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Nepal
>> Regional Overview >> Nepal Overview ACTIVITY DATA SHEET
PROGRAM: Nepal
TITLE AND NUMBER: Reduced Fertility and Protected Health of Nepalese Families, 367-002
STATUS: Continuing
PROPOSED FY 2001 OBLIGATION AND FUNDING SOURCE: $6,500,000 DA, $9,250,000 CSD
PLANNED FY 2002 OBLIGATION AND FUNDING SOURCE: $6,500,000 DA, $9,750,000 CSD
INITIAL OBLIGATION: FY 1996 ESTIMATED COMPLETION DATE: FY 2005Summary: USAID's health program in Nepal supports U.S. national interests to stabilize world population growth, protect human health, and reduce the spread of infectious diseases. Its major purpose is to reduce fertility and improve maternal and child health, directly supporting the Mission Performance Plan's health and population goals. Although current program objectives are being met, the needs in Nepal are vast. The maternal mortality rate is among the highest in the world, at 1,500 deaths per 100,000 live births. Population growth is 2.4%, and one out of every 10 children die before reaching the age of five. USAID meets its program objectives by expanding the use of quality voluntary family planning (FP) services (with DA population funds); improving selected maternal and child health services (with CSD funds); increasing HIV/sexually transmitted infection (STI) prevention and control practices among high-risk groups (with CSD HIV/AIDS funds); and strengthening institutional capacity and control of selected infectious diseases with a focus on vector-borne diseases and antimicrobial resistance (with CSD Infectious Disease funds). The beneficiaries of the FP/reproductive health program include 11 million men and women of reproductive age and 3.5 million children.
Key Results: Two key results will indicate that this objective is being achieved. The total fertility rate will continue to drop from the 4.6 baseline (1996 Demographic Health Survey) to 4.0 children per women by 2002. The current estimate is 4.2. Under-five mortality rate will decline by an additional 35% from 118 (1996 Demographic Health Survey) to 85 per 1,000 live births by 2002. Data for several indicators reflect continuing progress in improving couple years of protection; increasing the number of children receiving Vitamin A capsules; improving the treatment of pneumonia symptoms in children; and increasing condom use in high risk groups to prevent the spread of HIV/AIDS.
Performance and Prospects: The program supports both national and district level activities. Nationally, USAID supports five Government of Nepal (GON) programs-Family Planning, Vitamin A, Community-Based Integrated Child Health, Safe Motherhood, and the Female Community Health Volunteer Program (a network of 46,000 volunteers who provide information and services to control diarrheal diseases, pneumonia, Vitamin A deficiency, and promote family planning and safe birthing practices). Within 33 districts, USAID supports activities to strengthen district-wide family planning services and to promote integrated health and family planning services at the community level, including HIV prevention among high-risk groups. The 2001 Nepal Demographic and Health Survey will be completed in September. Significant reductions in fertility and child mortality since 1996 are expected as a result of USAID's efforts in the health sector.
USAID is the lead donor for both public and private sector family planning services in Nepal. Activities aim to improve and expand pre- and in-service training, promote behavior change, and ensure contraceptive supply. In addition, USAID supports the Quality of Care Management Center, the premier quality assurance program for family planning and maternal health services. In FY 2000, USAID trained 1,351 health workers in competency-based family planning service delivery and counseling, of which 326 were in pre-service nursing education programs. The curricula included basic infection prevention practices, service delivery protocols for each family planning method, and informed choice counseling.
The USAID-supported distance education radio program, "Service Brings Reward," provided updated information to field-based health workers on family planning methods and informed choice. In FY 2000, more than 800 health workers regularly listened to the radio program. The community-focused radio drama series, "Cut Your Coat According to Your Cloth," encourages smaller, healthier families. In FY 2000, survey results showed that 80% of men and 50% of women in monitored districts regularly listened to the radio drama. In addition, approximately 10,000 women successfully completed health education and adult literacy classes, which aim to better inform consumers of health and family-planning services.
During the last six years, the Logistics Management Information System, integrating both contraceptives and essential commodities, has been an important USAID contribution to Nepal's health sector. During FY 2000, 70% of the nation's 75 district stores kept in stock at least a 3-month supply of contraceptives. As a result of USAID's efforts in the public sector, national contraceptive use increased 11.4% from the previous year. Future program activities in this area will target unmet needs and expand access and use of voluntary long-term methods.
