2
STRATEGIC OBJECTIVE
No. 519-003
“HEALTH OF SALVADORANS, 
PRIMARILY WOMEN, YOUTH 
AND CHILDREN, IMPROVED”
1997 - 2005
CLOSE-OUT REPORT
USAID EL SALVADOR
Health Office
Complejo Embajada Americana
Blvd. y Urb. Santa Elena
Antiguo Cuscatlán, La Libertad
El Salvador, Centro América
3
Strategic Objective Close-out Report
SO Name: Health of Salvadorans Primarily Women, Youth and Children, Improved
SO Number: 519-003
Approval Date for Strategy: June 17, 1996
Approval Date for SO: August 7, 1997
Performance Period: August 7, 1997 to September 30, 2005
Country: El Salvador
I. BACKGROUND 
Although El Salvador’s health system had improved after years of civil war, serious 
inequalities between urban and rural areas existed by June 17, 1996, when USAID’s new 
health strategy was approved. Maternal and child morbidity and mortality rates were 
high, mainly due to preventable causes such as respiratory infections and diarrhea 
disease. Rural Salvadorans lacked access to adequate health care, especially preventive 
maternal and child health services, water and sanitation services and proper hygiene 
practices.
On June 7, 1996, Strategic Objective (SO) No, 519-003 “Sustainable Improvements in 
Health of Women and Children” was approved under USAID/El Salvador 1997 – 2002 
Strategy “Sustainable Development and Democracy in El Salvador.” On April 2, 1997, 
the Mission Director approved Results Package “Increased Access to Potable Water and 
Sanitation Systems” to finance $9.755 million for water and sanitation activities. 
Subsequently, on August 7, 1997, three other results packages (RP) were approved under 
the SO No. 519-003 at a funding level not to exceed $53,930,000 for the period 1997 
through 2002. These RPs were an integral part of the USAID’s 1997 - 2002 health 
strategy. Thus the SO 519-003 framework comprised four RPs: “Increased use of 
appropriate child survival practices and services,” “Increased use of appropriate 
reproductive health practices and services,” “Enhanced policy environment to support 
sustainability of child survival and reproductive health programs” and “Increased Access 
to Potable Water and Sanitation Systems.”
USAID, one of the largest donors in primary health care in El Salvador, designed its 
strategy (1997-2002) to address inequities in the health care system and improve 
reproductive and child health by increasing the quality of and access to reproductive 
health and child survival services by the rural poor and by improving the policy 
framework and strengthening the institutions that support these services. The strategy 
directly supported the Government of El Salvador’s (GOES) process of health care 
reform, which placed an emphasis on improving maternal and child health care. In the 
4
FY2003 Results Review and Resource Request (R4) document, USAID/El Salvador 
requested LAC/W approval of a two-year extension to the Strategy, from September 30, 
2002, to September 30, 2004, in light of the workload associated with the response to the 
2001 earthquakes in El Salvador. The Mission planned to bring most of the activities to 
close late in FY 2004 or by June 2005. On March 15, 2005, this SO as well as the other 
three core SOs were extended through September 30, 2005.
II. SUMMARY OF OVERALL IMPACT 
The purpose of the Health SO was to expand and sustain quality health care for infants 
and children; improve quality and access to reproductive health services and practices, 
especially for rural women and adolescents; support the Ministry of Health (MOH) 
efforts to decentralize the planning and management of health services at the local levels; 
and prevent and control sexually transmitted diseases, including HIV/AIDS. By the end 
of the program, USAID’S assistance contributed to the following results: 
Strategic Objective Level:
- Infant mortality decreased from 35 to 25 deaths among children under the age of 
one per 1000 live births, surpassing the target of 32.
- Total fertility declined from 3.58 to 2.97 births per woman of reproductive age, 
surpassing the target of 3.1.
- DPT3 Immunization coverage of children under 5 years of age increased from 
65% to 72%, exceeding the target of 68%. 
- The percentage of births attended by a skilled birth attendant increased from 58% 
to 69.4.5% showing an improvement in maternal care, surpassing the target of 
63%. This proxy however, does not coincide with the reported increase in 
maternal mortality from 120 to 173, registered by the Demographic Health 
Surveys in 1998 and in 2003. The rise in maternal mortality rates is believed due 
to survey imperfections.
