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Archives for Cross-Cutting Programs

NOAA-USAID Join Forces for Global Development

Posted by  on Friday, April 1st 2011     

As featured in the White House Office of Science & Technology Policy Blog by Hillary Chen

Hillary Chen is a Policy Analyst in the White House Office of Science and Technology Policy

Earlier this week I had the pleasure of joining with scientists and development experts at a workshop jointly sponsored by the National Oceanic and Atmospheric Administration (NOAA) and the United States Agency for International Development (USAID).  The workshop focused on ways to re-energize scientific collaboration between the two agencies and help developing countries deal with challenges in climate change, biodiversity and human health, and geospatial analysis capacity.  It brought together NOAA’s and USAID’s scientific and technical experts in a range of fields including science-based ecosystem management, weather monitoring and forecasting, climate services and analysis, satellite-based and information services, and spatial analysis and geospatial technologies.

The workshop fits within the Administration’s larger efforts to make better use of science, technology, and innovation for global development under President Obama’s Policy Directive on Global Development.  OSTP Director John Holdren and USAID Administrator Raj Shah have noted that as a global leader in science, technology, and innovation with $148 billion invested in domestic research and development (R&D), the United States can have a significant impact in developing countries by applying its technical expertise to global challenges.

Past successful collaborations between NOAA and USAID include the Indian Ocean Tsunami Early Warning System that was established after the devastating tsunami of 2004.  Current joint efforts between the two agencies include the Famine Early Warning Systems Network (FEWS NET), which uses satellite and ground-based data to provide timely food security information for 25 countries in Africa and other parts of the developing world and the U.S. Coral Triangle Initiative Support Program, which aims to improve the management of millions of hectares of coastal and marine ecosystems to protect food security and strengthen resilience to climate change for the 363 million people who live in this area.  At a time when we are all reminded that natural disasters anywhere in the world can have widespread and even global implications, it was inspiring to see NOAA and USAID building their shared capacity to understand and respond to challenges beyond our borders.

This latest collaboration between USAID and NOAA is a great example of how U.S. R&D can be leveraged efficiently to accelerate growth and make societies around the world—including our own—more resilient to environmental changes around the globe.

Actress Lucy Liu: “Fight Human Trafficking by Nurturing Women and Girls”

Posted by  on Tuesday, March 29th 2011     

Lucy Liu on field visit with UNICEF in 2008 to Cote d’Ivoire. Photo credit: U.S. Fund for UNICEF.In the past several years I’ve met with girls and women who have survived brutal treatment as sex trafficking victims, and have been involved with several documentaries about their struggle to survive and give back.

In the past several years I’ve met with girls and women who have survived brutal treatment as sex trafficking victims, and have been involved with several documentaries about their struggle to survive and give back.

Meena Haseena was nine when she was kidnapped from her home in Bihar, India, and taken to a brothel where she was beaten and raped for twelve years. When she ran away to get help from the police, they returned her to the brothel, asking only that she be spared beatings. (New York Times columnist, Nicholas Kristof, chronicled her story in his book with Sheryl WuDunn, “Half the Sky: Turning Oppression Into Opportunity for Women Worldwide.”)

This is human trafficking, a lucrative and growing transnational crime that brings in roughly $32 billion per year[1] internationally. Of those profits, $28 billion[2] are made from commercial sexual exploitation, which characterizes 79% of identified trafficking cases.[3] The victims are predominantly female.

As the United States Government takes this week to consider crime and violence perpetrated specifically against women, we must think of the circumstances that lead to girls and women like Meena being trafficked into captivity and viciously raped of their rights. In the brothel, Meena wasn’t allowed condoms, and so she bore a daughter and son in captivity. They were taken away from her and raised as slaves. When Meena learned that she might be killed, she managed to escape, but it took her 14 years to rescue her first child, a daughter, from the brothel.

The organization Apne Aap Women Worldwide ultimately helped rescue Meena’s daughter from the brothel and then started a boarding school in Bihar to protect and educate girls. In school, girls are not as at risk for being kidnapped. This is success. There are many organizations working to address child trafficking, and their solutions deserve attention.

UNICEF, for example, established anti-trafficking committees in three districts of India and trained police on relevant Indian laws that protect the rights of potential trafficking victims.[4] They learned that police and state authorities provide models for their communities by enforcing laws against the exploitation of women and girls. In those districts, if a girl goes to the police to report being trafficked into a brothel, we can only hope that the police won’t send her back, but instead, shut down the brothel.

