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Egypt
>> Regional Overview >> Egypt Overview ACTIVITY DATA SHEET
PROGRAM: Egypt
TITLE AND NUMBER: Healthier, Planned Families, 263-020
STATUS: Continuing
PLANNED FY 2001 OBLIGATION AND FUNDING SOURCE: $58,100,000 ESF ($48,100,000 Program Activity; $10,000,000 Cash Transfer)
PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCE: $44,650,000 ESF
INITIAL OBLIGATION: FY 1996 ESTIMATED COMPLETION DATE: FY 2009Summary: This objective reflects a major redirection of the health and population program. It shifts the priority to capacity strengthening and sustainability and addresses the needs of families rather than exclusively women of reproductive age and their children. This is an integrated approach that is consistent with the Government of Egypt's (GOE) desired orientation and priorities. The earlier separate population (263-004) and health (263-005) programs have been merged under this unified objective to maximize efficiencies and impact. With USAID assistance, Egypt has achieved substantial reductions in infant and child mortality; has succeeded in making family planning and reproductive health more widely available and accepted; and has embarked upon comprehensive long-term health reforms. Remaining challenges in the health and population sector include: stark differences in the health status between rural Upper Egypt and the rest of the country; population growth that will add nearly two million people annually to Egypt's population; low knowledge of health risks; limited practice of preventive and health-maintaining behaviors; and structural deficiencies in the health sector that decrease efficiency and impact.
Key Results: This objective will achieve the following results: a) increased use of basic services by the poor and vulnerable; b) adoption of healthy behaviors; and c) basic services sustained when USAID assistance is phased out.
Access to vital health services and information increased in 29 districts (of 74) in Upper Egypt through investments that upgraded health worker skills, intensified health outreach, and improved information systems. Over 50 small nongovernmental organization (NGO) grants have been awarded. The returns on USAID assistance to develop informative and appealing mass media messages promoting safe birthing practices and family planning were multiplied when the GOE significantly increased the television airtime devoted to these public health messages. The GOE "Gold Star" quality assurance system was revamped with USAID technical assistance in FYs 2000-2001 in order to provide health managers with more powerful tools for ensuring patient choice and provider adherence to quality standards. Infant mortality rates declined more quickly than anticipated, due in part to higher coverage rates for the immunization of young children and antenatal care of pregnant women. Egypt has achieved one of the highest rates of childhood immunization in the world. Similarly, the acceptance of modern contraceptive methods increased ahead of planned levels, contributing to lower total fertility rates. Continued reductions in infant mortality and fertility are expected to result from maintaining high rates of immunization and through the increased use of maternal/child health services and family planning.
Performance and Prospects: The FY 2001 and FY 2002 activities are illustrative.
Building upon prior success, the prospects are excellent for reaching significant results in FY 2001 and 2002. USAID will continue to support a full range of activities that promote policy change to further encourage health reform and private sector participation. These activities include training health workers, providing technical and management assistance, research, equipment and supply acquisition, and health facility renovations. In FY 2000, USAID assistance helped the Ministry of Health and Population (MOHP) establish the human and financial systems required to provide basic health care to the under-served in Alexandria under the "Family Doctor" model-an integrated and more efficient way of organizing and paying for services. Using technical assistance, USAID-in close collaboration with the World Health Organization (WHO), United Nations Children's Fund (UNICEF), United Nations Fund for Population Activities (UNFPA), and the MOHP-worked successfully with medical schools to update the curriculum in conformance with international standards and improve provider skills and performance. In FY 2000, advocacy work with the GOE resulted in national legislation making seat belts a requirement for front-seat passengers in all vehicles, a requirement the GOE is now vigorously enforcing. Prospects are good for developing new programs that increase surveillance response capacity against infectious diseases, educate women and their spouses on the disadvantages of female genital cutting, and enhance sustainability of basic health programs supported by USAID and other donors.
