USAI[D/PERU STRATEGIC OBJECTIVE CLOSEOWT REPORT Date: June 28,2002 1. SO NAME & NUMBER: Improved Health, including Family Planning, of High-Risk Populations - 527-003 2. GEOGRAPHIC LOCATION OF SO: Nationwide 3. CHANGES IN RESULTS FRAMEWORK DURING THE LIFE OF SO: Neither the SO nor the IRs have changed 4. SO LEVEL IMPACT (EXPECTED VS. ACTUAL) USAID has contributed to improving the health of high-risk populations in Peru by helping people take appropriate preventive, promotive and curative actions and by strengthening sustainable institutions and operations. SO 3 implemented an integrated population, health and nutrition strategy through which it supported U.S. and local NGOs and Peruvian public sector institutions in efforts to: (1) strengthen the quality of basic health services, including immunization, famiIy planning, oral rehydration therapy for diarrhea and reproductive and maternal and child health services; (2) extend the coverage and increase the use of these services by population groups in which mortality, morbidity and fertility have remained high; (3) promote health in homes and communities; (4) encourage long-term sustainability by strengthening local organizations that deliver health services; (5) improve capacity in the health sector to report and diagnose emerging diseases; (6) test new models of service delivery; and (7) expand the participation of public and private sector entities in HNfAID prevention. SO 3 generally exceeded expectations. Public health and family planning services, and the institutional base that supports them, maintained their level or improved as a consequence of USAID assistance, despite the political and economic uncertainty which has continued to plague Peru. Outcomes are reflected in such indicators as proportion of births attended by trained personnel, incidence of malaria, proportion of children with diarrhea who come to the health facility dehydrated, and proportion of children with acute respiratory infection who come to the health facility with pneumonia andlor complications. In some cases it is possible to show changes attributable to activities supported by USAID. For example Project 2000 had a significant effect on behaviors, attitudes, and health outcomes in the areas in which it operated - knowledge of alarm signs for childbirth has increased, and maternal mortality has decreased by 25% while in other areas it increased by 1.9%. The VIGIA infectious disease pro,pm implemented a new poky for anti-malarial drugs, a surveillance and conwol system for hospital infections, and the evaluation of alternative tools for malaria control (intermittent rice irrigation, rapid tests for malaria diagnosis). The Reprosalud Project incorporates women in the prioritization of reproductive health problems, and provides community-based participatory education and advocacy. The Reprosalud mid￾term evaluation shows significant gains, compared to controls, in such indicators as women obtaining prenatai care, child birth attended by a trained health professional. and women with unrnet needs for family planning. Examples of SO level results obtained are presented below. The tables in Annex 1 show actual and - planned values for indicators included in the Performance Monitoring Plan (PMP). Infant mortality rate has declined steadily, reaching 57 deaths per 1000 live births in I991,43 in 1996 and 33 in 2000. Maternal mortality ratio declined from 265 maternal deaths per 100.000 live births in 1996 to 185 per 100,000 in 2000. Total fertility rate declined from 3.5 children per woman in 1996 to 2.9 in 20. Child mortality rate (under 5 years) decreased from 59 in 1996 to 47 per 1000 children. 5. IR-LEVEL IMPACT: Institutionally strengthened 89 "model health centers" certified by the Ministry of Health in priority regions of the country. Thanks to Peruvian family planning program 96% of married women of reproductive age are knowledgeable about modern contraceptive methods. Starting from near total dependence on USAID donated contraceptives; the GOP increased its contraceptive budget to $2.0 million in 2000. Peru's Child Survival Program has improved child heaIth as evidenced by the following results: between 1996 and 2000, as a result of USAID assistance, immunization coverage of recommended vaccines increased from 63% to 66%. 80% of children under five years of age suffering from diarrhea are correctly treated with extra liquids and/or oral rehydration therapy. 