operations research on such issues as mothers' perceptions of health services, equity considerations, and determinants of behavior will form the basis of information, education and communication content and media for target populations. Peer education will be expanded to cover high-risk groups and work establishments, e.g., the mining and cotton industries. School health activities such as referral services, life skills curriculum, and peer education will be developed and expanded.

The new reproductive health activity is focused on the entire sexually active population and on HIV/AIDS prevention. The child health activity concentrates on certain interventions, not on the whole panorama of child health needs. While building on certain aspects of the current youth activity, the new program is more concentrated, with measurable, national results. Performance measures could include increased community health center use; decreased sexually transmitted infections prevalence; increased condom use; expanded voluntary counseling and testing center use; increased use of family planning methods and increased couple years of protection for the general population and youth ages 15 to 24 year olds; improved nutritional practices; increased assisted deliveries; and expanded immunization coverage.

Possible Adjustments to Plans: N/A

Other Donor Programs: Our efforts will complement and support those of other donors working in reproductive health and child survival, specifically United Nations agencies (UNICEF and UNFPA), the Netherlands, the European Union, the World Bank, and World Health Organization. All donors work together within the context of the Government of the Republic of Mali's ten-year Health Program.

Principal Contractors, Grantees or Agencies: TBD

Selected Performance Measures: This activity will be under a new country strategic plan with the first obligation proposed in 2002. Baselines and targets will be developed.