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Improving the Lives and Livelihoods of Women at Work

Posted by  on Friday, March 25th 2011     

Submitted by Arup Banerji, Director for Social Protection and Labor at the World Bank

As I write this from my home city of Kolkata (Calcutta), India, the changes for women here in India during the last 100 years—since the first International Women’s Day—are wonderfully evident. Women are among the top political leaders; they are CEOs of major corporations, especially in the Indian financial services and biotech industries; and they form the backbone of a thriving and dynamic NGO sector. Women are among India’s most renowned doctors and engineers, artists and sports stars, scientists and economists—in a way that would have been inconceivable even when I was a child (which was a little less than 100 years ago!)

Arup Banerji is the Director for Social Protection and Labor at the World Bank. Photo Credit: World Bank

But the reality below the surface of this feel-good story remains challenging, in South Asia and in developing countries worldwide. According to the ILO, only 37.6% of adult women in South Asia were employed(pdf) in 2008 (compared to 86.2% of men). These figures have barely budged since 1998, and are among the lowest ratios in the world, after the Middle East and North Africa. In Sub-Saharan Africa, about 63% of adult women work—still vastly fewer than the 85.4% of men who work there. And in both South Asia and Sub-Saharan Africa, more than 60% of female employment is in low productivity agriculture, with relatively few women working in manufacturing or higher-productivity services. Of course, the fact that women are not employed does not mean that they aren’t working: Women’s work in the home and community, whether childcare, cleaning or cooking go unrecorded in the official statistics. For developed countries, the implicit value of women’s unpaid work is of the order of 10% of GDP; for developing countries, it is higher. But women still face barriers to obtain paid productive work.

These barriers are especially high for young women, who often lack the skills needed to enter productive work.  Part of the challenge is that for an economy to generate the skills needed for productivity and growth, it needs a wide-ranging set of interventions across the life-cycle and sectors. These are summarized in the new publication from the World Bank’s Human Development Network on the “STEP” framework – or Skills Towards Employment and Productivity. STEP presents evidence and analysis showing that traditional training programs are insufficient to help people obtain and use the sorts of skills needed for today’s economies. The process has to begin with effective early child development policies—especially nutrition and pre-school stimulation—continue by ensuring that children learn in school, and guarantee that the labor market works well enough to match the skills that workers have with those employers demand.

However, beyond these longer-term issues, there is also evidence emerging around the sorts of active labor market programs that can address some key barriers to work for women. This is summarized in a recent World Bank Employment Policy Primer(pdf) on youth employment.

One example: In India, the Better Life Program in the 1990s aimed to give adolescent girls a ‘second chance’ education, through an integrated program that combined formal education with knowledge of life skills, vocational training and health services. A rigorous evaluation of the program found that girls who had completed the program were more likely to be literate, to have completed secondary education and to be employed.

Many of the women engaged in work today are in the informal sector—as self-employed entrepreneurs. Women own three of five micro and small enterprises in developing countries. The skills needed to be successful at this go beyond basic education. A Peruvian lending program(pdf) to poor less-educated women added entrepreneurship skills training to the lending, and found that this improved their business practices, and led to 16-28% greater sales.

But for formal work, having education and even skills may not be enough—those skills have to match those demanded by employers, even more so in countries where there is a flourishing private sector and thus available jobs. One set of programs that have had proven success are the “Jovenes” programs in Latin America, which work with the private sector to give beneficiaries specific skills demanded by employers.  In those programs, women participants have seen increases in employment by 6–12% in some countries.

Sometimes the barrier is information, since women often lack knowledge about which occupations are the most rewarding. The Jua Kali voucher program in Kenya(pdf) provided some of its female beneficiaries with information about wages in various occupations; a recent assessment finds that more than one in ten then switched to better paying jobs as compared to girls who didn’t get this information.

These are just some examples of success—many others exist, and yet others may be successful but have not been rigorously evaluated to know whether they work.  As we begin devising the World Bank’s 2012-2022 Social Protection and Labor strategy, we hope to deepen this knowledge about what works and what doesn’t, and to work as a global community to improve the lives and livelihoods of women at work.