90% of infants are breastfed at least part of the time. With USAD assistance, the Ministry of Health developed a basic package for monitoring child growth and development, which is now implemented in health facilities throughout the country. Under VIGIA, the USAID infectious diseases activity, a study on rice irrigation showed that productivity levels could be maintained while reducing the number of malaria-transmitting mosquitoes. The VIGIA project coordinated the development and implementation of "Sanitary Intelligence Units" in 10 Health Directorates. A USAID supported non-governmental organization officially transferred thirteen high school￾based reproductive health education and counseling programs to school authorities. With USAID support, CARRAS developed a rotating fund for basic medications, supplying over 300 health establishments. The fund is self-sustaining and generates additional funds to support free or low cost health services. A private entity, the Center for Training in Primary Health Care, graduated from USAID assistance and was certified by the Ministries of Health and Education to train nurse assistants- (Due to economic crisis in the region students are unable to pay very modest Center fees, and the Center has been forced to temporarily suspend this course.) USAID supported the Ombudsman's Ofice in the implementation of a system to monitor quality of family planning services as well as compliance with Tiahrt Amendment. Max Salud, a local NGO supported by USAID to manage a network of primary health care centers, has been able to recover 51% of costs meeting the expected sustainability level at this point in its deveIopment. With technical assistance from Project 2000, the Ministry of Health installed a new Budgeting and Programming System, based on service delivery costs, in all 34 Regional Health Directorates of the country, and quality training was implemented to ensure its efficient utilization. In areas of emphasis of USAID health projects, the maternal mortality ratio decreased by 35% as compared to non-USAID areas where it decreased only by 5%- Reproductive health guidelines, developed with support from USAID, were approved and aR being used by the Ministry of Health to standardize quality family planning services. 6. LESSONS LEARNED IN IMPLEMENTATION OF THE SO: Project 2000 It is possible to increase the utilization of services and reduce maternal and child mortality through the improvement in the quality of care of MCH services. It is possible to establish a system of continued quality improvement of services; however. this requires a support system at the Regional and/or Central level of the Ministry of Health and an adequate human resources policy. Accreditation of services provides incentives for health providers and health es~blishrnents to improve quality of care, and based on this experience, it is recommended to establish a national system of accreditation of health care services. Bilateral Agreements with the Government of Peru (Ministry of Health) should incorporate not only conditions precedent clauses but annual specific objectives in terms of counterpart results to be achieved and products to be adopted andlor produced as a result of technical assistance offered under the agreement. USAD contractors providing technical assistance, training and logistical support under a bilateral agreement with the Government need to develop a marketing strategy for new and ongoing activities in order to appropriateIy inform new authorities and mid level managers who are frequently changed, primarily for political reasons. It is both convenient and practical to fully involve counterpart in all stages of project planning and jmpIementation, including acceptance and adoption of products as they are produced, thus ensuring the timing institutionalization of products and sustainability of the project. Collaborative work with Health Teams of other Missions is extremely valuable as is SouthSouth collaboration between USAID counterparts and both should be promoted and supported. Buen lnicio Carefully imparting the basic principles underlying the healthy growth of children as a preventive, home-based and community activity, along growth monitorjng and nutrition activities, plays an important role in bringing about optimal health, nutrition and well-being of children in poor communities. Earthquake It is not only important to build or rehabilitate the heaIth facilities damaged during a natural disaster, but also essential to teach and organize the population to be prepared for such events. Building/rehabilitating facilities should be done to last. Populations affected by the earthquake have demonstrated that they are willing to be organized in order to collaborate with authorities to rebuild their communities. Work with both women and men for maximum results in reproductive health awareness, gender equity and improving the use of forma1 health facilities. Women's empowerment impacts upon household decision-making, couple communication and education of the children in the family. Reproductive health awareness increases the demand for prenatal visits. binh attendance by trained professionals and family planning