oversight

Foreign Assistance: Impact of Funding Restrictions on USAID's Voluntary Family Planning Program

Published by the Government Accountability Office on 1997-04-25.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                   United States General Accounting Office

GAO                Report to Congressional Requesters




April 1997
                   FOREIGN
                   ASSISTANCE
                   Impact of Funding
                   Restrictions on
                   USAID’s Voluntary
                   Family Planning
                   Program




GAO/NSIAD-97-123
                 United States
GAO              General Accounting Office
                 Washington, D.C. 20548

                 National Security and
                 International Affairs Division

                 B-276613

                 April 25, 1997

                 The Honorable Benjamin A. Gilman
                 Chairman
                 The Honorable Lee H. Hamilton
                 Ranking Minority Member
                 Committee on International Relations
                 House of Representatives

                 For fiscal year 1996, Congress placed funding restrictions on the U.S.
                 Agency for International Development’s (USAID) voluntary family planning
                 program that (1) reduced its appropriation from the previous year,
                 (2) delayed the release of funds for 9 months, and (3) required that funds
                 be apportioned over 15 months. For fiscal year 1997, Congress also
                 delayed the release of funds and required that they be apportioned at a
                 rate not to exceed 8 percent per month.1

                 As you requested, we have reviewed the impact these restrictions have had
                 on USAID’s family planning program and are likely to have in fiscal year
                 1998. Specifically, we sought to determine

             •   what has been the effect of the fiscal year 1996 and 1997 funding limits and
                 delayed release of funds on USAID’s voluntary family planning program,
             •   what would be the effect of current funding restrictions if they were
                 imposed in fiscal year 1998, and
             •   whether a relationship exists between USAID’s family planning program and
                 a reduction in abortions.


                 Since 1965, the United States has provided voluntary family planning
Background       services to (1) support the right of couples to determine the number and
                 spacing of their children, (2) reduce unintended pregnancies, (3) promote
                 maternal and child health, and (4) stabilize world population. The United
                 States contributes almost one half of all donor funding to family planning
                 programs in more than 60 countries with a combined population of
                 2.7 billion people. The Congressional Research Service reported that USAID
                 has expended over $5 billion on international family planning during the
                 past 30 years. Since the 1970s, legislation has prohibited the use of USAID



                 1
                  Section 518A of the fiscal year 1996 Foreign Operations Appropriations Act (P.L. 104-107, Feb. 12,
                 1996) and section 518A of the fiscal year 1997 Foreign Operations Appropriations Act (P.L. 104-208,
                 Sept. 30, 1996).



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funds to perform abortions as a method of family planning and to motivate
or coerce anyone to have an abortion.2

USAID’s  Office of Population manages a substantial portion of the Agency’s
family planning program. USAID awarded about 65 percent of its annual
family planning funding through contracts, grants, and cooperative
agreements to about 30 cooperating agencies that work primarily with
USAID field staff and host government agencies on centrally managed
family planning programs. USAID overseas missions and regional bureaus
manage the remaining 35 percent of annual funds in bilateral or
government-to-government programs, often using the centrally managed
programs in support of their country-specific programs.3 See appendix I
for a list of countries receiving family planning assistance and
participating cooperating agencies.

Appropriations to the family planning program generally increased from
the start of the program in 1965 through fiscal year 1995. Congress
appropriated $356 million in fiscal year 1996, a 35-percent decrease from
the $545 million appropriated in fiscal year 1995. In addition, Congress
imposed funding restrictions that (1) delayed release of fiscal year 1996
funds until July 1, 1996 (9 months into the fiscal year), and (2) required
that the funds be evenly apportioned over a 15-month period at a rate not
to exceed 6.7 percent of the appropriated amount in fiscal year 1996
($23.7 million per month). Congress appropriated $385 million in fiscal
year 1997, an 8-percent increase from fiscal year 1996, but continued to
include funding restrictions. The 1997 appropriations act delays the
release of funds until July 1, 1997, and requires that they be apportioned at
a rate not to exceed 8 percent per month, unless the President determines
that the delay is having a negative impact on the proper functioning of the
family planning program and Congress approves the determination. In that
event, the funds may be released on March 1, 1997, at 8 percent per month
($30.8 million per month).4


2
 The current restriction, included in section 518 of the fiscal year 1997 Foreign Operations
Appropriations Act, prohibits (1) using funds to pay for the performance of abortion or involuntary
sterilization as a method of family planning or to motivate or coerce any person to practice abortions
or undergo sterilization and (2) funding any research that relates to the methods or performance of
abortion or involuntary sterilization as a means of family planning.
3
Congress legislated this split of family planning funds beginning with the fiscal year 1996 Foreign
Operations Appropriations Act and continued it in the fiscal year 1997 Foreign Operations
Appropriations Act.
4
 See section 518A of the fiscal year 1996 Foreign Operations Appropriations Act and section 518A of
the fiscal year 1997 Foreign Operations Appropriations Act. This monthly apportionment is known as
“metering.”