Intermediate Result Level:
- Contraceptive prevalence increased from 59.7% to 67.3% of women in union 
using some form of contraception, exceeding the target of 64%.
- Provided a total of 3,300,906 Couple Years of Protection (CYPs). The annual 
targets for CYPs were exceeded in the last four years of the strategic period.
- As planned in the targets, all MOH health facilities were implementing the 
Directly-Observed Treatment Short Course (DOTS) to treat tuberculosis 
successfully. 
- USAID supported decentralization of the MOH into small service delivery units 
called SIBASI (Integrated Basic Health System) achieving the target of 85% of 
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decentralized SIBASI by the end of the strategy, up from the 26% measured in 
2001.
- Of all families benefited by water and sanitation activities, the percentage that 
wash their hands increased from 62% to 86%, exceeding the target of 85%.
- 27 water systems and 7,800 latrines were constructed benefiting more than 81,000 
people. In 75% of the 27 benefited communities, there was an average reduction 
of 47.5% in diarrheal diseases in children under 5 years of age.
In addition, the following achievements were accomplished, for which no targets 
were originally established: 
- 9,428 gray water absorption pits were constructed.
- 27 Community Health Committees were formed and trained in tight coordination 
with the MOH in the 27 communities where water systems were constructed.
- A tuberculosis treatment success rate of 88% was achieved with patients 
undergoing Directly-Observed Treatment Short Course (DOTS).
- After USAID’s HIV prevention intervention with the Policía Nacional Civil 
(PNC), PNC members reporting having had only one sexual partner in the 
previous 12 months increased from 63% to 70% between 2003 and 2004.
- MOH procurement system was enhanced, reducing the average time it takes to 
complete procurement processes by 3.5 months.
- Exclusive breastfeeding of children up to 6 months old increased from 16 to 24% 
between 1998 and 2003.
- Pre-natal care increased from 76% to 86% and post-natal care from 43.3% to 
54.2% between 1998 and 2003.
- Neonatal death by asphyxia was reduced from 1.22 to 0.7 per 1,000 live births 
between 2001 and 2005.
Other Achievements by Implementing Partners:
A. Ministry of Health (MOH)
A total of 56,441 people of the MOH were trained in different aspects such as child 
survival, reproductive health, dengue, TB, and HIV/AIDS through USAID’s support
under this SO.
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Reproductive Health: 16,821 people were trained in topics like family planning, 
contraceptive logistics, obstetrics emergency, prenatal and postnatal care, delivery care, 
referral systems, and adolescents health.
Child Survival: 14,564 MOH people were trained in breastfeeding, immunizations, IMCI, 
Integrated Nutrition Care (AIN), IEC strategies, mother-baby package, and perinatal care. 
USAID also supported the training of 1,900 field personnel in community-based 
Integrated Management of Childhood Illness (IMCI) and the identification of life￾threatening danger signs. Nearly 500,000 children under 3 years of age benefited with 
child health services.
HIV/AIDS: USAID provided technical assistance, training, equipment and dissemination 
for an HIV/AIDS hotline to the Ministry of Health. Technical assistance and financing 
were provided to the MOH for the development and implementation of an HIV/AID 
awareness and prevention campaign at the national level. Organized HIV prevention 
activities, including peer education and voluntary counseling and testing were provided 
for more than 6,500 members of the Policía Nacional Civil (PNC). USAID played a key 
role in the Coordinating Committee for El Salvador, CCE, of the Global Fund to ensure 
the implementation of El Salvador’s approved country plan for period 2003-2008 ($23 
million). A total of 603 persons from the MOH were trained in prevention activities, in
Voluntary Counseling and Testing (VCT) and in mother-to-child transmission preventive 
activities.
Tuberculosis: More than 16,000 first grade students nationwide were tested for TB as 
part of an Annual Risk Infection Study. This study will serve as the basis for the planning 
of a future country TB strategy. Assistance was provided to carry out the expanded 
direct-observed treatment short course (DOTS) to all MOH facilities nationwide and to 
all Instituto Salvadoreño de Seguro Social (ISSS) health facilities. USAID assistance 
also contributed to the achievement of a 85% curative rate as well as an 88% successful 
treatment rate.
Policy and Reform: USAID support helped strengthen the human resources, financial 
administration, supply and maintenance systems of the MOH to assure effective 
decentralization. Assistance was also provided to strengthen the monitoring and 
evaluation system of the MOH, as well as to develop guides for organization and 
functioning of the SIBASI. 7,700 people from MOH and other organizations were trained 
in decentralization, administration and management.