counseiing. Low educational status of girls and women is strongly related to high-risk health behaviors and to poor health. ALCANCE Achieving organizational and financial sustainability of local NGO is not feasible in three yeztrs. Community based educational services cannot be sustainable without cross subsidies. SHIP Short-term (5 years or Iess) external funding to establish new NGOs is rarely sustainable. There is an unsatisfied demand for quality health services that when tapped by an institution that provides such services, contributes to the sustainability of the institution and the health of the community. Publiclprivate partnerships in health improve the performance of both sectors - the private sector contributes innovation, flexibility, adaptability, entrepreneurship, and efficiency while the public sector contributes policy deliberation, coverage, public health normative guidelines, epidemiology, legal structures and experience. Clear policies and commitment are required in order to sustain effective publidprivate partnerships. In providing health care services, it is extremely difficult, but not impossible, to maintain a balance between investment in health promotion and prevention of illness and injury and recuperative services and between financial sustainability and social commitment. Coverage with Quality, PASARIE, Commodities Logistics Management, Contraceptive Logistics Administ ration Supervision and training of health care providers are key to achieve sustainability. quality assurance and quality controi and can be provided economically because they generally do not require heavy materia1 support. A strong personnel supervision system helps maintain continuity of services in times of uncertainty and social and political changes. The commitment of citizens, users and providers can be achieved through community participation, local health committees and community surveillance activities Citizen involvement increases access to and quality of health care. It is extremely difficuit to bring about change in curriculum and models of instruction in schools of medicine and midwifery if there is not the political will to do so. Lacking such commitment on the part of university authorities, the most that can be done is operations research and the development of training and evaluation tools. Health providers are motivated to work by good treatment, sense of belonging to the institution, receiving credits for inputs, opportunities for making decisions and working in environments with clear regulations. Even when health personnel in public facilities are poorly paid, such non￾monetary incentives can improve work environment, lag behind the above issues as priorities to improve work environment. Health activities will not produce significant impact in the country if isolated and not associated with other development actions such as education, nutrition, work, and democracy. 7. LIST OF EVALUATIONS/SPECIAL STUDIES Demographic and Health Survey (DHS IV) 2000. ENDES 1996 and ENDES 2000 have been the main source for evaluation during this period. Reports from MoH have also served this purpose on an annual basis. Project evaluations of multiple activities and programs have also been carried out. Project 2000 Evaluation of Impact of Improvement in Quality of Care in Maternal Mortality (year 2000). Study of Costs in Hospitals and Health Centers in Peru (1995). Study of Health Demand in Peru (1995). VIGI A A KAP study regarding prevention and control of hospital infections in selected hospitals. A social-anthropological study concerning diseases presenting with fever. jaundice, and hemorrhages in the Cuzco and Ayacucho regions. A social-anthropological study of factors associated with severity and Iethality of T3 in selected areas. A study on the costs of hospital infections in selected hospitals. Analytical review of ethnographic and other qualitative studies carried out in Peru concerning emergent and reemergent infectious diseases. Design and implementation of an EntomologicaI Sweillance System, including entomological map of Peru. Economic assessment of alternative strategies for malaria control. Evaluation of a rapid test for malaria diagnosis, as used by health promoters. Evaluation of alternative strategies for Yellow Fever prevention and control. Evaluation of the National EpiderniologicaI Surveillance Network and the design of an information system for this surveillance network. New policy for antimalarial drugs based on study of drug resistance and efficacy. Study of social and anthropological characteristics of populations at risk of contracting Yellow Fever, including migration patterns. Study of the Economic hpact of Malaria in Peru. Study of the Economic hpact of Tuberculosis in Peru, including an evaluation of atternative strategies for TB control. Study