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                   The President submitted a Presidential Determination to Congress on
                   January 31, 1997, certifying that the funding delay from October 1996 to
                   July 1997 was having a negative impact on the proper functioning of the
                   family planning programs. In February 1997, Congress approved the
                   determination that allowed for the release of the funds on March 1, 1997.


                   USAID  took steps to minimize the impact of fiscal year 1996 and 1997
Results in Brief   funding cuts and the delayed release of funds on its family planning
                   program. It did not have to drop any countries from the program or
                   terminate any contracts, grants, or cooperative agreements. USAID was able
                   to maintain the structure and scope of its family planning program
                   because it (1) consolidated programs and cut activities in 1995 in
                   anticipation of fiscal year 1996 governmentwide cuts, (2) supplemented its
                   fiscal year 1996 appropriation with carryover funds, and (3) drew funds
                   from its family planning pipeline.5 For the first 5 months of fiscal year
                   1997, USAID managed its program with fiscal year 1996 funds and pipeline
                   funds. However, to maintain the scope of its current programs,
                   cooperating agencies and missions had to delay or cut back some program
                   elements and could not implement some planned expansion.

                   The delay in releasing funds reduced USAID’s family planning pipeline
                   44 percent, from an estimated $745 million as of October 1, 1995, to an
                   estimated $414 million as of October 1, 1996. During this time frame, the
                   development assistance pipeline, which includes such programs as child
                   survival and democracy, increased about $500 million, or 39 percent.6 As a
                   result, some centrally managed and bilateral projects operated with
                   pipelines close to levels considered disruptive by USAID.7 With the release

                   5
                    Carryover funds are unobligated balances brought forward from prior years. USAID family planning
                   funds are 2-year monies; that is, they can be obligated over a 2-year period rather than the standard 1
                   year in which they are appropriated. The pipeline is the difference between the funds that USAID
                   obligates to its various activities and the amount it has spent on them. A USAID official told us that as
                   of December 31, 1996, USAID’s aggregate pipeline totaled $6.4 billion, consisting of funds for
                   Development Assistance (including family planning), the Development Fund for Africa, the Economic
                   Suport Fund, Support for East European Democracy, assistance for the New Independent States of the
                   former Soviet Union, and Special Assistance Initiatives.
                   6
                    Family planning funds were subtracted from the development assistance account for purpose of this
                   pipeline comparison.
                   7
                    USAID officials believe that 4 months of pipeline funding is the minimum level at which missions and
                   cooperating agencies can satisfy existing commitments without disrupting program implementation.
                   They also stated that mission and cooperating agency subagreements with U. S.-based and host
                   country institutions; research subcontracts; materials, supplies, and bulk purchase contracts; and
                   staffing contracts are usually premised on long-term funding availability. As pipelines decrease to the
                   4-month level, these officials stated that missions or cooperating agencies must end or renegotiate the
                   terms of their agreements, limit bulk purchases, distribute layoff notices, and arrange for employee
                   repatriation.



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                    of fiscal year 1997 funds in March 1997 rather than July 1997, USAID should
                    have sufficient resources to cover its fiscal year 1997 requirements.

                    Our analysis shows that if the fiscal year 1998 funding level remains at
                    $385 million, a 9-month delay (until July 1998) in releasing funds occurs,
                    and funds are metered on a monthly basis, most of USAID’s bilateral
                    projects would be in serious jeopardy of running out of funds sometime
                    during fiscal year 1998 and the centrally managed projects would have
                    minimal levels of funding available by September 1998. For example, by
                    September 1998, the average bilateral pipeline would have no funds and
                    the centrally managed pipeline would have an average of 6 months of
                    funding in contrast with the 12- to 18-month level recommended in Agency
                    forward-funding guidelines. USAID officials stated that under this funding
                    scenario, USAID would not have access to sufficient funds to satisfy
                    program needs, and certain bilateral family planning programs would have
                    to be terminated. On the other hand, our analysis shows that if fiscal year
                    1998 funding is available in October 1997, rather than July 1998, the
                    current bilateral and centrally managed programs will not be in jeopardy,
                    even if the funds are metered.

