How Child Survival Funds Are Used

Between fiscal years 1985 and 1995, USAID reported that it obligated over $2.3 billion for the child survival program. A total of 83 developing countries received some mission-level child survival funding during this period. As shown in table 2, of the 10 countries that have received the most child survival assistance from USAID missions, 5 were in the Latin America and Caribbean region, 4 were in the Asia and Near East region, and 1 was in the Africa region. Funding Supports Different Types of Activities

Between 1985 and 1995, activities related to the three major causes of death among young children—acute respiratory infections, diarrheal diseases, and vaccine-preventable diseases—received about $972 million, or 41 percent of the child survival funds. Identifying Amounts Used Specifically for Child Survival Is Difficult

USAID is unable to determine with any degree of precision how much funding is actually being used for child survival activities because (1) of the way Congress has directed funding; (2) USAID guidance allows considerable flexibility and variation in attributing child survival funds; (3) the amounts reported are based on estimated percentages of projected budgets, which sometimes are not adjusted at the end of the year to reflect any changes that may have occurred; and (4) the amounts reported are not directly based on specific project expenditures. USAID’s Contribution to Child Survival

USAID has made significant contributions, in collaboration with other donors, in reducing under-5 mortality rates. Five countries achieved the World Summit goal of 70 or fewer deaths per 1,000 live births. USAID’s Center for Development Information and Evaluation (CDIE) concluded in a 1993 report that USAID’s child survival activities had achieved many successes and made a significant contribution in expanding child survival services and reducing infant mortality in many countries. 5). 6). 7). Although the railroad bridge in Mozambique was considered a nutrition intervention, other infrastructure projects that have used child survival funding were classified as water quality/health, health systems development, and health care financing. According to USAID, the agency does not have a mission in these countries, had closed out assistance, or was in the process of closing out assistance because of budgetary or legal reasons or because sustainable development programs were not considered feasible. On the other hand, USAID attributes mission-level child survival funds to activities in 17 countries that have a mortality rate of 70 or fewer deaths per 1,000 live births. In fiscal year 1995, USAID used about $89.5 million of child survival funding for activities in these 17 countries. Agency guidance states that any of the following key factors indicate the need to consider developing strategic objectives that address family planning, child survival, maternal health, and reduction of sexually transmitted diseases and HIV/AIDS: annual total gross domestic product growth less than 2 percent higher than annual population growth over the past 10 years, unmet need for contraception at or above 25 percent of married women of childbearing age, total fertility rate above 3.5 children per woman, mortality rate for children under age 5 at or above 150 per 1,000 live births, stunting in at least 25 percent of children under age 5, maternal mortality rate at or above 200 deaths per 100,000 live births, and prevalence of sexually transmitted diseases at or above 10 percent among women aged 15 to 30. Comments From the U.S. Agency for International Development

The following is GAO’s comment on USAID’s letter dated July 23, 1996.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed the U.S. Agency for International Development's (AID) child survival activities and accomplishments, focusing on how child survival funds are being used to support AID objectives.

What GAO Found

GAO found that: (1) since 1985, AID has classified obligations totalling over $2.3 billion for activities in at least 83 countries as child survival; however, due to the way Congress directs funding to child survival, particularly since 1992, and AID's approach to tracking and accounting for such funds, it is not possible to determine precisely how much is actually being spent on child survival activities; (2) between 1985 and 1995, AID reported that it spent about $1.6 billion, or 67 percent of the child survival funds, for four types of activities: immunizations, diarrheal disease control, nutrition, and health systems development; (3) AID also reported that about 41 percent of the total amount identified as child survival has been used to address the three major threats to children under age 5 in the developing countries: diarrheal dehydration, acute respiratory infections, and vaccine-preventable diseases; (4) during GAO's field visits, it also noted that part of the cost of rehabilitating a railroad bridge and constructing a water tower in Mozambique and carrying out urban sewerage projects in Egypt were identified as child survival expenditures; (5) AID said the projects in Mozambique were critical for reducing child mortality because they supported access to water, food, and health services; (6) AID and other donors have made important contributions toward improving child mortality rates in many countries; (7) in 9 of the 10 countries receiving the most AID mission-level child survival assistance since 1985, mortality rates for children age 5 and under have dropped; (8) in addition, 5 of these 10 countries achieved mortality rates by 1994 of 70 or fewer deaths per 1,000 live births, a goal set for the year 2000 at the World Summit for Children; (9) both AID and independent evaluations have pointed out successes, such as collaboration with other donors to immunize children and promote oral rehydration therapy in the treatment of diarrheal disease; (10) in fiscal year 1995, AID's child survival funding was used in 17 countries that had an under-5 mortality rate of 70 or fewer deaths per 1,000 live births; (11) AID mission-level funding for child survival in these countries was $89.5 million, or 31 percent of the total child survival funding obligated in that year; (12) on the other hand, many countries that were far from achieving the goal, did not receive assistance for child survival; and (13) according to AID, most of these countries did not receive assistance because AID did not have a program in the country, had closed out assistance, or was in the process of closing out assistance due to budgetary or legal reasons or because sustainable development programs were not considered feasible.