on the Feasibility of Introducing Intermittent Rice higation as a Tool for Malaria Control. The study of factors associated with severe morbidity and mortality in daria, and the evaluation of protocols for caring for severe malaria cases. Good Start Study on the nutritional status in children under five and women in the Departments of Loreto, Cuzco, Apurimac and Cajarnarca.. SHIP AIarcon, Jorge, et al. Oct 1996. Evaluaci6n de Impacto de la Cobertun y Calidad de Servicios de Salud (Arequipa, SHE' South). Alcantara Chavez, Jorge y Chavez Franco, Carlos. Feb 2001. Cornpendio, An6lisis. ConcIusiones y Recomendaciones del Estudio de Investigaci6n , "Conocimientos y Pdcticas en Przvenci6n. Control y Atenci6n de Enfemedades de Transmisi6n SexualNWSIDA, de Diversos Grupos PoblacionaIes de las Ciudades de Chiclayo y Lambayeque". Bardales, Alejandro, et al. Junio 2000. Estudio de Necesidades y Dernanda de Servicios de Salud para la EvaluaciBn de la Factibilidad de InstaIar una CIinica Max Salud en el Distrito de la Victoria. Begazo Dongo, Hector. 1999. Max Salud: Evaluaci6n de Alternativas para el Autofinanciamiento. CARE Peru. Dic 1999. Evaluaci6n Final de 10s Sujetos ~ducativk del Proyecto EBADECA. CEDES (Centro de Investigacih, Estudios, EvaluaciBn y Asesoria para el Desarrollo). Febrero 1999. Evaluacih de Fortalecimiento Institucional y Participaci6n Cornunitaria en Instituciones del FIS-CARE, Informe Find. 3 Volumenes: Resumen Ejecutivo, Anexos kequipa, Anexos Puno. Instituto de InvestigaciBn Nutricional. Marzo 1997. Proyecto de Evaluaci6n del Estado Nutricional de 10s Niiios que Asisten a 10s Wawa Utas del Programa CAREmS en Puno. MaIca Villa, Mary (Consultora de CMS). Dic 1999. Evahaci6n de Opciones de Financiamiento para Incrementar la Sostenibilidad Financiers de Max Salud. Coverage With Quality, Pasare, Commodities Lugistics Management, Contraceptive Logistics Administration Georgetown University, enero 2000. Metodos de 10s dias fijos para la Planificaci6n Familiar. INOPAL III, setiembre 1998. Base InternacionaI de Datos de Investigaci6n Operativa Sobre la AtenciBn Postaborto. Instituto para la Salud Reproductiva, setiembre 1999. M6todo de 10s dos dias para la planificaci6n familiar. JHPEGO Corporation, 1994. Issues in Cervical Cancer. Ministerio de Salud, 1997. Guias Nacionales de Atenci6n a la Salud Reproductiva. Ministerio de Salud/MSH, marzo 1999. Proceso de Mejoramiento Continuo en Redes de Salud￾11. Pathfinder International. DignBstico de 10s Servicios de Salud Integral para Adolescentes en fos Establecimientos Pliblicos de Salud (Propuesta de DiagnBstico y Linea de Base). POLICY, 1999. Derechos SexuaIes y Reproductivos. Population Council, 1998. Chapter on Access and Quality of Care (Final Report of INOPAL m). Population Council, Federico LeQ and Pontificia Univenidad Cat6lica del Perk Sandra Vallenas, 1998- Institutionalizing Operation Research to Strengthen Peru Ministry of Health's Reproductive Health Services in Priority Regions, Final Report. PRIME Peru, 1998. Proyecto de Adolescentes, Instrumentos para el autodiagnSstico de Adolescentes. Universidad Johns Hopkins, MINSA, 1999/2002. Estrategia Comunicacional en Salud Reproductiva del Ministerio de Salud. ReproSalud Con voz propia (estudio). Diagn6stico de la Situaci6n de la Producci6n y Comercialimci6n de Artesanias del Pro~vecto ReproSalud (Duvai Zarnbrano). Escuchando a las mujeres de San Martin y Ucayali (Genero y Salud Reproductiva). Astrid Bant y Angelica Motta. Estudio Complementario: Calidad de atenci6n de 10s servicios y establecimientos de salud desde la perspectiva de mujeres nrrales usuarias de 10s rnismos (Jeanine Anderson). Estudio Complementario: Significados y Prricticas sobre infecciones vaginales entre mujeres de 6reas rurales, peri-males y nativas del Peni (Norma Fuller). Estudios Cornplementarios: Embarazo, pmo, puerperio y cornplicaciones asrxiadas - Sisternatizacion del product0 de 10s autodiaposticos (Alejandro Diez). Estudios Complementarios: Sisternatizaci6n y AnGIisis de 10s Problemas de SaIud y las acciones de 10s proveedores de saIud locales (Alejandro Diez). Hablan Ias Mujeres Andinas. Carmen Yon Leau. Men as Partners. The Population Council. Mid-Term Evaluation ReproSalud Project (in process). Pricticas y representaciones de gknero (Patricia Ruiz-Bravo). Significados y pr5cticas sobre regIa blanca entre las rnujeres de 5reas rurales y nativas del Pefi (N. Fuller). Tendiendo Puentes. Jeanine Anderson. 