Women: A Resource in Development

Posted by  on Thursday, March 24th 2011     

By: Caren Grown, Senior Gender Adviser

Seeing  the flurry of material published to commemorate Women’s History Month and the 100th Anniversary of International Women’s Day, I was unsettled  by a popular view suggesting that women are an under-utilized resource of development.  This view cannot be further from the truth; in fact, women are the most over-utilized resource in development. Indeed both labor force and time use data show that women, on average, work about twice as much as men in both paid and unpaid work.  But women’s work is under-valued and under-paid, and much of it takes place outside the formal paid economy, from childcare to subsistence farming.

Caren Grown, Senior Gender Adviser at USAID.

It is important to recognize the progress that women have made in the paid labor market over the past thirty years. More women participate in paid employment, especially in non-agricultural employment, now than ever before, reflecting the growth in economic opportunities available to them. Up until the financial crisis in 2008, female labor force participation increased in almost all regions, with the fastest growth in being in Latin America and the OECD and among young adults. According to the recently released 2011 State of Food and Agriculture report, women comprise an average of 43 percent of the agricultural labor force of developing countries, ranging from about 20 percent in Latin America to almost 50 percent in Eastern and Southeastern Asia and sub-Saharan Africa.

Yet it is also true that in most countries around the world, females face inferior employment opportunities relative to males; they are clustered in female-dominated job sectors or informal employment that is low-wage and insecure. Unfortunately, time series evidence on the female share of informal employment do notexist for most countries. Nonetheless, cross-sectional evidence since 2000 indicates that informal employment – which does not usually provide job security, benefits or adequate income – continues to represent a larger share of women’s employment than men’s.[1] Data limitations prevent tracking progress toward reducing sex segregation, both across and within occupations, which is related to women’s low wages and women’s reliance on informal employment, but it remains extensive.

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Making the Unavoidable Unacceptable

Posted by  on Tuesday, March 22nd 2011     

On World Water Day, March 22, safe drinking water and sanitation experts gather across the globe both to celebrate successes and to develop more effective, sustainable ways of meeting this vital development need. One element of those conversations is that the lack of safe drinking water and sanitation in developing countries poses a number of multidisciplinary challenges:

  • This is primarily a global public health challenge, but requires primarily public works solutions.
  • Water and sanitation are important in their own right, but both are also vital to sustainable progress for other important development challenges including health, nutrition, education (especially for girls), poverty alleviation, and human security.
  • Solutions require innovation, but most importantly they require appropriately and sustainably scaling the answers known since Roman times, or at least since the introduction of chlorine into New Jersey’s municipal water supply in 1903.

As challenging as it is, however, we can undeniably achieve universal access to water and sanitation with today’s technology, funding, and political leadership.

That last statement resonates most loudly for the 884 million people who lack safe drinking water today, and for the 2.6 billion people who lack improved sanitation facilities. The approximately two million deaths due annually to unsafe water and sanitation, and the waterborne diseases causing those deaths, can for the most part be prevented. And preventing them is not simply smart development policy for the United States; it is a life and death situation for millions of people, and a significant leadership opportunity for this Administration and country.

On World Water Day let us recognize that this challenge is not simply solvable. It is being solved by communities all over the world, and the government of the United States and its philanthropies, corporations, and citizens are helping in often very effective and sustainable ways. Health specialists, engineers, and economic development experts work together to not just drill more wells and build more latrines, but to strengthen capacity of indigenous groups and communities in developing countries to provide these services themselves.

So as USAID and its partners in the United States and abroad continue to implement fully the Senator Paul Simon Water for the Poor Act of 2005 [PDF], some suggestions follow on how to accelerate that progress and make sure the work sustains itself over the long run:

2011 is the year of quality, effectiveness, and sustainability in the water and sanitation sector. Implementing agencies of the U.S. Government and outside entities (nonprofits, philanthropists, civic groups like Rotary International, corporate philanthropies, and private citizens) should always ask themselves the tough questions during the early stages of each program:

  • Is the activity they are implementing or supporting likely to endure technically? Are local businesspersons trained and incentivized to manage a supply chain?
  • Is the financial model in place to ensure that the funds will be available locally to repair, upgrade, or expand the system?
  • Is the ribbon-cutting ceremony not just the self-congratulatory end of the program, but simply the next step toward a sustainable water and sanitation intervention that endures 15-20 years?
  • Is there an ongoing monitoring and evaluation program whose successes and failures are frequently updated and knowable to all stakeholders?

