-. 
!2 "Z;USAID x-L FROM ThE mERICAN mFU I DOMINICAN REPUBLIC 
Close-out Report 
Increased use of Sustainable Basic Health Sewices and Practices 
SOAG 517-0281 
CLOSE OUT REPORT 
Scraregic Objective - Sustainable Basic Health Senices 
Name: Increased use of Sustainable Bas~c I-Iealth Senxces and Praccces 
Number: SO.-\G no. 51'-0381 (mciudmg Project .Agreements 51--(.12-6 and Jl--C~233: 
Approval date: 09 September 1999 SO-AG 517-0281 sped \nth GODR 
Geographic area: The whole of the Dominican Republic 
The USAID/DR Mission officdy closed Suategc Objective (SO) 3 "7nCn~td Lif o<Sui:xx~i..., BdI: 
Heal/h Semi-CJ and Pro'-:ice~"and SO.-\G 51--0281 on 30b September 2034. Thts 502 rvas mimted in 199- 
as part of the Slission's h-e :-ear Strategy, incorporadng and developing the rr-ork of 'Fm~;i P.bc:nj. ixi 
Health (Project .lgreement 517-0259), which commenced acmiaes 11" June 1995 and closed 30 
September 2000. 
SOAG 517-0281 was signed rrith the GODR on 9 September 1999, consolidating mto it the work OF 
Project .-\greement 0359 (Family Planning and Health), Project .-\greement 01-6 :.-\IDS Prer-ention'. ~nd 
incorporating the work of REDS-SCD for health sector reform. This \\.as the kt secror aqeemenr 
(SOL4G) to be signed wlth the GODR, superseding and incorpotanng all ongoing protects ind 
agreements. 
SO2 was reviewed in 2000 due to the formulation of a new ll~ss~on Strategy This re\ieu. nude 
adjusnnents to all IR acmities, focusing on further identified needs of HK;.-\IDS and health sector 
Reform. Changes to include Tuberculosis were incorporated in Apnl 20111 
The actirities carded out under SO?. successfdl~- supported the der-elopment of ke!- health senxces. 
working jointly with a rride range of governmental, SGO and pncate parmen. Of note 1s the hrge 
counterpart conmbution of more than CS$lj million throughout the Lie of the SO. CS;\ID ongtnxl 
obhgations were $32,939,638, which was reduced to $21.2-8,945 b!- close our and reihmeied to 
S0;iG-010. The GODR conmbutions totaled $10,979,879. The SO had a focus on susninablli~-. \nth 
decentralization of senices and cross-cutdng themes the results oi rvhch helped form Sol{?. Sol(? 
came into effect in .-\ugusr 2002 for the S~~~fmnrd Impmirmtnf ~n thr Hral:!) 0:' I ijnrr~iir Po?u.Liani zn :fie 
Dominiian Rcpwbhc. The two Strategic Obiectires ran m parallel unal 30" -Seprember when SO2 
closed, whilst SO 010 condnues und 2007. Several programs and actirines \\,dun 501 were connnuous 
and parallel with SO 010 and it is d~fficult to separate the results md outcomes of these. Speciiic 
termination dates for the SO2 Intermednte Results have been agreed to enable more chnn- oioutcomes 
within both of the Strategic Objectn-es. 
SO2 was impacted by the national emergency caused by Humcane George oi Seprember 1998 and the 
work of Special Objective 517-005 (closed out 31" March 2002). It should be noted that dunng the 
period of the SO there were two nerc Presidents, in 1996 and 2NXI. each causing 2 ch~n~ oi 
government and many changes uirhin the Dominican Health Senices. ..\ funher chmge oigor-emmsnt 
took place just before the close out oi 517-0281, in .\ugust 1004. 
A. BRIEF HISTORY OF STRATEGIC OBJECTIVE 2 
The history is complex, with many overhpping ageements, acu~lnser and progr3rns. .A m3=~ of ill kc\- 
programs and actirities can be seen in .-\ppend~x ;\. 
hied access to reproductive health care by youth, uith illegal abomons esdmated at 1 out oi even. 