                    Some studies have shown a correlation between increased use of modern
                    contraceptives and a reduction in abortion. A recent Demographic and
                    Health Surveys project conducted by Macro International, Inc., indicated
                    that in countries where USAID is the primary family planning service funder
                    and contraceptive use increases, fertility rates have dropped significantly,
                    and abortion rates have declined. For example, in Almaty, Kazakstan,
                    contraceptive use increased at USAID-supported clinics by 59 percent from
                    1993 to 1994, while abortions declined by 41 percent over the same period.
                    However, because of the lack of accurate and reliable data, researchers
                    have been unable to prove conclusively that a statistically based causal
                    relationship exists between increases in the use of modern family planning
                    methods and decreases in abortion in developing countries.


                    USAID minimized the impact of funding cuts on its family planning program
Impact of Funding   by consolidating programs and cutting activities in 1995 in anticipation of
Cuts                governmentwide fiscal year 1996 budget reductions. USAID’s Office of
                    Population directed its field support staff, missions, and cooperating
                    agencies to plan for a 35-percent reduction in funding. USAID reported that
                    its downsizing activities included




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                                                •   a consolidation of worldwide programs such as training, policy
                                                    development, breastfeeding, and data collection and evaluation;
                                                •   cuts in social science research, contraceptive development, publications,
                                                    and regional activities; and
                                                •   reductions in staff and freezes in hiring by cooperating agencies.

                                                    The January 1997 Presidential Determination reported that funding for
                                                    multilateral programs was cut, and smaller projects were designated for
                                                    phaseout without renewal. However, USAID placed a high priority on
                                                    service delivery programs and worldwide contracts for contraceptives and
                                                    protected them relative to other program components. USAID staff stated
                                                    that the advance planning for funding cuts, the metering of fiscal year 1996
                                                    funds for 3 months, the availability of fiscal year 1995 carryover funds, and
                                                    unexpended pipeline funds enabled USAID to preserve the structure and
                                                    scope of the family planning program in fiscal year 1996. During fiscal year
                                                    1997, USAID will use the fiscal year 1996 funds available and the 7 months of
                                                    fiscal year 1997 funds metered from March through September to cover
                                                    expenditures. The pipeline will recover $21 million of the $328 million
                                                    depleted in fiscal year 1996 by September 30, 1997, because available
                                                    funds will exceed estimated expenditures. (See fig. 1.)



Figure 1: USAID Family Planning Program by Funding Source (dollars in millions)


                                   Fiscal year 1996                                            Fiscal year 1997

                                                                                                  Fiscal year 1996 funds ($285)
Pipeline depletion ($328)
      Pipeline funds                                                 Fy 1996 funds 54.6%

                                                                                                                  Pipeline recovery ($21)
                                                                                                                     Pipeline recover


                                                    FY 1995 Funds
                                              Fiscal year 1996 funds ($71)
                                  FY 1996 Funds                                                     FY 1997 funds 41.4%
                                                                                                   Fiscal year 1997 funds ($216)
           Fiscal year 1995 carryover funds ($81)

                                                    Source: USAID and GAO.




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                       USAID  did not drop any countries from the program or terminate any
                       contracts, grants, or cooperative agreements during fiscal year 1996 or the
                       first 5 months of fiscal year 1997. However, cooperating agencies and
                       missions had to delay or limit some program elements to maintain their
                       current scope and could not implement some planned expansion. For
                       example, a USAID official stated that successful educational pilot projects
                       for birth spacing, maternal health, and the use of contraceptives were not
                       expanded into countrywide activities. Further, the USAID mission in
                       Mozambique reported that a cooperating agency would not be able to
                       initiate a child-spacing project in additional districts as planned.


                       The 9-month delay in releasing fiscal year 1996 family planning funds
Impact of Delayed      reduced bilateral and centrally managed pipelines. For example, the
Funding and Metering   combined bilateral-centrally managed pipeline declined from an average of
                       19 months as of September 30, 1995, to 10 months as of September 30,
                       1996—a decrease of 47 percent. In contrast, the pipeline for the
                       development assistance account increased from 17 months as of
                       September 30, 1995, to 21.9 months as of September 30, 1996—an increase
                       of about 29 percent. (See fig. 2.)