Dengue: A total of 16,393 people from the Ministries of Health and Education were 
trained in dengue prevention activities.
B. The Salvadoran Demographic Association (SDA):
With USAID support, the SDA opened three pharmacies, carried out more than 24,000 
fund raising activities, purchased specialized new medical equipment, remodeled three 
clinics, opened five laboratories, improved its computerized information system, and 
developed a social marketing, information and promotional campaign. All these 
activities helped the SDA achieved 96% financial sustainability, allowing it to continue 
with its own funding to support all its programs, especially the rural health and 
adolescents reproductive health programs.
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In addition, the SDA reached 109,341 new family planning users, thus expanding access 
to birth planning and spacing for new couples, and provided 600,173 couple years of 
protection between 1999 and 2005. During this same period, the SDA provided through 
their clinics 575,017 maternal health care interventions and 63,161 child health care 
interventions. Also, 245,941 women and 159,165 children were referred by SDA 
promoters for health care to MOH clinics; and 60,214 adolescents, 207 pregnant 
adolescents, and 1,131 parents and teachers were reached with reproductive health 
messages.
C. CARE Water and Sanitation for Health (PROSALUD):
Under this intervention, 27 water systems by gravity or pumping were constructed and 
7,800 latrines were installed using the ventilated improved pit (VIP) and/or composting 
type, benefiting more than 81,000 people in rural communities. Also, solutions for gray 
water disposal were provided to these communities through the construction of 9,428 
absorption pits. Besides the water and sanitation facilities, the program carried out 
promotion activities, developed intense community organization, and health education 
interventions. A participatory methodology approach was used to make community 
individuals and local government authorities active participants in the construction, 
operation, maintenance and administration of the potable water and sanitation facilities 
installed.
III. SIGNIFICANT CHANGES IN THE RESULTS FRAMEWORK AND 
SUMMARY OF PERFORMANCE INDICATORS USED
FY 1998 - 2001
Under the agreement signed between USAID and the Government of El Salvador in 
1997, the original SO name was “Sustainable Improvements in Health of Women and 
Children Achieved” and included the following Intermediate Results (IR): 
IR 1: Increased use of appropriate child survival practices and services.
IR 2: Increased use of appropriate reproductive health practices and services.
IR 3: Enhanced policy environment to support sustainability of child survival and 
reproductive health programs.
FY 2001 – 2002: In FY 2001, adjustments were made to the following indicators that 
were being tracked under the performance monitoring plan; these adjustments did not 
represent a revision of the strategic plan. Under IR 1, the indicator “Number of Ministry 
of Health (MOH) units implementing IMCI” was replaced by “Number of health 
promoters trained in community IMCI.” For IR 3, the indicators “Percent of townships 
served by MOH-supported health promoters” and “Percent of MOH expenditures 
allocated to primary care” were deleted and both substituted by the indicator “Number of 
Integrated Basic Health Systems (SIBASI) developed by the MOH.” The resulting 
Results Framework included the following indicators:
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SO-Level Indicators
1. Maternal Mortality Ratio
2. Percent of Deliveries Attended by MOH-Trained Personnel
3. Total Fertility Rate
4. Infant Mortality Rate
5. Child Mortality Rate
6. Percent of Municipalities Reporting Over 90% Coverage with DPT
Intermediate Result-Level Indicators
IR 1:
- Rural areas with significant reduction in diarrhea
- Number of rural health promoters trained in community IMCI
IR 2:
- Percent of pregnant women receiving prenatal services
- Contraceptive prevalence rate
- Couple Years of Protection
IR3:
- Number of SIBASIs developed by the Ministry of Health
FY 2002-2005: The ability of the Mission’s Health SO team to manage performance had
been limited by inconsistencies in the SO framework since the beginning of the strategy. 
Therefore, in FY 2002, the name of the SO was changed to “Health of Salvadorans, 
primarily Women, Youth and Children, Improved,” and other small revisions were made 
at the IR level. Revisions in the health SO framework did not represent substantive 
changes in the focus, beneficiaries, activities, funding levels, planned targets or SO-level 
indicators of the program but were mostly related to changes in SO and IR names to
provide more logical consistency to the framework. Revisions at the IR and sub-IR level
described better the causal linkages needed to achieve the SO, improving the 
framework’s utility as a communication, planning and management tool. In addition, the 
Mission added several new indicators at the IR and sub-IR level; no indicators were
dropped.