In today’s tight fiscal times we need the answer to these questions to be “Yes” more frequently than in the past. This will get the biggest possible bang for our dollar, be it a development assistance or a philanthropic dollar.

So on World Water Day let us take a closer look at sustainably tackling the lack of safe drinking water and sanitation. This is an unassailably grave yet solvable development challenge, and a multi-track diplomacy opportunity with almost unlimited upside. The United States government and citizens have an opportunity to prevent more waterborne illness and mortality and should redouble efforts to do so in a sustainable, scalable fashion. Let us work together to turn water-related death and disease from an unavoidable fact of life to completely unacceptable.

World Water Day events in the Washington DC area: www.waterday.org
The United Nations World Water Day website: www.worldwaterday.org
UNICEF / WHO Joint Monitoring Programme for Water Supply and Sanitation: www.wssinfo.org

John Oldfield is Managing Director of the WASH Advocacy Initiative, a nonprofit advocacy effort in Washington DC entirely dedicated to helping solve the global safe drinking water, sanitation, and hygiene (WASH) challenge. Its mission is to increase awareness of the global WASH challenge and solutions, and to increase the amount and effectiveness of resources devoted to solving the problem around the developing world.

Bangladesh: Maternal Deaths Decline by 40 Percent in Less Than 10 Years

Posted by  on Friday, March 11th 2011     

Bangladesh is on track to meet the 2015 deadline for U.N. Millennium Development Goal 5 (50 percent reduction in maternal deaths).   The Bangladesh Maternal Mortality and Health Service Survey [PDF] jointly funded by the Government of Bangladesh, USAID, Australian Aid (AusAID) and the United Nations Population Fund (UNFPA) found that maternal deaths in Bangladesh fell from 322 per 100,000 in 2001 to 194 in 2010, a 40 percent decline in 9 years.

The decline in direct obstetric deaths is most likely the consequence of better care seeking practices and improved access to and use of higher-level referral care.  The decline in total fertility rate due to the successful family planning program has reduced exposure to high risk pregnancies and has thus prevented a large number of maternal deaths.

USAID’s program in Bangladesh has historically been very strong in family planning through the world’s largest social marketing program for non-clinical contraceptive methods and through the public sector for long-acting permanent methods.  We can confidently say that our long and unwavering investments in family planning have had direct impact in lowering the total fertility rate, and thus the maternal mortality rate, in Bangladesh.  Over the past five years, USAID has also invested in scaling up active management of the third stage of labor to prevent postpartum hemorrhage in the public and NGO sector.

The USAID program has also long invested in promoting and providing antenatal care through the NGO sector which linked women to the health system thus contributing to increased awareness and care-seeking for obstetric complications. USAID and CDC’s long term commitment to the in depth training of local scientists has resulted in the creation of Bangladesh’s premiere research institute, the International Center for Diarrheal Disease and Research, Bangladesh (ICCDDRB) which has the capacity to effectively guide valid and reliable research efforts such as the 2010 Bangladesh Maternal Mortality and Health Care Survey (BMMS).

USAID supported and provided technical leadership in implementation of the 2001 and 2010 BMMS to monitor the performance of the overall maternal health program. Without these two surveys it would not be possible for Bangladesh to monitor its progress towards achieving the MDG 5 goal.

Amanda Glassman, Director of Global Health Policy and a research fellow at the Center for Global Development, wrote “the results are also a good reminder that investments in family planning and girls’ education drive much of maternal health outcomes, and that USAID investment in social marketing of family planning and health seems to be paying off in improved health (see blog post).”

The Bangladesh Ministry of Health and Family Welfare is scaling up emergency obstetric care and active management of the third stage of labor; the Ministry has also recently approved distribution of Misoprostol tablets to all pregnant women shortly after delivery to prevent postpartum hemorrhage. There is also increasing availability of Magnesium Sulphate for management of pre-eclampsia. The predominance of hemorrhage and eclampsia deaths and deaths after delivery indicate a need to strengthen access to treatment for these two conditions, improve referral systems, and improve referral level care.

Every year, USAID provides basic health care services to nearly 20 million Bangladeshis, including provision of low-cost, quality family planning services and maternal and child health care. With USAID and international support, under-five mortality rates have declined by more than 50 percent in Bangladesh since 1990. USAID has trained and mobilized community health workers to provide critical maternal and child health care to supplement broader health interventions and support country-level capacity. Bangladesh already received a country award from the United Nations for significant progress in reaching MDG 4 (reducing child mortality) during the MDG Summit in New York on September 19.