4 pregnancies 
Inadequate water and sanitation systems, 5O0a of rural populanon gets \yarer from unsafe source and 
20% has no access to a lauine or toilet - worse in bate!-es: 
&red coverage for basic prevenm-e health care and fady planning \\ih nation11 health care 
system. 
In contest of these realities, ex-anding the reach and use of effective preventnave health care senices 
was seen as the Strategic priority. Throughout the life of S02. the Sfission has met the nulorin- oi its 
targets. The cross cuving themes aimed at increasing access to sen-ices, \ch~Ist increasmg effiaenc!. and 
equity of basic health sen-ices have had a positive and influencing impact on senlces ivadable to the 
populations most in need, as weU as supponing the government health system m the process of 
decenaalizing, increasing effectiveness and promoting greater access. 
During rhis period some health indicators reflected some kev improvements: 
Infant mortalicy dropped from 4; per 1.000 in 1996, to 37 per 1,CNl in 1999 ind to 51 per 11-1 in 
2002; 
Tod fertility rate VFR) dropped from 3.2 in 1996 to 3.0 in 2002 and to 2.6 b!- 4iK12; 
Increasing HK rates were maintained at 2.5'0 until 2002; 
Teenage pregnancy - in 2000 22.7" b women 15-19 years of age were mothers, th~s reduced slighdy to 
1 in 5 by 2002; 
Hn/AIDS work resulted in posim-e behaxior change indcators \uth mcreased condom use 
amongst all target groups and reduction in number of sexual paxmers for !-oung people and men 
who have sex nith men (31ShI). 
During the life of SO2 sex-eral key laws hare been adopted by the GODR. many as an outcome oi xork 
supported by CS.\ID. These include: 
A XationaI Strategic Hn'/.\IDS Plan and the estabhhment of the Presidenaal .\IDS Council 
(COPRESIDA); 
Establishment of the NGO Coalition for HK/;\IDS; 
The Sational Youth Iaw (2000); 
Soclal Security Law (2001); 
General Health Law (2001). 
Looking at the impacts of the IRs, it is possible to see holy they supported and Wed \xi& each other 
IRl: HK/.-\IDS work aimed to expand information and senices, increase nsk perception. promote 
poliq initiatix-es and adrocaq-, develop community-based responses and improve ~\-ulablLty and use of 
data, in be uith performance ~ndicaton agreed \xith the GODR. Sfultiple mechmims \\-ere u&ed by 
implementing partners, SGOs, government senices and the pnvate sector. .\ broad range oi 
information and educational materials xvas produced. and more than -@?,iu'*> \\.ere msmbured b!- pmer 
NGOs and made available xia a catalogue to a wider auhence. .-\ hugely successful and innox-am-e mais 
me& campaign was started by an EL' funded program m 1998-2c)M and connnued by .-l.;7ti~JID.-l unui 
2003 (and conanues under Sol@). The invoh-ement of youth and tlrget groups m the dex-elopment of 
this program informed the suatepes and themes for T\', radto 3nd me& presenuoons. The 
involvement of the me& sector resulted in appro.ximately USS4.S don m donated medu he. The 
active participation of more than 18 SGOs from across the counrq enabled the pro-pm to reach its 
targets of increased risk perception and the development of appropriate cornmurun based responses. 
Of pamcular importance was the increasing involvement oi people L~mg \x-~rh. or affected b!-, 
surpassed. In addition, REDS.CCD pro\ides suppon to SESPAS (Secretarut of Health B; Sock1 
Assistance) to carry out requisite reforms for the new health and soclal secuny system. This suppon. 
though faced with obstacles, has achieved 100ao completion of all objecnx-es. REDS:\LCD llso 
supports the SEP..IS' decen~alization of HIY,'.\IDS senices; ths 1%-ork \\dl be carned ion%-ud \\~ldun 
S010. REDS-XLCD provides suppon for a favorable policy en'ilronment, through support m rhe 
implementation of new health and soclal securiy systems. ensuring commuoly pzmupsnon. xnxlyzmg 
political processes at the local level, informing key players about the health and reform processes. and 
training. 