The final SO 519-003 Results Framework follows.
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February 27, 
2002 Revised 
Version
SO Indicator C: "Child Mortality Rate" 
SO Indicator D: "Total Fertility 
SO Indicator A: Rate"
"Maternal Mortality 
Ratio; proxy: % 
Births Attended"
SO Indicator B: "Infant 
Mortality Rate; proxy:% 
DPT3 coverage of 0<12 
month-olds
SO Indicator E: “deliveries 
attended by MOH trained 
personnel
Indicator 1.a: "# of 
decentralized healthcare 
delivery units (SIBASIs) 
developed"
Indicator 1.b: "% of rural 
households with adequate 
access to potable water"
Indicator 2.a: "activity 
sites with at least a 26% 
reduction in diarrhea 
among children <5yrs 
old"
Indicator 2.b: 
"Contraceptive 
prevalence 
rate; proxy: 
couple-years' 
protection"
 
Indicator 2.1.a: "legislation 
passed to decrease 
HIV/AIDS discrimination"
Indicator 1.1a:
"contraceptive 
phase-out plan 
developed and 
agreed upon by 
GOES and 
donors"
Indicator 1.2a: "% health 
facilities implementing 
DOTS"; Indicator 1.2b:
"# health promoters 
trained in community 
IMCI"; Indicator 1.2c: "% 
clients satisfied with 
reproductive health 
services"
Indicator 1.3.a: "# of latrines and water 
systems constructed or rehabilitated"; 
Indicator 1.3b: "% of family planning 
service delivery points stocked according 
to plan"
Indicator 2.2.a: "% of families 
washing hands after latrine use"; 
Indicator 2.2.b: "knowledge of HIV 
prevention methods among high￾risk groups"; Indicator 2.2c: "# of 
people treated for STIs"; Indicator 
2.2d: "# of condoms sold"
Health Strategic Objective
Health of Salvadorans, Primarily Women, Youth, and Children, Improved
IR # 1 Access to Quality Health Related Services Increased IR # 2 Use of Health Related 
Services/Practices Increased
Sub- IR 1.2
Provider 
Performance 
Improved
Sub-IR 1.3
 Infrastructure Supporting Health 
Related Services Improved
Sub-IR 2.2
Health-seeking 
Behaviors Increased
Sub-IR 1.1
Policies 
Supporting 
Access to 
Health￾Related 
Services 
Strengthened
Sub-IR 2.1 Policies Supporting 
Use of Health Related 
Services/Practices Strengthened
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VI. SUMMARY OF PROGRAMS AND ACTIVITIES IMPLEMENTED UNDER THE 
SO
Under the Health SO several integrated activities were carried out by the Ministry of Health, 
local and U.S. NGOs, and international and other U.S. Government agencies, through a variety 
of Global Health Bureau field support mechanisms and bilateral, interagency and host country 
agreements. Activities and interventions under this SO helped to achieve the two SO 
Intermediate Results, IR 1 “Access to quality health related services increased” and IR 2 “Use 
of health related services/practices increased.” The cornerstone of the health program under 
the SO was the Healthy Salvadorans ActivityNo. 519-0430 (SALSA), which entailed training,
technical assistance and the provision of materials and equipment to the MOH to improve 
reproductive, maternal and child health; water and sanitation projects; and support for a local 
family planning NGO.
Annex A includes a list of evaluations, assessments and studies conducted during the life of the 
SO. Annex B includes a list of agreements that have been closed per ADS 202.3.10.1. Annex C
includes the names of individuals directly involved in the planning, achieving, assessing and 
learning of the SO.
Following is the list of activities supported by USAID through its Health SO. The activities in 
numerals 1-6 were approved during a previous strategy but ended during the life of the 1997-
2005 strategy. Copies of the close-out reports for all these activities are included as Annex D.
1. Maternal Health and Child Survival (PROSAMI) Project No. 519-0367 with a Life of 
Project Funding (LOP) of $34,000,000. This project was approved on July 27, 1990 and ended 
on December 31, 1998. Close-out report completed on July 28, 1999.
