In 2016, USAID initiated a three-year, multi-country health emergency response to Zika and the negative pregnancy outcomes of the virus in Latin America and the Caribbean. This performance evaluation used a mixed-methods approach and comes in the final year of the response. It focuses on understanding the enablers and limitations addressed, accomplishments in strengthening systems in countries, and how the response was managed. The evaluation also reviews USAID’s initial decision-making process and the various implementation levels—regional, national, and sub-national/community—engaged during implementation.
Using experienced organizations and evidence-based approaches under a tight timeframe, USAID assisted governments in integrating Zika into existing arbovirus programs, establishing specialized training in entomology, and tracking insecticide resistance. The Zika response introduced a Quality Improvement approach into prenatal, pregnancy, delivery, and neonatal care for Zika, and brought men in as partners in Zika prevention prior to and during pregnancy. This assistance appears to have facilitated the absorption of innovations and strengthened partner country ability to better respond to Zika in the future.
Recommendations at this juncture include suggestions for effective close-out at the country level and for providing future access to the experience and technical materials prepared under the response. For the future, it is also recommended that USAID align contracting and budgeting elements with the needs of health emergency responses, and review management structures for rapid response within the Bureau for Global Health.