Over the past 15 years, USAID-supported child health activities have contributed to a 50% reduction in under-five mortality. In FY 2000, USAID efforts continued to produce significant results and to exceed targets. The GON National Vitamin A Program provided supplements to 94% of children from ages 6 months to 5 years in 64 of the 75 districts, averting more than 30,000 child deaths annually. The program is expected to achieve full-scale national implementation by October 2001, a first-ever for any developing country. USAID continued to expand the National Community-Based Integrated Child Health Program, which contributes to the reduction of infant and child mortality by preventing deaths from diarrhea and pneumonia. USAID continued to support effective case management of diarrhea in all 75 districts. It also expanded pneumonia case management to 13 districts with an additional 1,675 female community health volunteers trained in FY 2000, bringing the total number trained to over 9,000. Furthermore, 96% of the identified cases were correctly treated. Future program activities include continued expansion of the community-based treatment of childhood illnesses.
In FY 2000, the Maternal and Neonatal Health program began activities with a focus on improving the policy environment and program coordination, and increasing demand and access to quality services. The program established the national safe motherhood sub-committee; completed a strategy to develop and disseminate a safe motherhood newsletter for policymakers and provide a forum for sharing information; developed and implemented a hospital-based district-level training package to deliver obstetric first aid to women in remote communities; initiated the birth preparedness package, which is a unique set of tools to help women, families, and communities prepare for pregnancy, birth, and postpartum; and launched a national safe motherhood information, education, and communication strategy. In FY 2001, these activities will continue with a significant focus on piloting the birth preparedness program.
National HIV prevalence in Nepal remains at 0.2%. However, HIV prevalence among high-risk groups along the southern border with India is currently at 5%, and new data suggest that 50% of intravenous drugs users and 17% of prostitutes in Kathmandu Valley are HIV positive. Recognizing the urgency of the situation, the GON held a national advocacy event in December 2000, attended by the Crown Prince, who publicly expressed his support for HIV/AIDS prevention. In FY 2000, HIV and sexually transmitted disease prevention efforts for high-risk groups achieved significant results. Eighty-six percent of the prostitutes and 74.2% of their clients used condoms during their last sexual intercourse, up from 67% and 73%, respectively, in FY 1999. More importantly, prostitutes and their clients are consistently using condoms 51% and 46.3% of the time, up from 41% and 40%, respectively, in FY 1999. An open Indian border, continued trafficking of women and children for the sex industry, seasonal male migration for work, increasing prostitution, and intravenous drug use in Kathmandu Valley require an immediate expansion and a more aggressive prevention program. In response, USAID is expanding the current program to the far western districts of Nepal, where there is significant migratory activity. USAID is a lead partner in a multi-donor HIV prevention effort in Kathmandu Valley that focuses on both prostitutes and intravenous drug users.
Infectious disease activities focus on vector-borne diseases and anti-microbial resistance (AMR) with an overall objective to strengthen Nepal's Vector-Borne Disease Research and Training Center as a national and regional institution for vector-borne disease surveillance, reporting, response, and control. In FY 2000, baseline surveys of the leading vector-borne diseases were completed, and prevention and control programs were designed, with implementation to begin in FY 2001. The laboratory surveillance system to identify AMR was established along with a national advisory committee to lead development of national policies and practices.
Possible Adjustments to Plans: The Nepal country strategy for FY 2001-2005 has been approved and the above mentioned program adjustments have been incorporated into the health sector component of the new strategy. In FY 2001, USAID will replace the child health indicator (Vitamin A coverage) with a new indicator to report results of the infectious disease activities. Finally, under the new strategy, USAID will restructure the current program to make it more cost effective.
Other Donor Programs: The United Nations Population Fund, Germany, the United Kingdom, UNICEF, and the Gates Foundation are partners in reproductive health. The German Development Bank is co-funding social marketing activities through Catholic Relief Services. UNAIDS, the United Kingdom, and Australia are partners in the HIV/AIDS prevention activities. The World Health Organization (WHO) is partnering with USAID in the infectious disease activities. UNICEF, WHO, and Australia actively support national child health and nutrition programs.
