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# **UNITED STATES**

**The availability** of a formal information tracking system for the health sector considerablv simplifies the identification of annual U.S. aid expenditures by the Agency for International Development (A.I.D.). For purposes of comparison with othtr major bilateral donors, it is useful to point out the congressional requirement for advance approval of financing in sectors such as health, agriculture, education, and population. While financing levels are discussed at the cooperating country level, sectoral totals **are** held within certain limits -- a procedure that is in sharp contrast to budget planning in many donor countries. AI.D. health and population sector officials have a direct program and project administrative responsibility, in contrast to many other donors whose professional staff may act only in a technical advisory capacity to geographic regional offices that have the program responsibility.

**Al.D.** is required to prepare an annual report for Congress on the Child Survival Program. The system of calculating the percentage spent on the program is less than precise and often requires field staff to make arbitrary judgments. Similarly, the statistical system does not distinguish the **components of maternal health.**

Although .he new Maternal and Perinatal Health project is the first of its kind in A.I.D. to specifically address the causes of maternal mortality, maternal health has long been a component of primary health care systems and a stated argument for the importance of family planning. Support in the form of training and services is eligible. But the programmatic and financial emphasis has been small in view of the congressionally mandated programs for Child Survival and Population, which together absorb approximately two-thirds of the combined health and population accounts. Within the health accounts, expenditures for Child Survival activities are around 50 percent.

The A.I.D. pattern is a financial supply-driven program system in which the direction of sector activity is controlled through congressional program approval. This has the advantage of supporting specific initiatives such as family planning, child survival and AIDS. The disadvantage of the system is its inflexibility in meeting developing country priorities as expressed by developing countries themselves. The new Africa Development Fund of A.I.D. is one effort to provide greater program flexibility and may provide greater balance in sectoral efforts to address the issue of maternal mortality.

In spite of a well-developed health tracking svstem, special adjustments are required to make the data comparable with other donors. The populaticn account, for example, is tracked by the Office of Population and not by the Office of Health. There are comparable problems in tracking nutrition contributions to health. Major contributions to UN organizations such as UNICEF are not included in the health account, although special bilateral contributions to the UN are included.

Contributions from the health account to private and voluntarn NGOs are reco.ded, but not contributions from non-health accounts (such as agriculture) that may have a partial health function.

**The following** estimates are based on the official AI.D. health information system. Estimates of SM **content are based on** information from Al.E central and regional personnel and require a percentage attribution which, for this study, is based on the Herz-Measham criteria.