The Government of Bangladesh and the United States jointly rolled out President Obama’s Global Health Initiative in Bangladesh on November 23. GHI in Bangladesh will focus on providing quality services to reduce maternal and child mortality, resuscitate family planning programs, improve nutrition status among children under age five, and strengthen overall health systems over the next five years.

Unleashing the Power of Women and Girls

Posted by  on Thursday, March 3rd 2011     

Women and girls are an extremely powerful force for development. A woman’s economic wellbeing is fundamental to her family, her community, her children, and her children’s children. Women are vital to economic growth, income generation, and security and stability. More than 70 percent of the farmers in Africa are women, often toiling on small plots to grow fruits, vegetables and grains for their families.

They are central to the household economy — they not only grow most of the food, they prepare it and serve it, and keep the house clean and take care of the children. Young girls are responsible for much of the labor families need to survive: tending livestock, carrying water, harvesting crops, watching younger children, and doing chores.

Increasing family incomes, fighting poverty, improving nutrition, and building the skill base needed to sustain development – teachers, doctors, nurses, accountants, engineers – all depend on investing in and providing opportunities for women and girls. When women do earn income, they are more likely than men to spend it on food, education, and health care for their families. They are a huge and growing part of the population in many developing countries: in Nigeria, girls and young woman under 30 years of age account for 35% of the population; in the United States they account for just 20%. And gender equality matters for development: evidence shows that the incidence of poverty tends to be lower and the rate of economic growth higher in countries with greater gender equality.

A woman voting in the 2005  Liberian elections. Photo Credit:©2010 Benjamin Spatz

And yet women and girls face huge systematic disadvantages and hurdles that undermine their own progress, and the progress of their families, communities, and countries. According to the path-breaking report Girls Count, girls and women are less educated, less healthy, and less free than their male counterparts. Many are forced to marry at a young age and are extraordinarily vulnerable to HIV, sexual violence, and physical exploitation. They typically cannot own land, get credit, or even apply for many jobs. Between one-quarter and one-half of girls become mothers before age 18, and 70% of the people in the world living in poverty are women and girls.

I’ve seen first-hand the power of creating opportunities for girls and women. As a Peace Corps teacher in an all-girls school in the tiny village of Leulumoega in Samoa, I saw how girls with a basic high school education could get good jobs, help provide for their families, and become leaders in their communities.

I’ve met young women working in garment factories in Indonesia and data-entry centers in Ghana that speak about the empowerment that comes from earning their own incomes, and how they are able to wait longer to be married, have fewer children, and take better care of their families. And I’ve seen close up how, when given the opportunity, a woman president – Ellen Johnson Sirleaf of Liberia – can lead her country from the brink of ruin at the end of a terrible civil war and regain peace, stability, credibility, and the beginnings of economic growth and vibrant democracy.

We can and must do better to support women and girls. That’s why through President Obama’s Feed the Future Initiative we are focusing on investments that provide new opportunities for women farmers and help improve nutrition for their families. That’s why our microfinance and SME programs emphasize creating new opportunities for women to earn incomes to support their families. That’s why the Quadrennial Diplomacy and Development Review and USAID Forward puts a huge emphasis on investing in women and girls, and incorporates gender equality into our core aid effectiveness principles. We know that to accelerate development and build strong, stable and well-governed societies, we must unleash the power of girls and women.

Administrator Shah Delivers a TED Talk on Leveraging Science and Technology in Development

Posted by  on Wednesday, March 2nd 2011     

Administrator Rajiv Shah delivering a TED Talk in Long Beach. Photo Credit: Dan Shine/USAIIn the world of science and technology, we crave for the new and the different.  Innovation is described as applied invention sometimes, but true innovation creates an emotion when you’re exposed to it.  It’s a combination of fascination and an urgent instinct to share what you’ve just experienced with others.

I just finished day one of the annual TED conference in Long Beach, and amongst the sharing of breakthroughs in quantum mechanics, the relationship between policy and emotion, and a virtual choir, the audience got a chance to hear from USAID Administrator Raj Shah.