2. Family Health Services Project (Salvadoran Demographic Association – SDA) No. 519-
0363 with a LOP of $27,495,533.40. This activity was approved on July 31, 1990 and ended on 
June 30, 1999. Close-out report completed by SDA in December 1999.
3. Health Systems Support (APSISA) Project No. 519-0308 with a LOP of $77,000,000. 
Approved on August 27, 1986 and ended on July 31, 2000. Close-out report completed by the 
MOH in July 2003.
4. Displaced and Street Children (PROCIPOTES) Project No. 519-0420 with a LOP of 
$1,865,098.26. Approved on September 30, 1994 and ended on December 31, 1998. Close-out 
report completed on August 9, 1999.
5. Public Services Improvement Project No. 519-0320 with a LOP of $77,679,000. Approved 
on August 30, 1989 and ended on December 31, 2003. A close-out report for all the components 
implemented by the GOES, except for the Water and Sanitation (W&S) for Health component,
was completed on March 18, 1999. The W&S for Health component was funded at level of 
$33,122,727 and implemented by several U.S. NGOs. Under this component activities 
implemented by three U.S. NGOs through separate cooperative agreements ended in 1997. On 
April 1, 1998 CARE El Salvador entered into a cooperative agreement with USAID to continue 
activities under the W&S for Health component (PROSAGUAS). This agreement ended on 
December 15, 2002. Close-out report completed by CARE in March 2003. 
6. Healthy Salvadorans (SALSA) Activity No. 519-0430 with a LOP of $37,547,538. This 
activity started on July 30, 1998 with an original end date of September 30, 2002, but that was 
11
extended through September 30, 2005. This activity supported interventions with the Ministry of 
Health, the Salvadoran Demographic Association (SDA), and CARE for provision of potable 
water and sanitation (PROSALUD). Close-out report completed by the MOH in October 2005. 
Close-out report completed by CARE in September 2005. Close-out report completed by SDA 
in September 2005.
VII. PRINCIPAL IMPLEMENTING PARTNERS
A) Benefiting Partners in El Salvador during the life of the strategy:
1. Ministry of Health of El Salvador, MOH
2. Indigenous NGOs: 
ADS (IPPF affiliate)
FUSAL
CALMA
ASAPROSAR
AMS
ASPS
ADEMUSA
ADHU
AGAPE
CODECOSTA
CODELUM
FASTRAS
AMCS
ASALDI
ASADE
CIRES
CODECA
FUMA
FUNDEPRENS
FUNDEMUN
FUNDESO
IDEA
COMUS
CONAMUS
OEF
ORMUSA
OPRODE
PADECOMSM
PROCADES
PROGRESO
ASEI
ASIPES
FUNDAC
KNAPP
COSDECSAM
DIOCESIS DE ZACATECOLUCA
3. Legislative Assembly
4. National Civilian Police
5. National Secretariat of the Family
6. Former Ministry of Planning
7. Salvadoran Social Security Institute
8. Several local private universities
9. National University
B) Other Partners that provided technical assistance to the agencies listed in A above, including 
international and bilateral agencies:
Field Support Partners:
1. Abt. Associates - PHR+
2. Partnerships for Child Health - BASICS I and II 
 3. International Science and Technology Institute – MOST
 4. Academy for Educational Development (AED) – CHANGE and LINKAGES
5. University of North Carolina and IntraHealth - PRIME I and II
6. The Futures Group – SOMARC II, POLICY and Proyecto Acción SIDA de Centro-America - 
 PASCA
7. John Snow, Inc. – DELIVER
8. Family Health International (FHI)
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9. Contraceptive Logistics, Macro – MEASURE
10. LTG Associates - PopTech
11. Population Council – FRONTIERS
12. Tuberculosis Coalition for Technical Assistance (TBCTA)
Contractors/Recipients:
1. Cooperative for Assistance and Relief Everywhere (CARE)
2. Clapp and Mayne
3. Booz Allen & Hamilton
4. Management for Sciences in Health (MSH)
5. Management Sciences Corporation International (MSCI)
6. Cambridge Consulting Corporation (CCC)
7. Pan-American Social Marketing Organization (PASMO)
Other U.S. Government Agencies:
1. Peace Corps
2. Centers for Disease Control and Prevention (CDC)
Other Donors/Partners:
1. Pan American Health Organization (PAHO)
2. United Nations Fund for Population Activities (UNFPA)
3. Interamerican Development Bank (IDB)
4. World Bank (WB)
5. German Cooperating Agency (GTZ)
6. Japan International Cooperating Agency (JICA)
7. United Nations International Fund for Children (UNICEF)
VIII. PROSPECTS FOR LONG-TERM SUSTAINABILITY
The sustainability of the Healthy Salvadorans Program and other activities funded under this SO 
is the most important legacy of the strategic objective. Listed below are gains in a number of 
areas that USAID expects will be sustained over the long-term.
