A USAID Perspective on Foreign Assistance Dr. Randy Kolstad, PHN Director USAID/Zambia May 2008

1. A USAID Perspective on Foreign AssistanceDr. Randy Kolstad, PHN Director USAID/ZambiaMay 2008

2. Presentation Outline • Overview of U.S. Foreign Assistance • Mechanics of U.S. Foreign Assistance • The U.S. and the Paris Declaration, SWAps and the IHP+ • USAID Health Activities in Zambia • NOTE: This presentation represents informed personal opinion, NOT the official position of USAID or the U.S. government.

3. Overview of the US Foreign Assistance Paradigm

4. Brief Statistics • Worldwide, the U.S. provided $23.5 billion in ODA in 2006 • Sub-Saharan Africa received $5.6 billion • Humanitarian assistance was more than $3 billion • U.S. is largest contributor to the UN and multilateral development banks, a total of $2.4 billion • $637 million to the UN • $827 to the World Bank Group • The U.S. has provided over $2.5 billion to the Global Fund since its launch, or nearly one-third of the total resources

5. We know this data due to reforms prompted by a question from the US Secretary of State: How much does the US spend on democracy?

6. With this web of roles and responsibilities for foreign assistance, no wonder it was difficult to develop an accurate answer…

7. New US Foreign Assistance Strategic Framework • All programs designed to support one of five functional objectives • Peace and Security • Governing Justly and Democratically • Investing in People • Economic Growth • Humanitarian Assistance • Under each functional objective are • Program areas • Program elements • Program sub-elements • Specific definitions and indicators for each and every component • Guidance in 2006 was 446 pages

8. Strategic Framework includes Country Categories • Country categories are intended to: • Provide a way to measure progress along a continuum • Establish basis for “graduating” countries from USG assistance • Assist with / inform program choices • No direct correlation between budgets and categories • Country categories in Africa • Rebuilding (6 - including DRC, Liberia, Somalia, Sudan) • Developing (30 - including Zambia, Ethiopia, Nigeria) • Transforming (5 - including Mali, Tanzania) • Sustaining Partnership (5 - including South Africa) • Restrictive (1 - Zimbabwe)

10. This process and categorization covered 155 countries in 2008 THEREFORE • The task at the country level is: To translate the global strategic framework paradigm into activities that optimally support country-led priorities and strategic plans

11. Mechanics of US Foreign Assistance • In most cases, bilateral agreements between governments outline terms, objectives and funding amounts • Projects carry out the work outlined in the bilateral agreement • Grants, cooperative agreements and contracts are the vehicles by which the objectives are reached • Technical assistance • Training, curriculum development, policy development, specific assessments, etc. • Commodities • Renovation • Both country level and global level agreements • Designed in collaboration with host-country partners • Most managed in-country • USG projects are results-oriented with a very high degree of funds accountability

12. 5.Managing for Development Results 4 5 Ownership Partners 1 set the (Partner countries) agenda Aligning with Alignment Using 2 Mutual accountability partners’ partners’ (Donor — Partner) agenda systems Establishing Simplifying Harmonisation Sharing 3 com mon procedures information (Donor — Donor) arrangements The U.S. Government and the Paris Declaration • The U.S. Government has endorsed the Paris Declaration • Ownership • Alignment • Harmonization • Managing for results • Mutual accountability

13. Paris is not all about the money • Ownership begins with a host-country owned development strategy • Alignment calls for using country systems (procurement, PFM) where they meet acceptable standards, and for strengthening them where not • Harmonization is not synonymous with budget support, but coordination that ensures effective use of resources toward a common goal • Complementarity of efforts is the key • Results and accountability are key features of all USG programs

14. SWAps and the IHP+: Many common objectives • In the context of SWAps and the IHP+, the USG, nearly universally, does NOT pool funds • Equally universally, many common objectives exist between the USG and SWAps / IHP+ • Ownership: Developing countries exercising leadership over their health policies, strategies, and relationships • Alignment: External partners assistance is aligned in a way that supports national health strategies, and SWAps make full use of country systems • Coordination: Donors and international agencies coordinate their funding around national strategies • Results-based: National strategies and support from external partners targets delivering improvements in health outcomes • Graduation: Investments by foreign partners set developing countries on a course that moves them off of dependence on foreign assistance • Mutual accountability: Partners agree to a review of progress in implementing these principles

15. What this means at the Zambia level…

16. USAID/Zambia • USAID supports Zambia’s National Health Strategic Plan, specifically to • Prevent HIV & provide care and treatment for those infected and affected by AIDS • Control and prevent malaria • Improve maternal & child health • Promote family planning & reproductive health • Reduce the burden of TB

17. USAID/Zambia – PHN Funding Through Time PHN Funding FY 2004 – FY 2007 (millions) FP, MCH, TB & Malaria

18. PHN Inputs by Partner, Account and Level (FY 2007 Amounts) Bilaterals Field Support Centrally funded Total = $93.7m

19. HIV Purchase ARVs, test kits and laboratory commodities Improve ARV, CT and PMTCT service delivery Care and support at clinic and community level BCC to reduce stigma and increase use of family planning for HIV positives HR planning and retention Malaria Support indoor residual spraying Purchase and distribute bed nets, RDTs and ACTs Support case management and treatment during pregnancy Maternal child health Support emergency obstetric care Community and facility IMCI EPI Family planning / reproductive health Purchase FP commodities Post abortion care TB Expanding DOTS Improving laboratories Cross-cutting Planning systems HIV and essential drugs supply chain system Example activities in Zambia

20. Questions?