8. ESTIMATED OTHER DONOIUPARTNIEWCOUNTERPART CONTRIBUTIONS: -Ministry of Health - cash and in-kind -Pathfinder International -CARE -Movimiento Manuela Ramos -UNICEF - cash -PRISMA -Universty Research Corporation -MAXSALUD - income generations -Consortium of seven Peruvian NGOs -PAHO, World Bank and ID3 - collaborate with USAID on a shared agenda -Academy for Educational Dev. -John Snow -Population Council -Abt Associates -Macro International -The Futures Group -J'HPiego 9. PEOPLE DIRECTLY INVOLVED WITH THE SO NAME TITLE I DATES WORKINGON I SO Susan Brems Previous SO 3 Team Leader 1993 - 1999 Thomas Morris Deputy Chief 1996 - 1998 Thomas Moore Project Coordinator 1995 - 1998 Jennifer Vernooy Project Coordinator 1993 - 1998 Barbara Feringa PHI Fellow - Technical Advisor 1995 - 2000 I for Re~roSalud Proi I I ect Richard Martin I SO 3 Team Leader ( 1999 - Present Luis Serninario Health Advisor 1 1993 - Present Maria Angelica Borneck PopuI Coordinator Lucy Lopez Project Coordinator/Population 1996 - Present Advisor Kristin Langlykke Project Coordinator 1998 - Present Jaime Chang Project Coordinator 1998 -Present Raquel Huttado Project Coordinator 1997 - 2001 Christine Adamczyk Deputy Chief 1998 - 2002 Libertad Barraza 1 HPN Secretaryneam Leader 1986 - 2001 2 Giuliana Brescia ) Project Secretary 1 1996-2001 Myriam Sarco 1 Population 1 1990 -Present Assistant Nelly Luna Administrative Assistant 1996 - Present Carmela Sarmiento Project 1994 - Present Paola Buendia Project Secretaryfleam Leader 1998 - Present I Ingrid Miranda / Project Secretary 1996 - 1999 Michael Burkly I ID1 1999 - 2001 10. LIFE OF SO mTNDING (in thousands of dollars): [ PL 480 (Iocal currency) 9.851 1 -- .- USAID TOTAL 144,600 , GRAND TOTAL 144,600 4 11. SUMMARY LIST OF ACTIVITIES UNDER THE SO: Activity TitldShort Description Strengthening Private Sector Health Institutions SHIP - identify & evaluate models of private primary health care services delivery which improve access coverage, efficiency and sustainability of services in two areas of Peru. Reproductive Health in the Community - increase the utilization of family planning and other selected reproductive health interventions in peru-urban and rural areas of high mortality and fertility. FY 1997-2001 Funding Amount $13,331,101 Start and End Date Project 2000 1 $25,734,343 9/30/93 Ministry of Health WOH) - increase the use of child and 1213 1/00 Pathfinder maternal health interventions. . CARE Impiementing Organizations 812 1/95 8/30/05 AIDS Help $1,000,000 9/24/96 Ministry of Health - strengthen and expand the 6/15/00 participation of public and private sector entities in W/AIDS prevention. CARE (South) Max Salud (North) URC (Norzh) Addressing the Threats of $10,541,750 9/29/97 Ministry of Health Emerging and Re-emerging 9130103 Infectious Diseases - VIGIA - strengthen GOP's ability to identify, prevent and contain illness from infectious diseases i I through a comprehensive strategy ' aimed at preventing occurrence. Coverage with Quality $4,780,873 - seeks to strengthen the ability of the MOH to implement stated GOP policy in family planning on a national scale. 9/23/96 Ministry of Health 91 25/03 Contraceptive Management $2,713,994 9/23/96 PRISM - seeks to develop a sustainable 9/25/03 contraceptive management system ' in Peru. I Family Planning within the Reach of High Risk Populations, ALCANCE - increase the use of famiiy planning i.e. contraception and other selected reproductive health interventions among high-risk populations. Good Start - reduce chronic malnutrition and micronutrient deficiencies in-. targeted peri-urban and mra1 communities. - PAS ARE - a myriad of activities undertaken by 6-10 cooperating agencies with agreements anchored in the Global Bureaus. Program Development & support Terminating projects carried Forward to FY 1997 1/10/97 1 ASDE, CADE, AGROVIDA. 9/30/02 ADAR, Vecinos Peru. TADEPA, PLAiiFhMI, PLANIFAM, KALLPA, PATHFINDER Note: This SO is carrying forward a pipeline of $10,955,192 of Child Survival funds and $8,992,395 of Population funds to support the continuation of some activities under the new Strategic Objective No. 11. Improved Health for Peruvians at High Risk. Annex 1 SO Level Impact IR 3.1 People Take Appropriate Preventive Actions 66% only with all vaccines (up from 63% in 1996) Planned 40 50 per 1000 200 3.1 Infant mortality rate Under five mortality rate Maternal mortality ratio Total fertility rate Actual 33 per 1000 live births 47 per 1000 live births 185 per 100,000 live births 2.9 I tv~e ofvaccine I I I Immunization coverage of children 18-29 months*, by 1 Measles I 84.4 1 92 I Actual (%) BCG DPT PoIio I All 66.3 1 -- * under one not used in latest DHS Planned (%) 96.2 84.7 76.4 ( of tetanus toxoid vaccine I I 95 97 95 I Actual 1 f lannd No. of condoms consumed 24.6 million 30 million 1 Planned (%) 70 Immunization coverage of women who receive two doses I Actual I Planned Incidence of malaria 228.42 per 100,000 I 644 per 100,000 Actual (%) 58.6 IR 3.2 People Take Appropriate Promotive Actions methods Planned (%) 60 Proportion of births attended by trained personneI Contraceptive prevalence rate Actual (96) 5 9 96% of married woman of reproductive age