C. SIGNIFICANT CHANGES IN THE LIFE OF THE SOAG 0281 
SO2 was part of the LSr\ID/Dominican Republic Strategc Plan 199--2@32, \nth the SO.+G 5l--i?2SI 
signed 9 September 1999 and incorporating the exisMg ..Igreements 51--0259 and 51--1:12-6. Other 
than the mergmg of project agreements and acti\ities, there were no rmjor changes m the results 
framework dudng the life of the SO. Work carried out by the Speclal Oblecnre 2 response to 
Hurricane George fed into SOAG 0281 and continued \vorliing in pinllel und 2lX32. Ongmll CS..IID 
fundmg for the SO.\G \>-as for $32,939,638, which was amcnded to $213-8,945 and the funds a-ere 
transferred to the new SO-10 to continue ongoing work. 
The major strategic change du&g this pedod was the innoducnon of S010, \vhch coincided \xi& a 
new Mission Director and program review in 2000. \K'ork was commenced with P.IHO on Tuberculosis 
detection and treatment. Fork was also developed aith the GODR, including CERZS. ZESP.+S and 
COPRESIDA, to cam- out a demographc health sun-ey. 
D. SUMMARY OF ACTMTIES CARRIED OUT DURING THE LIFETIME OF THE 
STRATEGIC OBJECTIVE 
As reflected in the maex of programs and act%ities (see ;\ppendLu .\j. the SO2 work his been a ~LY oi 
multiple programs and activities, \\ith cross-overs and parallel aork among different agreements. Specul 
Objectire RECOS, and S010. The majorit)- of the targets hare been met. or surpassed, xh~ch n-1s the 
result of a broad range of acm-ities and establishing snong parmerships uith SGOs. insniuaond 
contractors, government depamnents and the private sector. 
IR1: The Alission supponed a six year program of ..liiionJID.-i !.\ED) whch success+- de\-eloped a 
strong and positive response ~lthin the SGO sector, including the Increasing pamclpanon of peop!e 
li\ing with, or affected by, HK/..IIDS and nith a focus on capaciy budding. \l'ork was crors-tuning 
and targeted at young people, 'bateye' (ex-sugar cane plantations) youth. sex \\-orken. men haring sex 
with men, rural women, hotel and 'zona franca' workers, as well as the general populnon. The 
establishment of COPRESID.l in 200C1 enabled the process for a naaonal response to En. .+IDS. 
informed and supponed by the Coalttion of HK./.\IDS SGOs. 14n!.\IDS acnvities mcluded: 
Expansion of Information & Senices: Kith T.1 and training suppon of SGOs 2nd parmers. 
acti\ities dex-eloped included peer outreach, condom promonon. in-school educsaon. teacher 
naining, counselor training, and the integration of HK-YI? treatment and prevennon tnto emnng 
Family Planning Senices. .\ key snategy was to ensure the coordination of rmss medla. educanonal 
work and serrice programs, each reinforcing the efforts of other program aspects The d~rerse mass 
media camplgn, including soap opera: repelring spots on T\'. radio. In p~t and on blllbolrds. and 
mno~.ative national song competition, were excellent examples of coordumoon md posim-e 
parmerships. 
Increase risk perception and Health-Seelang Behavior: IECiCBC pro-grams were developed by 
NGOs uith field-level actilities aimed at changing beha\iors. as \veU as concurrent poLcy and 



















UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT 
Santo Domingo. Dominican Republic 
UNITED STATES GOVERNMENT 
MEMORANDUM 
Date: Tuesday. June 28.2005 
To: Elena L. Brineman. Mission Director 
From: David J. Losk, Health and Population Oficer 
Through: Dan Gowen. Program Development Officer 
Subject: Approval of Close Out Report: SOAG 517-0781 
Your approval is requested to officially close Straregic Objective Agreemenr So. 5 17-02s 1. 
Increased Use of Sustainable Basic Health Senices and Practices. The anached repn 
complies with the requirements of the USAID 4DS. 
You ail1 see in this report that the activities supported under SOAG 028 1. from Sepremkr 
9, 1999 to September 30,2001, largely met their goals and had a broad impact on the 
Dominican health sector. hlany of these activities were incorporated into and cc.nunus undzr 
the current SOAG 10. 
Your approval of this report \\ill provide documentation that SO.i\G 0'81 \\as appropriately 
closed. 
Disapproved 
Date 8/7- //BS 
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