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Figure 2: Comparison of USAID’s
Development Assistance and Family
Planning Pipelines (1995-1996)      Months of pipeline
                                    25

                                                                                                     21.9

                                    20                                19

                                                         17

                                    15



                                                                                                                    10
                                    10




                                        5




                                        0
                                                              1995                                          1996

                                                               Development assistance            Family planning


                                    Note: The development assistance account includes programs such as child survival,
                                    democracy, and the environment. We subtracted family planning funds from the development
                                    assistance account for the purposes of this comparison. Projections for the development
                                    assistance account were not available for 1997 and 1998.

                                    Source: USAID and GAO.




                                    USAID  attempted to minimize the impact of delayed funding and metering
                                    on the family planning projects by developing a metering plan. The plan
                                    incorporated program priorities and project funding needs into a timing
                                    schedule for each project so that funds were provided in the month that
                                    the project was calculated to fall close to or below a 4-month minimum
                                    level.8 According to USAID officials, these actions, along with those

                                    8
                                     USAID officials stated that they did not anticipate that funding restrictions would continue in fiscal
                                    year 1997. Such knowledge might have changed their input into the development of the fiscal year 1996
                                    metering plan, resulting in different funding levels and timing for each project.



                                    Page 7                                                      GAO/NSIAD-97-123 Foreign Assistance
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associated with funding cuts, carried the bilateral and centrally managed
projects through fiscal year 1996 and minimized the impact of the funding
delays. A Deputy Director of the Office of Population told us that the
delayed release of fiscal year 1996 funds, in combination with metering,
had the most significant adverse impact on the bilateral and centrally
managed pipelines. USAID missions and cooperating agencies reported
some incidents of program delays or cuts. For example, the mission in
Mozambique reduced its level of contraceptive commodities, and the
mission in Nepal reported that it was unable to work with a
nongovernmental organization to establish a new family planning and
maternal health facility. In addition, a USAID official indicated that up to 19
research contracts, including clinical trials of new contraceptives, were
delayed or interrupted because of the delayed release of funds.

Pipelines were further reduced by the 5-month funding delay and the
$385 million appropriated for fiscal year 1997. USAID projected that without
an early release of funds, the pipeline would average 6 months for
centrally managed projects and 6 months for bilateral projects by June 30,
1997. USAID further projected that 12 centrally managed and 8 bilateral
projects were in urgent need of funds.9 For example, Pathfinder
International, a participating cooperating agency, reported that if available
funds were stretched past March 1997, it would have to cut its
nurse/midwife training programs in Uganda. Additionally, CARE, another
cooperating agency, reported that it would have to phase out its medical
training program in maternal and reproductive health in Peru if funds were
delayed until July 1997. USAID projected that without the March release of
funds, it would have been about $40 million short in meeting its urgent
funding requirements between March and June 1997.

Because funds were released in March 1997 rather than July 1997, USAID
said it will be able to meet its urgent requirements during this time frame.
USAID will have $123 million in fiscal year 1997 funds and $95 million in
fiscal year 1996 funds available to support its urgent needs between March
and June 1997 as well as other projects approaching the 4-month minimum
level. USAID officials indicated that while the funding release in March is
beneficial, USAID must develop a fiscal year 1997 metering plan.10 The
Director of the Office of Population also said that continued metering will


9
 A USAID official stated that the questionable accuracy of bilateral pipeline data (due to delayed
posting of expenditures) led USAID to do a detailed pipeline review and, more importantly, to obtain
information from the missions and cooperating agencies about their projects’ funding levels. As a
result, USAID identified the 20 projects in urgent need of funds.
10
    USAID expects to complete the plan by May 1997.



Page 8                                                     GAO/NSIAD-97-123 Foreign Assistance
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                      adversely impact programs because it reduces USAID’s flexibility and its
                      ability to respond to emergency needs.

                      USAID staff also stated that the current funding restrictions have associated
                      administrative and program costs. They provided information showing
                      that designing and implementing the metering plan for the legislated delay
                      in funding cost $1.5 million and involved up to 143 people on a part-time
                      basis in Washington and the missions. In addition, the Presidential
                      Determination stated that the number of separate actions to fund USAID
                      family planning programs is nearly triple what would be required without
                      the metering.

