Partnering for policy change and performance : USAIDs [i.e. USAID"s] nonproject assistance in population and health

This report provides a brief overview of this experience. Part I provides an overview of NPA, including how it is defined, its advantages and disadvantages, guidelines for NPA programming, factors to consider in NPA program evaluation, and lessons learned about NPA from PHN projects to date. Part II presents four case studies (Ghana, Philippines, Niger, and Ecuador), drawn largely from evaluations of NPA projects in PHN. Lessons learned about NPA programs are as follows: (1) Donor and host country governments must generally agree about the policy reforms needed and the steps required to achieve them. (2) NPA should not attempt reforms that are not important to or supported by host governments, or try to instigate reforms when the process or obstacles are not clearly understood. (3) NPA is perhaps most useful in institutionalizing policy reforms already embraced by host governments with a well-developed institutional capability for analysis and a transparent treasury system. (4) The analysis needed before designing an NPA program is more extensive than that needed for traditional project development. (5) The goals and objectives of NPA are often complemented by project assistance components. (6) The amount of TA needed to implement an NPA program is inversely related to the capacity of the host country government to design and implement the NPA program. (7) Performance benchmarks must be clearly articulated. Detailed plans for documentation and frequent review of progress toward benchmarks must be agreed upon in advance by both sides. (8) Conditionality for an NPA program should be short and simple. Designers should not make conditions contingent upon meeting other conditions or place so many conditions that the NPA program becomes too complicated to implement. (9) NPA"s biggest contribution to policy reform may be allowing USAID to participate in the ongoing policy dialogue, and keeping key policy issues on the table despite changes in the political environment and government. (10) USAID and host country governments should be concerned less with benchmarks and their associated reforms and more with the capacity building that will make programs sustainable in the long term. (11) NPA should probably not be attempted in a country where understanding of the political process at the central level and the ability of the Ministry of Health to effect change are limited. (12) NPA programs may not do well in countries where there is little need for resource transfers, or when human resource constraints and bureaucratic procedures and systems impede the flow and spending of program funds.