Principal Contractors, Grantees, or Agencies: John Snow Inc; Save the Children/U.S.; The Asia Foundation; CARE; Plan International; The Adventist Development and Relief Agency; Family Health International; the Centers for Disease Control and Prevention; Environmental Health Project (Camp Dresser & McKee International and the Institute for Science and Technology, Inc.); Commercial Market Strategies Project (Deloitte Touche Tohmatsu); International Center for Diarrheal Disease Research, Bangladesh; Management Sciences for Health/Rational Pharmaceutical Management Plus Project, United States Pharmacopeial Convention; Center for Development and Population Activities; and Johns Hopkins University.
FY 2002 Performance Table
Nepal: 367-002
Performance Measures:
Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY00 (Plan) FY01 (Plan) FY02 (Plan) Indicator 1: Condom use by persons with high-risk behaviors in target areas: clients, last use 41 58 70 74 55 65 75 Indicator 2: Children receiving vitamin A supplementation on a regular basis 92 (32 districts) 92 (42 districts) 94 (59 districts) 94 (64 districts) 80 (62 districts) 80 (72 districts) 80 (75 districts) Indicator 3: Annual couple-years of protection (CYP) for MOH and USAID-supported programs: All MOH-supported services 946,833 1,028,877 1,066,441 1188000 1,176,000 1,234,800 1,296,540 Indicator 4: Condom use by persons with high-risk behaviors in target areas: clients, consistent use 31 30 40 46 40 50 50 Indicator 5: Condom use by persons with high-risk behaviors in target areas: CSWs, last use. 61 62 67 86 60 65 70 Indicator 6: Condom use by persons with high-risk behaviors in target areas: CSWs, consistent use 27 33 41 51 35 50 50 Indicator 7: Children with pneumonia symptoms given appropriate treatment in intervention districts 78 (4 districts) 87 (6 districts) 94 (11 districts) 88 (13 districts) 60 (10 districts) 60 (12 districts) 60 (14 districts) Indicator Information:
Indicator Level (S) or (IR) Unit of Measure Source Indicator Description Indicator 1: IR Percentage of clients. AIDSCAP I & II periodic surveys. Percentage of CSWs and clients in target area reporting condom use consistently and during last intercourse of risk. Indicator 2: IR Percentage of children Minisurveys conducted by the Nepali Technical Assistance Group (NTAG) in collaboration with the MOH. Percentage of children in target areas aged 6-60 months who have received a vitamin A capsule on the preceding semi-annual national capsule distribution day. Indicator 3: IR Couple-years of protection MOH's logistics management information system; and NGO and private sector progress reports. Number used to estimate protection provided by family planning services during a one-year period, based upon volume of all contraceptives sold or distributed to clients during that period and disaggregated by type of service that USAID/Nepal supports: All MOH-supported services Indicator 4: IR Percentage of clients. AIDSCAP I & II periodic surveys. Percentage of CSWs and clients in target area reporting condom use consistently and during last intercourse of risk. Indicator 5: IR Percentage of commercial sex workers (CSWs). AIDSCAP I & II periodic surveys. Percentage of CSWs and clients in target area reporting condom use consistently and during last intercourse of risk. Indicator 6: IR Percentage of commercial sex workers (CSWs). AIDSCAP I & II periodic surveys. Percentage of CSWs and clients in target area reporting condom use consistently and during last intercourse of risk. Indicator 7: IR Percentage of children John Snow, Inc. reports. Percentage of children 0-60 months old with pneumonia symptoms referred or treated appropriately by a community health worker in intervention districts. U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 40,452 DA 28,290 DA 12,162 DA 23,789 CSD 16,949 CSD 6,840 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Fiscal Year 2000 6,872 DA 7,400 DA 7,000 CSD 6,436 CSD 0 ESF 0 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 0 DFA Through September 30, 2000 47,324 DA 35,690 DA 11,634 DA 30,789 CSD 23,385 CSD 7,404 CSD 0 ESF 0 ESF 0 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 6,500 DA 9,250 CSD 0 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 6,500 DA 9,250 CSD 0 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 6,500 DA 34,324 DA 94,648 DA 9,750 CSD 12,289 CSD 62,078 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA
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Last Updated on: May 29, 2002 |