                      Cooperating agencies have also cited the increased administrative costs
                      incurred as a result of the funding restrictions. For example, AVSC
                      International, USAID’s second largest cooperating agency, stated that the
                      legislatively mandated delays and metering “required us to increase the
                      paperwork, staff time, and administrative expense associated with
                      providing family planning and reproductive health services overseas. For
                      every dollar intended to provide access to these services last year, a
                      smaller quantity of services was actually provided.”


                      Our analysis shows that if fiscal year 1998 funding parallels the fiscal year
Impact of Funding     1997 level of $385 million, Congress delays the release of funds for
Restrictions on       9 months, and funds are metered, USAID’s family planning program will
USAID’s Fiscal Year   have an average 3-month pipeline as of September 1998, 1 month below
                      the 4-month minimum level. The bilateral programs will have no funds in
1998 Needs            the pipeline, and the centrally managed programs will have about a
                      6-month pipeline on average. (See fig. 3.)




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                                          B-276613




Figure 3: USAID’s Projected Pipeline
(June 30, 1997, Through Sept. 30, 1998)
                                          Months of pipeline
                                          12


                                                                                    10
                                          10
                                                                                                                  9

                                                                                8                           8
                                           8
                                                     7    7

                                                                                          6      6
                                           6


                                                                                                                       4
                                           4
                                                                                                                               3

                                           2
                                                               1

                                                                     0
                                           0
                                                     Bilateral projects         Central projects                All projects

                                                                      6/30/97   9/30/97       6/30/98   9/30/98


                                          Source: USAID and GAO.




                                          If actual expenditures vary significantly from the estimates, pipelines will
                                          expand or contract accordingly. USAID staff noted that actual expenditure
                                          rates can vary significantly from month to month, depending on a variety
                                          of factors, including the stage and type of a family planning project. In
                                          addition, missions such as Nigeria reported that USAID’s financial
                                          management information systems do not always accurately report all
                                          actual mission expenditures on a timely basis.

                                          USAIDofficials stated that with the funding scenario shown in figure 3,
                                          some bilateral programs would be delayed or shut down. For example, the
                                          mission in Indonesia reported that if the funding restrictions were to



                                          Page 10                                              GAO/NSIAD-97-123 Foreign Assistance
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continue in fiscal year 1998, it would be forced to suspend its integrated
family planning and reproductive health activities midway through
completion, jeopardizing maternal health and child health programs as
well. Moreover, the Kenyan mission reported that it may have to delay
implementation of family planning programs and concentrate instead on
sexually transmitted disease programs. USAID staff also stated that the U.S.
government would lose the long-standing confidence of other donor
countries, cooperating agencies, and host governments if bilateral and
contractual agreements are compromised. Although other donors have
increased their level of funding for family planning programs, USAID
officials told us that these donors are not able to provide the full range of
program support, such as contraceptive development and operations
research; logistics management; training; demographic and health surveys;
and the provision of contraceptives, which is unique to USAID’s family
planning program.

USAID staff also stated that if fiscal year 1998 funding levels parallel fiscal
year 1997, the release of funds is delayed, and funds must be metered,
many of the adverse program impacts that would have occurred with a
July 1997 release of funds, as cited in the January 1997 Presidential
Determination, would be realized in fiscal year 1998. Likely consequences
include the indefinite deferral of training programs and the suspension of a
range of service delivery programs. They also indicated that they would
have to implement alternative funding strategies, such as shifting funds on
a temporary basis among selected family planning and other development
programs, terminating programs, and asking other donors to meet urgent
program needs. USAID officials believe that all mitigating measures carry
risks that are unacceptable or undesirable for proper program
management. For example, they believe that shifting funds from selected
programs on a temporary basis to those with a “dangerously low” pipeline
is not prudent management and would only exacerbate the problem when
the programs “borrowed from” need funds.

Our analysis shows that if the release of funds is not delayed and funds are
made available in October 1997, USAID would not be forced to curtail
projects and other activities within its family planning program and
project pipelines would exceed USAID’s 4-month minimum level. The
bilateral pipeline would average 6 months, and the centrally managed
pipeline would average 14 months as of September 30, 1998. According to
a Deputy Director of the Office of Population, an October 1997 release of
funds, rather than a delayed release, is preferable, even if the funds are
metered on a monthly basis.