are knowledgeable about modem family planning Actual (%) 69 Planned (%) 70 Planned (%) 55 Actual (%) Percentage of infants who are breast-fed exclusively for at least 6 months 57 IR 3.3 People Take Appropriate Curative Actions Planned (8) 25 Percentage of women who did not have any prenatal visits during their last pregnancy Actual (%) 15.5 IR 3.4 Sustainable Institutions and Operations in Place Planned (%) 60 Percentage of children with diarrhea who come to health facility dehydrated Percentage of children with acute respiratory infections that come with pneumonia and/or complications Actual (%) 12.6 I 1 Actual 1 Planned I Actual (5%) 23.2 Planned (96) 70 Planned (%) 40 Percentage of total budget recovered by institutions Starting from close to total dependence on USAID funds, GOP increased its contraceptive budget to $2.0 million in Y2000 Actual (%) 5 1 MoH expenditure in contraceptives - -- 2,000,000 1 Actual (%) USAID contribution to the 500,000 Planned (5%) overall contraceptives budget (began as 100%) Clearance: SO3 Team Leader: RMartin PDP:ECVarillas 5?&~-' 54 Planned 88 Number of facilities certified as model centers in priority zones 80 Actual 89 Planned (8) 85 MoH regions reporting data on common infectious diseases on a weekly basis Actual (%) 91.4 PERFORMANCE MONITORING PLAN Strategic Objective 3 and Related Intermediate Results PERFORMANCE INDICATOR I I I 1 I I I STRATEGIC OBJECTIVE 3: IMPROVED IIIEALTH, INCLUDING FAMILY PLANNING USE, OF HIGH-RISK POPULATIONS I I I R-i Reported INDICATOR DEFINITION AND UNIT OF MEASUREMENT Delinition: The estimated number of deaths in SCHEDULU FRFKWENCY DATA SOURCE RESPONSIBLE SCHEDULE RESWNSIBLE TEAMlCOSTS BY REPORT TwM Vie 3e111ogr11pIiic !ledrlr Survey DHs), :onducted by Ihe Wonal nstitute of itatistics (INEI) Unit of ~i~cxurc: Deaths per 1,000 live binhs ?.Under-fivr: Morrality Rate R4 Reported METHOD1 APPROACH OF DATA COLLECTION c r I < 3. Mamwl Mortality Ra~io . Popula~ion-based survey. DATA ACQUISITION BY MISSION , Rates will be given both nationally and disaggregated by high-risk populations. ANALYSIS & REPORTING Dcfi~~itian: The estimated number of deaths per 1,000 children under age five in a given period. Unit of meaurc: Deaths per 1,000 children under ! agc live DHSflNEi I . Population-bascd survey . Rates will bc given both nationally and disaggrcgatcd by high-risk populations Definition: The csdmatcd number of maternal deaths pr 100,000 live births, from conception ~hrough 42 days after childbinh. Unit of Mcosurc: Maternal deaths per 100,000 live I births De~nltlun: The avenge number of children women will have at thc cml of their childbearing years if fertility potterns at [lie time of survey prcvdil; calculntcd by suln~ning the agespecific rcrtility rates over all ages of thc childbcnring perid, as observed in a givcn ycar. Direct source every 5 years; indirect sources (Unicef) for inlervening years Direct source every 5 years; indirect sources far intervening years DHSllNEl I , Population-based survey I Evcry fivc years lltrouah indirect . National ratio . Rates will k given barb ~u~iomlly snd disaygregaled by high-risk papulnriom. I Evcry five years from diruct source DHSIINEI Vnlt uf Mensurc: Birllis per wouliln COMMIIN'I'SI ~~'~'~~iTB~Ga~~idb~socio-ccanonlie and gcogrlptiic vi~riiiblcs. '1'11~ 1996 DlIS was ;I ni~tionel survey of 33,498 randomly sclcctcd housclwlds, 31.24 1 fc~irdc ~ncrdrers aged 15.49 a110 :I sub-samplc or2.942 nlalc t~lcnltkrs apd 15-59. I'lm 1)IlS is contluwd cvcry fivc yciirs; for interim yciirs, indirect sourccs (UNICEF Annual Rcprt) will IK: USC~ for lrclld analysis. a Popul:~tion-based survey million. I I SO3 USAlD contribu~ion for DHS is $1 collection I after 8n I after data R4 or 6 months after data collection SO3 & PDP 1 NEItMacro SO3 collection R4orsix ~nonrhs aiier dam collsction S03&PDP INEIIMacro Intermediate Result 3.1: People Take Appropriate Preventive Actions Definition: An estimate of the proportion of living cliildren under 12 months (DHS data for 12-23 1. In~lnuniza!ion coverage of :hildren younger than one, by lyp of vaccine. )AS survey every five years MOHIEP1 data annually in January 503- Public Sector RP R4 or 6 months after dam collection for DHS data or 3 months after data collection for MOH data , Population based survey , Service statistics. EPI quarterly report months) vaccinated before their first birthday. Types of vaccines are polio (3 doses), DPT (3 doses) and measles (1 dose.) . , Rates will be given both nationally and disaggregated by high-risk populalions Unit of Mcasurc: Percent of children under one 2. Immunizalion coverage of women who receive two doses of tetanus-toxoid (IT) vaccine. Definition: An estimate of the proportion of women aged 15-49 who received at least two doses of tctanus roxoid. MOH . Service statistics. EPI quarterly