In FY 2001 and FY 2002 ($9.5 million and $10 million, respectively), the highly successful Healthy Mother and Healthy Child activity will be extended. This activity supports child and maternal health interventions nationwide (e.g., vaccinations, antenatal care visits, and safe birthing practices) and district-level activities in 29 districts of Upper Egypt, including a program of small NGO grants.
In FY 2001 and FY 2002 ($21 million and $16.6 million, respectively), population and family planning activities will continue to expand couples' access to reliable information and services related to reproductive health. Women of reproductive age are the primary beneficiaries of this activity, though service providers are including an increasing number of men and other family members in their consultations. Abortion remains illegal in Egypt, and the GOE is fully committed to voluntary and safe family planning, making it an excellent partner for USAID with a notable record of accomplishment.
In FY 2001 and FY 2002 ($2.8 million and $4 million, respectively), infectious disease surveillance response will be improved through: (1) strengthening the national infectious disease surveillance and control program to more effectively prevent and respond to infectious disease threats; (2) assessing the GOE tuberculosis program and developing a plan for USAID assistance that will help reduce the spread of virulent, resistant strains; (3) completing the first phase testing of a potential vaccine against schistosomiasis; and (4) programs to reduce risk through universal infection control and HIV/AIDS education.
In FY 2001 and 2002 ($5.5 million and $4.75 million, respectively), USAID technical assistance and training will support replication of the "Family Doctor" model, a policy dialogue to enhance sustainability, and other health reforms. Family and reproductive health services and policies will be enhanced through support based on the achievement of benchmarks under USAID's health policy reform program (see below).
In FY 2001 and FY 2002 ($2.4 million and $3 million, respectively), workforce health will be improved by local training and by sending 18 Egyptians to the United States to pursue public health training at the masters' degree level.
In FY 2001 and FY 2002 ($5.1 million and $4.5 million, respectively), a new program will be developed to integrate information, education, communication, and behavior change activities across the health and population portfolio. Appealing and informative health/population messages will be prepared for dissemination through various media. The new approach will promote family planning, safe pregnancy and birth, and healthy practices (e.g., voluntary blood donations and not smoking).
In FY 2001 and FY 2002 ($1.8 million per year), USAID will implement training programs that increase Egypt's capacity to provide the broad array of services that result in healthier and better planned families.
The high level of GOE commitment to population and maternal and child health strongly suggests that further progress is feasible over the next eight years. The MOHP has a clear mandate to provide public health services to the poor and vulnerable, an impressive record of expanding services, and the infrastructure for widespread impact (over 4,500 service sites). Stabilizing Egypt's population growth, reducing geographic and urban/rural disparities, and improving maternal and child health are GOE priorities for which there is long-standing and strong political commitment. In public appearances and official documents, top government officials repeatedly draw attention to the negative implications of population growth for Egypt's socioeconomic development and the need for social programs that ensure health care coverage for the poor.
Cash Transfer: In FY 2001, USAID plans to obligate up to $10 million for the fourth and final year of the existing Health Policy Support Program. By the end of this program, major innovations in service delivery and health insurance will have been accomplished through the achievement of benchmarks under the GOE's national health reform program. These benchmarks include: (1) an increase in MOPH expenditures on primary and preventive health care by 10% annually; (2) improvements in the personnel and management practices of MOHP facilities; (3) development of a "Family Health" service model and a fund to pay providers for services based on quality and efficiency; (4) the establishment of mechanisms for the public sector to accredit and contract private and NGO providers; and (5) expansion of the provider network serving the poor and under-served eligible for financing under public health insurance. GOE commitment to fundamental reform in the health sector has been demonstrated by its commitment of funds to the "Family Doctor" model, close cooperation with donors on a pilot activity in Alexandria, and the launch of reforms in two more governorates.
Possible Adjustments to Plans: USAID plans to phase out bilateral assistance to the population and health program by the end of FY 2009, in accordance with the new USAID strategy. By the end of FY 2002, USAID will develop a plan for an orderly phase out of assistance in health and population.
