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India
>> Regional Overview >> India Overview ACTIVITY DATA SHEET
PROGRAM: India
TITLE AND NUMBER: Reduced Fertility and Improved Reproductive Health in North India, 386-002
STATUS: Continuing
PLANNED FY 2001 OBLIGATION AND FUNDING SOURCE: $17,000,000 DA
PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCE: $13,500,000 DA; $2,000,000 CSD
INITIAL OBLIGATION: FY 1995 ESTIMATED COMPLETION DATE: FY 2004Summary: This objective responds to the global issue of stabilizing population growth under USAID's Strategic Plan. India adds more than 17 million people a year - one fifth of global population growth. The purpose of this objective is to reduce the current high level of fertility and improve women's reproductive health in North India. The direct beneficiaries are approximately 30 million women of childbearing age (15-49) in Uttar Pradesh (UP). Couples of reproductive age throughout India will benefit from the broader commercial availability of family planning and other reproductive health products. The secondary beneficiaries are children under age five, in particular, female children whose survival will be enhanced.
Of the objective's two principal components, the major intervention is the Innovations in Family Planning Services (IFPS) activity implemented in UP. Under IFPS, program interventions will focus on 29 selected districts of UP (initially 28 districts; one more was recently added). Statewide efforts include contraceptive social marketing, logistics and information, and education and communication activities. Each intervention is tested on a small scale in select areas/districts. If sound potential is demonstrated, it is scaled up in a phased manner in additional districts. Hence, reproductive health camps and service site improvement cover all 29 districts, but the more complex district planning efforts are currently operational in 10 districts. An innovative feature of the IFPS activity is that it is programmatically driven by a performance-based disbursement system; funds are only disbursed to the Government of India (GOI) against achievement of specific benchmarks.
Key Results: This objective is expected to significantly contribute to reducing fertility and improving reproductive and child health in north India. The intermediate results are: (1) increased use of reproductive health services; (2) increased quality of family planning services; and (3) increased use of family planning services.
Recent population-based surveys indicate that the total fertility rate in UP has declined by over half a child in five years, from 5.2 in 1993 to 4.6 in 1998. The use of modern contraceptive methods increased from 20.9% to 25.8% in the past five years, which is an over all increase of 23% in the 28 districts of UP. A substantial portion of this increase can be attributed to an increase in the use of spacing methods, which increased by 39% in the past five years. Also, the percentage of pregnant women receiving two doses of tetanus toxoid during their last pregnancy in 28 districts of UP increased from 43% in 1993 to 62.8% in 2000. In 2000, the percentage of deliveries attended by trained providers increased by 20%. Finally, over the last year 7,400 providers have been trained to deliver quality reproductive health services.
Performance and Prospects: This objective has two principal components: IFPS and the Program for Advancement of Commercial Technology/Child and Reproductive Health (PACT/CRH) activity.
A FY 2001 obligation of $12,760,000 million in DA funds is planned for the U.S. cooperating agencies that provide technical assistance for the IFPS activity. Of the 28 IFPS districts, more intensive efforts were conducted in 15 districts. In these priority districts, the results were very encouraging. For example, the use of modern methods of family planning in the 15 priority districts was 28.3% compared to 21.7% in the 13 other IFPS districts (as noted above, the aggregated 28 IFPS district mean = 25.8%). The proportion of deliveries assisted by trained providers and the proportion of pregnant women receiving at least two doses of tetanus toxoid in the 15 priority districts was higher than in the 13 other IFPS districts (41.1% vs. 28.5% and 64% vs. 61% respectively). (Respective means for all 28 IFPS districts are 36.6% and 62.8%). However, the proportion of pregnant women receiving adequate amounts of Iron Folic Acid (IFA) in the 15 priority districts was not significantly different than that of the 13 other IFPS districts (28.7% vs. 28.4% respectively). The IFA coverage was poor both in priority and other IFPS districts mainly because of logistical reasons, namely the irregular supply of IFA tablets in the public sector. USAID is currently working with the World Bank, GOI, and the Government of UP to develop a comprehensive health and family welfare logistics management system for the state of UP in order to address planning deficiencies and ensure adequate stocks of key maternal/child health commodities.
USAID continues to play a major role in introducing new service approaches and technologies to improve the quality of reproductive health and family planning services, including increased access and demand. USAID helped the government of UP to develop a comprehensive UP population policy that focuses on voluntarism and informed choice and steers away from provider or acceptor incentives and disincentives. USAID played a major role in district planning, statewide support for reproductive health, an increased acceptance of oral contraceptives in North India, and the promotion of social marketing.