report , Disaggregation by age and residence Annually in January $03- Pubtic Sector RP R4 or 6 months after dala collectian SO3 MOHIEPI SO3 MOH, NGOs, S038rPDP MOH Unit of Meiuure: Percent of reproductive age women 3. Number of con'homs distributed or purchased Definition: ~umkr of condoms distributed or sold through USAID-supported channels in a given period. MOH, NGOs MOH service statistics, PRISMA, APROPO. Annually in January S03- Facility Based FP compiles data S03- Facility Based compiles data 3 nronths after data collcclion R4 or 3 months after data collcc~ion Unit of Measure: Millions of condoms Definitio~~: Number of malaria cases identified in a given perid as a proportion of the total population per 100,000. ---- -- --P 4. Incidence of riralaria R4 Rcportcd Service statistics, distribution records . Disaggregation by health rcgion Annually in January 1 ~cluded Couple Years of Protection / (CYP) as ons of its indicators Udt of Mcwure: Number of cases per 100,000 inhabitants COMMENTS1 NO'I'ES: MOI . . .. - .. . -. - i : Minislry of Hcaltt~. EPI: Expandcd Program on Immunization. In lhc strategic - plan, - this il~!cr~nrdiote ol)jectivc ha1 Due to its higlicr rcl;~tionsl~ip with pron&c actions, it was c60nged to thu 1K 3.2. midwives, nurses, nurse auxiliaries or trained technicians. .. - Delinilion: Trained wrsonnel refers to doctors. f￾Ullt of Measure: Proportion'of births DcRnitios: Estimated protection from pregnancy provided by contraceptive methods during a one￾year period, based upon the volume of all contraccpiives sold or distributed to clients during that period. Unit of Mcwure: Millions of couple-years of protection Definition: The prcenrag of women in union (or their partners) of reproductive age who are using a contraceptive mcthod at a given point in time. Includes all methods. Unit of Memurc: Pcrceni of women in union aged 15-49 Dcflnltian: Exclusivity refers to non-use of supplenrenrs like juices or othcr solid foods for children under six months U~llt ol Mcnsurc: Percent of all breiit-fed infants - ." .. Definition: A prc~~t~ care visit is defincd as a rrrecting bctwecn a pregwa woman and a hcallh carc providcr in which her and her felus' lrcalth status is discussed. Health carc provider is any person, ley or professional, who has ken tmined ilr the provision of prcnaral care serviccs. DHSIINEI N(uiono/ Flousel~old Survey (ENAFIO), conducted by I NEI MOH, FPP IRISMA, NGOs DHS I INEI ENAHO 15 Intermediate Result 3.2: People Take Appropriate Promotive Actions 1, Proportion of births 7 attended by trained pcrsonnel R4 Reported - - 2. Couple-years of protection (Cup) R4 Reported -- 3. Contraccptivc prevalrnce rate - - 4. Percentage of infiints who arc brcasf-fed exclusively for the first six months -7 5. Psrconfage of wwcn who did not hare any prcnatial visits during their last pregnancy --- - -- - - COMMEN'I'SINO'I'ES: 1NEl sourcc: N;llional I(0usch01d Strrvbys (BNAliO)- ENAIIO is ii nutioaul tnultipurpose survcy of 20,000 nrndamly~sclcctcd Ironsetlotds, A fi~ nrcxlule iw ir~cludetl :dtcr~~:rtivcly cvcry otlrcr ycirr. DHS I lNEl ENAIIO . Population-based survey Disaggregation by residence, type of pcrsonncl, mother's age , Service statisfics, distribution records . Disaggregation by type of contraceptive method. . Population-based survey , Disaggregation by residence, type of contraccptivc method. . ~o~ulaiion- based survey . Disaggregation by residence, parity, mother's age. , Population-bawd survey . Disaggregation by residcncc, age. Every 5 years for DHS Every two ycars for ENAHO Annually in January SO3 S03- Facility￾based RP compiles data Every 5 years fol DHS Annually for ENAHO S03- Facility￾based & Conrmuniry￾based RPs Every 5 years for DHS Annually for EN AH0 Evcry 5 ycars for Dl4S Annually for ENAI.10 S03- Public Scctor & NC;O tical111 RPs R4 or G months after data collection R4 or 3 months after data colleclion 6 months after data collection G monrhs after data collection G months niter dm collcction tuily pli~nning rnodule S03&PDP S03&PDP MOH. NGOs SO3 INEI/Macro ns MOH, Program on Diarrheal Diseases [ntermediate Result 3.3: People Take Appropriate Curative Actit I. Percenr of children with Jiarrhea that come to the ~ealth facility dehydrated RJ Rcported 2. Percent of children with icute respira~ory infrctioris :hat come to the health facility ~ith pneumonia andlor :omplications R4 Reaorted $03- Public Sector RP requests data from MOH Definition: The number of children aged 0 to 5 seen at health facilities within the public sector system (MOH) who have acute diarrheal disease with dehydration 1-111. U~ilt of Measure: Percent Definition: The dumber of children 0-5 years old seen at health facilities within the public sector system (MOH) who have acute respiratory infections (ARI) of pneumonia. Unit of Measure: Percent . Service statistics from the program on diarrheal diseases R4 and quarterly Quarterly S03-PDP MOH-CDD program division S03-PDP MOH-ARI program MOI.1, Program on Acute 1 Respiratory 1 Infections S03- Public Sector RP requests data from MOH , Service Statistics from the program on acute respiratory infections R4 and quarterly Quarterly .