- IMCI and AIN have been incorporated into the MOH’s strategy and will continue to be 
supported under USAID’s new strategic objective (2005-2009). These programs have 
also been incorporated into the curricula of some Salvadoran medical and nursing 
schools.
- USAID supported an effective logistics system for micronutrients distribution which the 
MOH is using nationwide.
- Patient-(especially adolescent) friendly services and adolescents’ peer to peer approach to 
reproductive health, concepts promoted by USAID and its implementing partners, have
been adopted by the MOH throughout its facilities.
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- A nationwide maternal mortality surveillance system was implemented with USAID 
support and currently is being used throughout the country. USAID will continue to 
provide technical assistance to ensure optimum functioning.
- A nationwide perinatal information system was created with USAID assistance under the 
1998-2005 strategy. The MOH has adopted this system for all hospitals and has assigned 
a person full time to monitor its implementation.
- The MOH is replicating USAID’s initiative of developing community birth plans to 
increase the number of skilled deliveries in other SIBSASI not supported under the 1997-
2005 health strategy. 
- Initially designed and implemented in 7 SIBASIs with USAID support, the MOH has 
decided to implement its nutrition surveillance systemnationwide. 
- The MOH has fully adopted and assigned personnel to follow up on the USAID 
supported Contraceptive Logistics System for the management, distribution and 
information of contraceptive needs. In addition, the MOH has been increasing its 
commitment to and the absorption of the costs for the purchase of its contraceptive needs 
with GOES funding. 
- Water and sanitation systems built by USAID are being managed by USAID-trained 
community members and maintained through cost recovery mechanisms. The community 
development approach of USAID’s water and sanitation projects implemented by CARE,
has been adopted by the GOES water agency (ANDA). 
- The MOH will continue to support activities carried out under the community health 
program supported by USAID, including the hiring of community health personnel.
- USAID will continue to support the MOH’s process of modernization under its next 
strategy. SIBASI operating manuals developed under this SO are still in use, and USAID 
will continue to provide technical assistance to improve the MOH’s human resource, 
supply management and financial analysis systems.
- HIV/AIDS behavior change activities initiated by USAID with the National Civil Police 
force are continuing with assistance from the Global Fund for AIDS/TB/Malaria. The 
National AIDS program currently runs the AIDS hotline.
- The DOTS program, established with USAID assistance, continues as the primary TB 
treatment program in the country.
- USAID technical assistance resulted in the elaboration of the Ministry of Health’s 2005-
2009 National Strategic Plan to Reduce Maternal and Perinatal Mortality, which supports 
many of the interventions undertaken under this SO.
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- Improvement of the managerial and administrative systems of the MOH such as human 
resources, supply management, and procurement, that lead to an effective 
decentralization will continue being developed and implemented by the Ministry of 
Health and continue being supported by USAID under the new strategy (2005-2009).
IX. TOTAL COST OF THE SO
The total approximate value of the Health SO was $ 148,367,996 and included the following 
sources of funding:
Total USAID Contribution $81,598,000
- USAID Population Account: $ 32,639,200
- USAID Child Survival Account: $ 48,958,800
SO 519-003 OBLIGATIONS FROM FY 1997 THROUGH FY 2004
(000)
Activity FY 97 FY 98 FY 99 FY 00 FY 01 FY 02 FY 03 FY 04 TOTAL
519-0308 600 1,280 1,880
519-0363 3,338 315 625 4,278
519-0367 3,348 1,000 4,348
519-0420 700 200 900
519-0320: 2,656 1,552 2,500 1,583 775 688 9,754
 PROSAGUAS 500 500
519-0430 6,890 6,581 8,949 8,399 8,589 9,780 7,125 56,313
Field Support '1/ 410 916 500 500 1,099 56 3,481
Peace Corps/SPA 20 20 32 20 27 25 144
TOTAL 11,052 12,153 10,226 11,052 10,805 9,353 9,807 7,150 81,598
1/ Field Support obligated directly to Washington's contracts (not under an activity).