He described how we are changing the way USAID approaches aid, highlighting innovations in healthcare delivery, mobile banking, and the prevention of HIV transmission.  He focused on how important leveraging these science and technology game-changers has become, and provided a strong vision for the future.

This is a tough crowd.  TED prides itself on showing us things not seen before.  From us, they saw USAID’s innovative vision and Raj’s passion, and from all the conversations and excitement that ignited following his talk, it’s clear they were intently excited and inspired about what they saw.  Just as importantly, millions more will have access to that vision when his talk makes it’s way to www.ted.com.

Addressing the World’s Greatest Development Challenges

Posted by  on Sunday, February 20th 2011     

As a career Foreign Service Officer, I’ve seen many international frameworks that try to address some of the world’s greatest development challenges. It’s a tricky balance to strike—ensuring the inclusion of viewpoints from the international partners we depend on, but not losing the needed focus at the expense of broad buy-in.

Susan Reichle, Assistant to the Administrator for USAID’s Bureau of Policy, Planning and Learning (far left) speaks at the Center for Strategic and International Studies. Photo credit: USAID

The Organization for Economic Co-operation and Development (OECD) recently released statebuilding guidance that achieves this fine balance. This guidance will help shape and improve the international community’s engagement with fragile states.

Over the past two years, USAID has been deeply involved in the development of this guidance. USAID worked closely with other OECD members to stress the important role that legitimacy plays in making governance more effective and less fragile. This idea was outlined in USAID’s 2005 “Fragile States Strategy” where concrete examples of what it means to be “legitimate” and “effective” were developed. USAID also helped the OECD to more clearly define the significance of gender roles and relations and place these at the core of how we improve state effectiveness

Yesterday, I had the opportunity to comment on the statebuilding guidance at a panel discussion hosted by the Center for Strategic and International Studies (CSIS). After presentations from the OECD’s Stephen Groff and CSIS’s Mark Quarterman, I became even more convinced that the guidance offers a critical framework to address fragile states, one that helps us avoid conflicting signals and wasted time when every minute counts.

Additionally, the statebuilding guidance reinforces many of the reforms we’re focused on through USAID Forward. It emphasizes the importance of evaluation, the imperative of working with local partners, and the opportunity of employing technologies like geographic information systems (GIS) to better connect and adapt our programs to changing conditions in the countries in which we work, especially in fragile states.

The statebuilding guidance also complements our broader U.S. foreign policy goals as outlined through the Presidential Policy Directive on Global Development (PPD) and the Quadrennial Diplomacy & Development Review (QDDR). As called for in the PPD, the guidance promotes a modern aid architecture in support of common objectives, and applies a unique approach and division of labor when working in conflict affected countries. Furthermore, the guidance contributes to the development of “standing guidance and an international operational response framework to provide crisis and conflict prevention and response,” called for in the QDDR.

I am pleased with the OECD’s timely work and proud that USAID was able to play an active role in its formulation.

USAID’s Battleground: Expanding Access and Strengthening Health Systems

Posted by  on Tuesday, February 15th 2011     

Administrator Shah: “Our experience with GHI has made it clear: our largest opportunities to improve human health do not lie in optimizing services to the 20% of people in the developing world currently reached by health systems; they lie in extending our reach to the 80% who lack access to health facilities. That is where the success of everything I’ve discussed today will be determined.  That is our battleground.  And I am proud to say: that is where USAID will lead the fight.”

Today, in a packed auditorium at NIH, Administrator Shah outlined a global health agenda around five transformational goals.  Dr. Shah believes that we can achieve the following by 2016: save the lives of over 3 million children; prevent more than 12 million HIV infections, avert 700,000 malaria deaths, ensure nearly 200,000 pregnant women can safely give birth, prevent 54 million unintended pregnancies, and cure 2.4 million people infected with TB.  To achieve these ambitious goals, he emphasized the need to strengthen health systems by empowering community health workers and midwives by equipping them with better diagnostics and treatments.

As part of the President’s Global Health Initiative, USAID helps countries integrate their health systems across WHO’s six health system “building blocks” (human resources; medical supplies, vaccines, and technology; health financing; information; leadership and governance; and service delivery) and within their national infrastructure.  Recent activities included: strengthening health care financing in Armenia, Azerbaijan, Georgia, and Senegal through the use of national health accounts; helping nine countries implement human resource information systems; and instituting performance assessments to raise standards for HIV services in six Central American countries.

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