- I - -. -- . .-I￾COMMENTSINOTES: Ilealth fxilitics are defined as all units of care (primary, secondary and tertiary) ithin the public scctor systems (MOH). [ntermediate Result 3.4: Sustainnbk Institutions and Operations are in Place I. Percenrage of the total 3udge1 recovered by targetcd institutions [activity-based] Annually SO3 collects ~nd compiles data SO3 SO3 requests data from MOH Annually Annually R4 R4 Qu;trtcrl y Dcfidtion: Average of thc amount of total revenues generated in a given year as a proportion of the entire budget of USAID-supported NGOs. innual ~inaz Reports of NGOs . Revenueslincornes generated as a proportion of total operadons budget. excluding any investment. Unlt or Mciuurc: Percent - Definition: Percentage of the Ministry of Health budget allocated to preventive and promotive activities. -- - 1. Pcrccnmge of ttw national :ir.alth budget allocawd to primary care --- MOH Annual Budget, Congress1 Budget Commission Budget allocated to%e programs of: Atencion Pn'ttrnrin, Snlud i3flnricrr. Pl(~trificnciotl Fwrilior, Epidetnins. Annually SO3 & PDP Unlt of Measurc: Percent Dclfnition: Total amount of dollars spent by the Ministry of Hcalth in contractptives in a givcn year. .L.L~-..-.-..-- 3. MOII uxpnditure in :ontritccptivcs K4 Rcporlud - .. .. - -. . MOH Quarterly reports. SO3 & PDP Udt of Measure: 1997 doHars --- Dcflsllio~~: Total vnlue of USAlD contributiols in contraccptivcs i~s a proportion of the total contnccptives budget in a given yciu. . -- 4. USAlD contribution ro the ~vcrall contrnccptiva budget It4 Reporrcd MOH USAlD record: 5=*-- - Value of USAID-donated contraceptives as a proportion of the value of contmceptivcs distributed by thc public scctor in a ~~VL'II yew, at USAID prices. f03 requests data from MOH SO3 I'rojuct 2NX) SO3 & PDP Uel oC Mtusure: Percent - - - - A, - DeflnllLon: Prilnary l~raltli ci~; workers includc Irci~lth profcusion;hu, tcclmiciafls i~nd proniotcrs. KC) primary hc:~ltlr cure inmrvcntion$ arc dcfincd nt~vc, - , Project 2000 quartcrly rcport' , PASARB quartcrly report SO3 Pathfinder CARE/ESAN Projcct 2000 lhlt sT Mciruurc: lrcrcenr .- - -- .- . - - - Dclfnllion: Kcy prlmwy henltli crvc inturvcntio~u arc dcfincd irlmvc. 6. Nudw ot' pcoplc in priority roncs thitr arc tritined in key primiiry Ire:ilth me intervcnriow [:ictivity-b:!scd] , Projcct 2080 quarterly report , PASARE quiirtcrly report Annuir l l y Unit of Meusurc: Number of paple RESULTS FRAMEWORK FOR SO3 IMPROVED HEALTH, INCLUDING FAMILY PLANNING, OF HIGH-RISK POPULATIONS PERFORMANCE INDICATORS: - Infant mortality mle - Under-jive mortality rare - Total fertility rate - Maternal mortality ratio 1 Intermetliatc Result 3.1 People Take Appropriate Preventive Actions Indicators: - I~~u~~~rniznrio?~ covemge of cl~ildret~ rtr~der one, by type of vaccirre - Immunization covervge of women who receive two doses of tcmus-toxoid vaccine - # of condoms distributed or purchased - hcidettce of mlnria Key activilia: moo0 ALCANCE ReproSrrlud VIGIA CCC PASARE Ayuda CONTRASKDA Note: hdicators in italics will be reported in tlic R4 Peopte Take Appropriate Promotive Actions Indicators: - % of birtlrs atfended by trained personnel - Couple Yews oJ Prorecrion - Contraceptive prevalence rate - 95 of infants who arc breast-fed exclusively for thc first six months - % of women who did not have any prenatal visits during their last pregnancy Key activities: moo0 SHIP RcproSolud PASARE ALCANCE CCC 'Transition to Primary Education People Take Appropriate Curative Actions Indicators: - % of children with diarrhea Ihat come to the bealth facility dehydrated - % of children with acrite respiratory infections fltat come to Itre heoltli fnciliry wit11 pneunror~in cmd/or cotrtplicnlions. Key activities: moo0 SHIP VlGIA Intermediate Result 3.4 Sustainable Institutions and Operations are in Place I I Indicators: - % of the total budget recovered by targeted institutions - % of:the national health budget allocated to primary health care - MOH expenciirures it1 cor~tr~ceptives - USAlD contribution to the overall contraceptives budget - W of people ar!cndud by primary health care workers - # of people in priority zones that are trained in key primary health care intervrntions - H of facilities certified as model health centers in priority zones - MOH regions reportit~g dm on corrr~t~orr ittfecrio~rs discnses or1 a weekly basis Key nctivitics: I2000 Coutraccptive Mut~ngcmcnt SIIIP ALCANCE CCC PASARE VIClA Ayuda CONTRASlDA Transititm to Primary Etlucation