Total Counterpart Contribution/Cost Sharing $66,769,996
- MOH Counterpart Contribution: $34,238,817
- ADS Cost Sharing: $18,422,559
- MSCI (PROSAMI) Cost Sharing: $ 6,886,660
- MSCI (PROCIPOTES) Cost Sharing: $ 253,653 
- CARE Cost Sharing: $6,968,307
X. LESSONS LEARNED
The list below highlights some of the lessons learned throughout the course of this Health SO: 
- Community involvement and the use of promoters and other community health personnel
have proven essential to the success of all interventions.
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- To ensure the sustainability of USAID’s interventions in the health sector, MOH
personnel must take ownership of activities from conception through implementation. 
- Supervision at all levels of the MOH is crucial to the success and sustainability of 
USAID-supported interventions.
- Water and sanitation projects that depend on community involvement or other partners 
require adequate time to negotiate and implement. Hastily implemented projects without 
the full participation of or ownership by the community may take longer to complete and 
are less sustainable.
- In most of the interventions if there are no adequate supplies and equipment, the activity 
becomes difficult to implement and impact can not be achieved.
- The constant turnover of MOH personnel hinders the sustainability of a program.
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XI.
ANNEXES
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ANNEX A
LIST OF EVALUATIONS, 
ASSESSMENTS, AND
 STUDIES CONDUCTED
DURING THE LIFE OF THE SO
Evaluation/Study Subject When Done by
1 Potable Water and Sanitation an Experience to Share November1999 CARE/PROSAGUAS
2 PROSAGUAS external mid-term evaluation May 2000 EHP
Eddy Perez
Harold Lockwood
Patricia Martin
Morris Israel, USAID/W
3 National Demographic and Health Survey (FESAL) 1998 Salvadoran Demographic 
Association (SDA) with the 
assistance of the Centers for 
Disease Control and Prevention 
(CDC).
4 National Demographic and Health Survey (FESAL) 2003 Salvadoran Demographic 
Association (SDA) with the 
assistance of the Centers for 
Disease Control and Prevention 
(CDC).
5 Assessment of sustainability: USAID Population Assistance 
to the Salvadoran Demographic Association (SDA)
May 2002 John Coury and Luis Hernandez 
(POPTECH)
6 Impact of the introduction of water and sanitation at the 
community level as a contribution to the food security and 
nutrition of the population
June 2000-
November 2002
INCAP (Guatemala)
CARE/El Salvador 
(PROSAGUAS)
7 National TB Program external assessment November 2001 TBCTA
8 HIV/AIDS surveillance external situation analysis January 2002 Bernie Branson, CDC
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Evaluation/Study Subject When Done by
9 Rapid Assessment on El Salvador’s Contraceptive Security February 2001 Mark Rilling, 
CLM/USAID/Washington
Lisa Luchsinger, 
CLM/USAID/Washington
Nora Quesada, DELIVER (John 
Snow, Inc.)
10 Rapid Assessment and Proposal - Commercial Marketing 
Strategies (CMS)
May 2001 Kelly Wolf, CMS
11 MOH training evaluation July/August
2002
Development Associates
12 SALSA/SO3 evaluation assessment October-November
2002 
Merri Weinger (GH; environmental 
health and behavior change)
John Austin (GH; water/san/environ)
Mary Vandenbrouke (GH; HIV/AIDS)
Laurie Cobb (POPTECH; RH; 
teamleader)
Karen Cavanaugh (GH; reform and 
financing)
13 Baseline and best practices assessment of seven SIBASIs in 
El Salvador
December 2002 Eric Seiber
14 School Desertion and Adolescents Reproductive Health in 
El Salvador
December 2005 POLICY
15 Nutritional Situation of Children Under Age 5, Women in 
Fertile Age and Lactating Women in El Salvador
June 2005 POLICY
16 Effect of Birth Intervals on Infant and Child Mortality in El 