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                      USAID believes that its family planning programs have been a primary factor
Family Planning and   in reducing abortion rates among its clients. A recent Demographic and
Abortion              Health Surveys project conducted by Macro International, Inc., indicated
                      that where USAID is the primary family planning provider and contraceptive
                      use increases, fertility rates have dropped significantly, and abortion rates
                      have declined. For example, it reported that in Almaty, Kazakstan, where
                      USAID has provided assistance to train doctors and nurses and to increase
                      contraceptive supplies, contraceptive use increased by 59 percent from
                      1993 to 1994; at the same time, abortions declined by 41 percent. In
                      addition, the Ministry of Health in Ukraine reported an 8.6-percent
                      decrease in abortions between January and June 1996, which it directly
                      attributed to the women’s reproductive health program that began in 1995
                      with USAID funding.

                      The researchers we spoke with stated that a statistically based causal
                      relationship between increases in the use of modern family planning
                      contraceptives and decreases in abortions cannot be conclusively proven
                      in developing countries. Representatives of the Alan Guttmacher Institute,
                      Princeton University, and the University of North Carolina have reported
                      that the inability to obtain accurate data on the incidence of abortion is the
                      primary difficulty in assessing the impact of modern family planning and
                      contraceptive use on abortion. Data is considered most reliable in
                      countries where abortion is legal and medical organizations maintain
                      records. Data is also considered reliable in countries where abortion has
                      been used as a means of contraception, for example, in the former Soviet
                      Union and Eastern Europe. Data is more suspect in developing countries,
                      where few resources exist to collect and analyze statistics, and in
                      countries where most, if not all, abortions are illegal and not reported.


                      In commenting on a draft of this report, USAID indicated that it agreed with
Agency Comments       the report’s conclusion that USAID’s management actions, combined with
                      congressional action to release fiscal year 1997 funds in March rather than
                      July 1997, had minimized the negative impact of funding cuts and other
                      congressional restrictions on its family planning program to date. USAID
                      also indicated that its family planning program would be in “serious
                      jeopardy of running out of funds” if there is a repetition of the fiscal year
                      1996 and 1997 restrictions in fiscal year 1998. USAID also provided
                      additional examples of program impact that we did not verify. Appendix
                      III contains the full text of USAID’s comments.




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See appendix II for information on our scope and methodology. We
performed our work from December 1996 to March 1997 in accordance
with generally accepted government auditing standards.

As arranged with your office, unless you publicly announce its contents
earlier, we plan no distribution of this report until 30 days after the date of
this letter. We will then send copies of this report to the Administrator of
USAID and other appropriate congressional committees. We will provide
copies to others upon request.

Major contributors to this report were Ron Kushner, Barbara Schmitt,
Michael Zola, Joan Slowitsky, Jose Pena, and Thomas Melito. Please
contact me on (202) 512-4128 if you have any questions on the information
in this report.




Jess T. Ford, Associate Director
International Relations and
  Trade Issues




Page 13                                       GAO/NSIAD-97-123 Foreign Assistance
Contents



Letter                                                                                            1


Appendix I                                                                                       16
                       Recipients of USAID Family Planning Assistance in Fiscal Year             16
Recipients of Family     1997
Planning Assistance    Participating Cooperating Agencies in Fiscal Year 1997                    17
and Participating
Cooperating Agencies
Appendix II                                                                                      19

Scope and
Methodology
Appendix III                                                                                     21

Comments From the
Agency for
International
Development
Figures                Figure 1: USAID Family Planning Program by Funding Source                  5
                       Figure 2: Comparison of USAID’s Development Assistance and                 7
                         Family Planning Pipelines
                       Figure 3: USAID’s Projected Pipeline                                      10




                       Abbreviations

                       USAID     U. S. Agency for International Development


                       Page 14                                   GAO/NSIAD-97-123 Foreign Assistance
Page 15   GAO/NSIAD-97-123 Foreign Assistance
Appendix I

Recipients of Family Planning Assistance
and Participating Cooperating Agencies

                       Albania
Recipients of USAID    Armenia
Family Planning        Bangladesha
Assistance in Fiscal   Belarus
                       Benin
Year 1997              Boliviaa
                       Botswana
                       Brazil
                       Cambodiaa
                       Colombia
                       Cote d’Ivoire
                       Dominican Republica
                       Ecuadora
                       El Salvadora
                       Egypta
                       Eritreaa
                       Ethiopiaa
                       Georgia
                       Ghanaa
                       Guatemalaa
                       Guinea
                       Guinea-Bissau
                       Haitia
                       Hondurasa
                       Indiaa
                       Indonesiaa
                       Jamaicaa
                       Jordana
                       Kazakstan
                       Kenyaa
                       Kyrgyzstan
                       Madagascara
                       Malawia
                       Malia
                       Mexico
                       Moldova
                       Moroccoa
                       Mozambiquea
                       Nepala
                       Nicaraguaa




