* !9

# **FEDERAL REPUBLIC OF GERMANY (2)**

The Germany Agency for Technical Cooperation (GT2:) is a government-owned corporation that provides technical services and implements bilateral liealth assislance projects. Since- 1985 such bilateral projects have represented 40 to 47 percent of total annual healtth sector commitments by the FedJeral Republic of Germany.

Project statistics for the current portfolio show annual expenditures as well as the year of origin and life-of-project funding. This mode does not facilitate estimates of annual expenditures.

Thirty-five selected current multiyear projects that contain Safe Mlotherhood components have a total project-duration value of DM138.56 million. A rough estimate of the SM content for these projects puts it at DM97.4 million (S54 million at current exchange rates), about 70 percent of the total disbursement value of current projects.

Annual expenditures on health, nutrition, and population projects increased from DM38.36 million in 1983 to DM63 million in 1988. An estimate 50 percent of these projects have an SM component. For 1988 the bilateral SM component was approximately S17.5 million. The outlook for an increase in SM components is favorable in view of' the progressive increase in annual GTZ financing.

Both the policymaking headquarters at Bonn and the implementing agency have endorsed the importance of maternal health. Training for traditional birth attendants was supported as early as the 1960s. Current SM components include prenatal care, identification of high-risk pregnancy, family planning, maternity hospital construction, primarv health care, outreach services, and training. The historical emphasis on hospital construction has shifted in favor of primary health care programs. The agency has put special emphasis on improving the status of women.

As a direct result of the 1987 conference there is now an effort to support regional training centers for maternal and family health in Ouagadougou for Francophone Africa, and in Haiare (IEC component) for Anglophone Africa.

The outlook for continued support for SM is favorable not onlv because of rising health expenditures but also because of the increase in total financing for development. The annual levels _of_ GTZ support for health or for SM components are not predetermined. West German assistance is based upon country request. In the absence of resident health repres.!ntatives (in contrast to projectassigned healthl specialists), it has been difficult for GTZ to generate demand for health sector assistance. For the past 10 years, health expenditures have been approximatelv 4 percent of total B1MZ annual commitments (5 percent in 1987). There is an agreement with W'HO to cooperate in specific projects for German assistance. Beyond this, there has been no special effort to strengthen national capability in developing countries to mobilize external assistance. In effect, the potential for greater BMZ assistance is possible if the demand cani be identified bv the deveioping countries.

Tangential to the main directions of SM support. GTZ is providing S3 to S4 million to improv.e hospital laboratories as one measure to control AIDS. The impact on improved blood transfusion services has obvious implications for obstetrical emergencies.

Health, Nutrition and Population Development Division Deutsche Gesellschaft fur Technische Zusammenarbeit (GTZ) GambH (German Agency for Technical Cooperation, Ltd.) Dag Hammarskjold-Weg **I** 6236 Eschborn I (Postfach 5180)