Salvador
June 2005 POLICY
17 Knowledge and skills of MOH health promoters on family 
planning counseling
September 2005 PRIME
18 Knowledge and skills of traditional midwives on family 
planning counseling
September 2005 PRIME
19 Hospital Sepsis Study in five major MOH hospitals in El 
Salvador
September 2005 POLICY
20 Birth Plan Strategy Evaluation July 2005 PRIME
21 Mother Baby Package Evaluation August 2004 BASICS
22 SIBASIS evaluation July 2005 PHR Plus
23 Formative Research on Practices on the Use of Iron July 2005 BASICS
24 Evaluation of Breastfeeding Program Julio 2005 BASICS
25 Health Systems Support Project (APSISA) Evaluation December 1993 External Consultants
19
Evaluation/Study Subject When Done by
26 2o. Censo Nacional de Talla en escolares de primer grado 2000 Donors (principally USAID)
27 Analysis of the implementation process of the IMCI 
Strategy
Dec. 2003 BASICS II
28 SIBASI Baseline 2002 PHR (+)
29 Sexual Abuse in Children and Adolescents Pregnancies May 2005 POLICY
30 Preventive and risk associated conditions to respiratory 
infections and diarrhea diseases in Salvadoran children
May 2005 POLICY
31 Associated factors to stigma and discrimination towards 
people living with HIV/AIDS in El Salvador
May 2005 POLICY
32 Socio-demographic and socio-economic factors related to 
HIV/AIDS knowledge and their association with positive 
and preventive practices among Salvadoran adolescents
May 2005 POLICY
33 Infant malnutrition associated factors May 2005 POLICY
34 Family Health Services Project No. 519-0363 Mid-Term 
Evaluation
June 1993 CCC
35 Evaluation of Gender utility PROECICIA SP as a 
biocontroler of water studies of the AEDES AEGYPTI 
January 2004 AED
36 Evaluation to determine the Chlorine concentration in water 
after carrying out the “untadita total” in different types of 
containers
December 2003 AED
37 Developing a behavior change strategy for the prevention of 
dengue in El Salvador
August 2002 AED
38 Hacia una mayor cobertura en salud: contratacion de ONG 
en El Salvador
2004 PHR(+)
39 Evaluacion de la descentralizacion administrativa financiera 
del Ministerio de Salud
Febrero 2003 PHR(+)
20
ANNEX B
LIST OF AGREEMENTS THAT 
HAVE BEEN CLOSED
 PER ADS 202.3.10.1
1. Family Health Services Project No. 519-0363
Cooperative Agreement No. 519-A-00-90-408-00
Implementer: Salvadoran Demographic Association (SDA)
Amount: $27,495,533.40
Period: July 31, 1990 – June 30 1999
2. Maternal Health and Child Survival (PROSAMI) Project No. 519-0367
Cooperative Agreement No. CA-519-0367-A-00-00188-00
Cooperating Agency: Management Sciences Corporation International (MSCI)
Period: June 1990 – December 1998
Amount: $32,356,029.00
3. Chicos Integrados por Trabajo, Educación y Salud (PROCIPOTES)
Project No. 519-0420
Cooperative Agreement No. 519-0420-G-00-4111-00
Cooperating Agency: Management Sciences Corporation International (MSCI)
Period: September 1994 – December 1998
Amount: $1,905,500
21
ANNEX C
NAMES OF INDIVIDUALS DIRECTLY 
INVOLVED IN THE PLANNING, 
ACHIEVING, ASSESSING AND 
LEARNING OF THE SO
USAID
Raul Toledo
Margarita de Lobo
Jose Antonio Ramos Chorro
Maricarmen de Estrada
Ana Cristina Mejia
Ileana de Parraga
Martin Schulz
Jack Dale
Alba Amaya
Meri Sinnitt
Terrance Tiffany
Connie Johnson
Karen Welch
Mary Vandenbroucke
Peggy Marshall
John Austin 
MOH
Eduardo Interiano
Jose Lopez Beltran
Herbert Betancourt
Guillermo Maza Brizuela
Patricia Portillo de Reyes
Alcides Urbina
Carlos Rosales
Carlos Melendez
Haydee de Escobar
Maria Elena Avalos
Genoveva Morales
Rodrigo Siman
Julio Garay
Jorge Cruz Gonzalez
ADS:
Jorge Hernandez Isussi
Jose Mario Caceres
Samuel Castro
Rafael Avendano
22
ANNEX D
ACTIVITIES AND IMPLEMENTING 
PARTNERS CLOSE-OUT REPORTS
P:\HIO.pub\HIOPUB\DOCS\SO3\SO 519-003 Close-out Report_FINAL_Revised _SDO_February 9 2006.doc