                       Page 16               GAO/NSIAD-97-123 Foreign Assistance
                       Appendix I
                       Recipients of Family Planning Assistance
                       and Participating Cooperating Agencies




                       Nigera
                       Nigeria
                       Oman
                       Paraguaya
                       Peru
                       Philippinesa
                       Romania
                       Russia
                       Senegala
                       South Africaa
                       Sri Lanka
                       Tajikistan
                       Tanzaniaa
                       Turkmenistan
                       Turkey
                       Ugandaa
                       Ukraine
                       Uzbekistan
                       Yemena
                       Zambiaa
                       Zimbabwea

                       a
                        Denotes country with bilateral program; remaining countries receive assistance through centrally
                       managed program.




                       AVSC International (Access to Voluntary and Safe Contraception)
Participating          Basic Health Management International
Cooperating Agencies   CARE
in Fiscal Year 1997    Center for Development Activities
                       Centers for Disease Control
                       Deloitte and Touche
                       Durex International (formerly known as Aladan, Inc.)
                       East-West Center
                       Eastern Virginia Medical School
                       Family Health International
                       Finishing Enterprises, Inc.
                       The Futures Group International
                       Georgetown University
                       International Planned Parenthood Federation/London
                       International Planned Parenthood Federation/Western Hemisphere Region
                       Johns Hopkins University



                       Page 17                                                   GAO/NSIAD-97-123 Foreign Assistance
Appendix I
Recipients of Family Planning Assistance
and Participating Cooperating Agencies




John Snow International
Leiras Oy
Macro International
Management Sciences for Health
National Academy of Sciences
Ortho Pharmaceuticals
Pathfinder International
Panalpina, Inc.
Pharmacia & Upjohn
Planning and Learning Technologies
Population Reference Bureau
The Population Council
University of Michigan School of Public Health
University of North Carolina
Western Consortium for Public Health
U.S. Bureau of the Census
Wyeth-Ayerst International




Page 18                                    GAO/NSIAD-97-123 Foreign Assistance
Appendix II

Scope and Methodology


              To obtain information on the impact of funding cuts, delays, and metering
              on USAID’s family planning programs, we interviewed and obtained
              documents from officials in USAID’s Center for Population, Health, and
              Nutrition, including the Office of Population, Office of Field and Program
              Support, Division for Policy and Evaluation, and Division for
              Contraceptives and Logistics Management; the Bureau for Management,
              including the Office of Budget and the Office of Procurement; the Bureau
              for Latin America and the Caribbean; the Bureau for Europe and the New
              Independent States; and the Bureau for Asia and the Near East. We
              analyzed USAID’s fiscal year 1995-98 family planning pipeline data, the
              metering plan, and the contraceptives procurement plan and reviewed its
              studies and analyses of program performance.

              We also interviewed and obtained studies and analyses from officials of
              the following organizations: AVSC International; Durex, a subsidiary of
              London International Corporation (formerly known as Aladan, Inc.);
              Centers for Disease Control; Carolina Population Center; Christian
              Coalition; International Planned Parenthood Federation; Population
              Action International; Population Council; Population Reference Bureau;
              and the Rockefeller Foundation. We were unsuccessful in our attempts to
              obtain the views of the National Right to Life Committee and the
              Population Research Institute.

              We did not conduct field visits to overseas locations for this review; rather,
              we relied on USAID’s and other organizations’ studies and analyses and our
              interviews.

              To project the impact of continued funding restrictions in fiscal year 1998,
              we evaluated family planning project pipelines to determine when these
              pipelines would fall below the USAID-determined 4-month minimum level.1
              We assumed that the fiscal year 1998 funding restrictions would be the
              same as those that Congress imposed in 1997; that is, a $385 million
              funding level, a 9-month delay in release of funds,2 and metering at
              8 percent per month. We also assumed that expenditure and obligation
              patterns would remain constant over time. Based on these assumptions,


              1
               USAID officials stated that their current reporting systems include pipeline information by funding
              account (economic support fund, development assistance, etc.) and country. They indicated that their
              reporting systems are currently not capable of computing pipeline amounts at the program level—the
              pipeline for the family planning program was manually computed. USAID officials indicated that when
              the new management system is fully operational it will be capable of readily identifying program
              financial data, such as rate of obligations and expenditures, and level of pipeline.
              2
               We assumed a July 1998 release of funds in fiscal year 1998.