Other Donor Programs: Close collaboration with the following donors complements USAID's activities in this sector: WHO, UNICEF, UNFPA, the European Union, and the World Bank.
Principal Contractors, Grantees, or Agencies: U.S. implementing organizations include Abt Associates; John Snow International, Inc.; Maximus; Pathfinder; Program for Appropriate Technology in Health (PATH); Save the Children Federation; the University of Maryland; the Naval Medical Research Unit (NAMRU-3); and the U.S. Centers for Disease Control and Prevention. UNICEF also is an implementing agency. The MOHP will continue to be a principal partner. USAID will also work in close cooperation with other government ministries, notably the Ministry of Communication and Information (on health education and promotion) and the Ministry of Higher Education (on medical and nursing education). The participation of the NGO community and private health partners will increase significantly through the life of this objective.
FY 2002 Performance Table
Egypt: 263-020
Performance Measures:
Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY00 (Plan) FY01 (Plan) FY02 (Plan) Indicator 1: MOHP expenditures for primary/preventive health care per capita NA NA 19.47 NA 20.25 21.06 21.90 Indicator 2: Infant Mortality Rate (IMR) 52.7 45.5 45.5 43.6 44 43 42 Indicator 3: Percent of births whose mothers received four or more antenatal visits NA NA 28.3 36.7 37 40 43 Indicator 4: Total Fertility Rate (TFR) NA 3.4 NA 3.5 3.55 3.5 3.4 Indicator Information:
Indicator Level (S) or (IR) Unit of Measure Source Indicator Description Indicator 1: IR MOHP per capita expenditures for primary/preventive health care: in LE (Egyptian pounds) and inflation adjusted MOHP for expenditure data. CAPMAS for population estimates. This indicator measures inflation-adjusted MOHP expenditures for primary/preventive health care per capita. The numerator is the amount of MOHP expenditures for primary/preventive health per GOE fiscal year, and the denominator is the estimated national population of Egypt at the beginning of the same year. Indicator 2: IR Average number of deaths of infants under one year of age per 1,000 live births * EDHS 2000 Infant mortality rate measures the number of deaths under one year of age per 1000 live births. Data are reported by national estimates and disaggregated by Upper Egypt and Lower Egypt Indicator 3: IR Percent of births * EDHS 2000 This indicator tracks the recommended minimum number of visits for proper antenatal coverage, as recommended by WHO. The numerator is the number of live births during the past five years whose mothers received four or more antenatal care visits, and the denominator is the total live births during the same period Indicator 4: IR The average number of children a woman would have at the end of her childbearing years if she were to bear children during those years at the currently observed rates * EDHS 2000 Total fertility rate (TFR) measures the average number of live births a woman would have if she experienced a given set of age-specific birth rates throughout her reproductive life. Data are reported by national estimates and disaggregated by Upper Egypt and Lower Egypt U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999* 0 DA 0 DA 0 DA 0 CSD 0 CSD 0 CSD 119,169 ESF 0 ESF 119,169 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Fiscal Year 2000 0 DA 0 DA 0 CSD 0 CSD 50,765 ESF 58,093 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 0 DFA Through September 30, 2000 0 DA 0 DA 0 DA 0 CSD 0 CSD 0 CSD 169,934 ESF 58,093 ESF 111,841 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Prior Year Unobligated Funds 0 DA 0 CSD 0 ESF 0 SEED 0 FSA 0 DFA Planned Fiscal Year 2001 NOA 0 DA 0 CSD 58,100 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 0 DA 0 CSD 58,100 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 0 DA 0 DA 0 DA 0 CSD 0 CSD 0 CSD 44,650 ESF 144,850 ESF 417,534 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA * These funds were previously obligated under former objectives 263-004 and 263-005, whose activities have been
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Last Updated on: May 29, 2002 |