The PACT/CRH activity is slated to receive a FY 2001 obligation of $4,240,000 in DA funds to stimulate private sector participation and commercial partnerships for the development, promotion, and availability of reproductive health and child survival technologies. In order to improve the access to quality reproductive health services, an integrated public/private sector-programming approach-District Action Plan (DAP)-was initially tried in six districts. After documenting its success, it was extended to four new districts in 2000. All 10 DAP districts are now providing integrated care for mothers, children, and fathers. It is envisaged that in the coming year DAP activities will be expanded to eleven more districts and will serve as a model for the entire state. A Population Week was organized to provide an impetus to the implementation of the UP population policy; state and district level activities were organized, including door-to-door campaigns to promote benefits of delayed marriage and planned families. The four-state, generic campaign "Goli Ke Hamjoli" (GKH) promoted acceptance and use of oral contraceptives in urban areas of North India. The sale of pills in the GKH areas increased by over 20% from 7.7 million cycles in 1998 to 9.3 million cycles in 2000. In UP, a statewide contraceptive social marketing project has been initiated for the promotion and distribution of condoms and oral contraceptives in rural areas. In the past year, the sale of condoms in rural UP increased by nearly 20 percent from 52 million condoms in 1999 to 62 million condoms in 2000, while the pill sales registered a 13% increase in sales from 2.96 million cycles in 1999 to 3.35 million cycles in 2000. In addition, a study to assess the demand for injectible contraceptives has been launched in UP. All these activities will broaden access to temporary contraceptive methods, allowing couples more choice in planning their family. However, much remains to be done to reduce fertility and increase the use of modern contraceptives.
Possible Adjustments to Plans: USAID is reviewing the activity in FY 2001 and will prepare a new strategy in FY 2002.
Other Donor Programs: Apart from USAID, the World Bank is the only other donor that is working in the area of reproductive health in UP. The IFPS Project focuses on 29 priority districts while the Bank-supported Reproductive Child Health (RCH) program focuses on other districts. Both USAID and the World Bank are engaged in providing support for contraceptive logistics statewide. USAID is supporting the training and improvement in the logistics management and information system and the Bank is supporting infrastructure.
Principal Contractors, Grantees, or Agencies: The major grantees are the State Innovations in Family Planning Services Agency and ICICI Limited. Technical cooperating agencies include: AVSC International, Cooperative for Assistance and Relief Everywhere, Center for Development and Population Activities, Johns Hopkins University, University of North Carolina, The Futures Group International, ORC-MACRO, Program for Appropriate Technologies in Health, Population Reference Bureau, Population Council, John Snow, Inc., Community Systems Foundation, and U.S. Bureau of Census.
FY 2002 Performance Table
India: 386-002
Performance Measures:
Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY00 (Plan) FY01 (Plan) FY02 (Plan) Indicator 1: Percentage of pregnant women receiving two doses of Tetanus Toxoid (TT) during their last pregnancy in 28 PERFORM districts of UP NA 40.5 59 62.8 46 66 70 Indicator 2: Contraceptive Prevalence Rate for the 28 PERFORM districts of UP NA 24.5 24.9 NA 27 29 31 Indicator 3: Percentage of deliveries attended by a trained provider, in 28 PERFORM districts of UP NA 33 29.9 36.3 35 36 37 Indicator 4: Number of IFPS-trained public sector providers performing to standards as defined by standardized clinical protocols in the 28 PERFORM districts of UP 69 409* 2346* 4348 3933 4343 NA Indicator 5: Total Fertility Rate NA 4.6 NA NA NA NA 4.2 Indicator Information:
Indicator Level (S) or (IR) Unit of Measure Source Indicator Description Indicator 1: IR Annual percentage in 28 PERFORM districts of UP a.1993 baseline was obtained from the UP NFHS Survey b. Annual population based survey in January of each year Percentage of women who gave birth during last year for which the mother received two doses of Tetanus Toxoid (TT) in 28 PERFORM districts of UP. Indicator 2: IR Percentage for the 28 PERFORM districts of UP a. 1995 baseline was obtained from the PERFORM survey b.Annual population based survey fielded in January each year Currently married women aged 15-49 using modern contraceptive methods (i.e. condoms, pills, IUDs, sterilization) in 28 districts of UP as of January 2000. Indicator 3: IR Annual percentage in 28 PERFORM districts of UP a.1993 baseline was obtained from the UP NFHS Survey b. Annual population based survey in January of each year Percentage of deliveries attended by trained providers (public and private physicians, nurses - midwives and traditional birth attendants), in 28 PERFORM districts of UP. Indicator 4: IR Annual cumulative numbers in 28 PERFORM districts of UP Reports from Cooperating Agencies. Regular follow up on training, complemented by a special provider survey that will validate a random sampling of those considered as "performing to standard". Number of providers trained in providing sterilization and those trained in providing IUD services, performing to standards as per standardized clinical protocols. * The figures have been revised since the reported data had erroneously captured providers from outside the 28 PERFORM districts. Indicator 5: IR Rate of the state of UP The source of the data has been changed from the National Family Health Survey to the Government of India's Sample Registration System due to problems of underesstimation of fertility in large-scale population surveys. Accordingly the data and the reporting periods have been adjusted. Number of children a woman would bear during her reproductive years if she were to experience the current fertility schedule. U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 170,956 DA 122,100 DA 48,856 DA 5,693 CSD 396 CSD 5,297 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 14,500 DA 21,986 DA 3,500 CSD 1,429 CSD 0 ESF 0 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 0 DFA Through September 30, 2000 185,456 DA 144,086 DA 41,370 DA 9,193 CSD 1,825 CSD 7,368 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 17,000 DA 0 CSD 0 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 17,000 DA 0 CSD 0 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 13,500 DA 106,694 DA 322,650 DA 2,000 CSD 6,707 CSD 17,900 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 |