              Page 19                                                     GAO/NSIAD-97-123 Foreign Assistance
Appendix II
Scope and Methodology




we used USAID pipeline projections at June 30, 1997, to establish a baseline
for our projections through September 30, 1998.

The June 30, 1997, baseline was based on pipeline levels that represent
USAID’s bilateral projects and centrally managed projects, including their
respective monthly expenditure rates. Bilateral pipeline levels were based
on PIPE data, one of USAID’s financial management information systems, as
of September 30, 1996. The data was then projected forward by adding
planned fiscal year 1996 family planning funding and subtracting
expenditures based on recent monthly expenditure rates from Mission
Accounting and Control System data. USAID provided us with centrally
managed project pipeline levels that were obtained directly from each
cooperating agency during USAID’s semiannual portfolio review process
and verified against vouchering data. USAID’s Contraceptives and Logistics
Management Division provided us with pipeline levels and expenditure
rates for contraceptives procurement.

To adjust the June 30, 1997, baseline to reflect the March 1997 release of
funds approved by Congress in February 1997, we added 4 months of fiscal
year 1997 funding—March 1 through June 30—and subtracted 4 months of
estimated expenditures based on USAID’s determination of urgent needs.
We then added the remaining fiscal year 1996 funds and fiscal year 1997
funds through September 30, 1997, and subtracted estimated expenditures
to project pipelines to the end of fiscal year 1997. Finally, we added the
remaining fiscal year 1997 and fiscal year 1998 funds through
September 30, 1998, to project pipelines at the end of fiscal year 1998.

We attempted to verify bilateral pipeline data with each USAID mission that
reported pipeline deficits. This exercise revealed inconsistencies between
the bilateral pipeline data provided by USAID’s Management Bureau Budget
Office and data provided by overseas missions due to delayed posting of
expenditures. As a result, some bilateral projects appeared to be running
deficits, when in fact the pipeline exceeded USAID’s 4-month threshold. We
also requested that these missions and cooperating agencies provide
information on the projected impact of funding restrictions on programs in
fiscal year 1998.

To determine the relationship between USAID’s family planning programs
and reductions in abortions, we interviewed and obtained documentation
and studies from officials of the Alan Guttmacher Institute and Princeton
University, in addition to the USAID offices and organizations previously
mentioned.



Page 20                                     GAO/NSIAD-97-123 Foreign Assistance
Appendix III

Comments From the Agency for
International Development

Note: GAO comments
supplementing those in the
report text appear at the
end of this appendix.




                             Page 21   GAO/NSIAD-97-123 Foreign Assistance
Appendix III
Comments From the Agency for
International Development




Page 22                        GAO/NSIAD-97-123 Foreign Assistance
               Appendix III
               Comments From the Agency for
               International Development




Now on p. 3.

Now on p. 3.




               Page 23                        GAO/NSIAD-97-123 Foreign Assistance
                 Appendix III
                 Comments From the Agency for
                 International Development




Now on p. 3.




See comment 1.




Now on p. 4.




Now on p. 4.




Now on p. 3.


See comment 2.




                 Page 24                        GAO/NSIAD-97-123 Foreign Assistance
                 Appendix III
                 Comments From the Agency for
                 International Development




Now on p. 4.




See comment 3.


Now on p. 11.




                 Page 25                        GAO/NSIAD-97-123 Foreign Assistance
               Appendix III
               Comments From the Agency for
               International Development




               The following are GAO’s comments on USAID’s letter dated March 24, 1997.


               1. While we recognize that USAID minimized negative impacts on the family
GAO Comments   planning program, USAID did not provide additional data to demonstrate
               that these types of consequences will occur.

               2. The report text has been modified to reflect this information.

               3. We noted in our report that release of funds in October 1997 rather than
               July 1998, even though metered, will enable USAID to continue funding
               family planning projects and that pipelines will exceed the 4-month
               minimum level. Nonetheless, it is likely that USAID will have to deal with
               the administrative burden of metering.




(711240)       Page 26                                     GAO/NSIAD-97-123 Foreign Assistance
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