N/A

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.17:

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Program Budget Code: 19 - HVMS Management and Staffing

Total Planned Funding for Program Budget Code: $1,455,000

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Four USG implementing agencies make up the USG President's Emergency Plan (PEPFAR) Country Team: (1) U.S. Health and

Human Services (Centers for Disease Control and Prevention) (HHS/CDC), (2) U.S. Agency for International Development

(USAID), (3) U.S. Department of Defence (DOD) and (4) U.S. Department of State (DOS). All agencies are under Chief of Mission

Authority. The Chief of Mission serves as the overall coordinator for PEPFAR. The USG PEPFAR country team consists of the

Deputy Chief of Mission (DCM), the CDC Chief of Party, the CDC Public Health Advisor-Deputy Director of Operations, the USAID

Mission Director, the USAID Health Team Leader, the USAID HIV/AIDS Specialist, and other skilled professionals with numerous

years of experience working in the U.S. and other countries. Technical coordination and management takes place through

monthly meetings with all agencies represented under the leadership of the DCM, complemented by biweekly technical working

group meetings. Inter-agency working groups are developed as needed for agency programming and implementation of the Mini-

COP.

The operating environment in Luanda is among the worlds most difficult and expensive. Luanda was recently ranked number one

on the list of most expensive cities in the world. Luanda also has the most expensive rental properties for expatriate staff. Annual

leases range from between $100,000 and $200,000 per year for a medium sized three bedroom house. Shipping, port, and

demurrage costs are also among the worlds highest. There is also a limited amount of local skilled human capacity, particularly in

the health sector, which forces programs to pay handsomely to acquire technically well trained English language proficient

workers. This often results in senior staff positions being filled by junior or entry level employees, as they are generally the only

ones available. As a result of these factors, it is impossible to operate here within current programmatic limitations. For example,

the operating ICASS costs, associated with programs financed through PEPFAR in Angola, cannot be covered by the 7% limit on

management and staffing as recommended in the FY 2009 COP Guidance. CDC´s ICASS cost consists partly of overhead and

operations costs paid to the US mission and is not disaggregated. Programmatic funding constraints in a very expensive

operating environment are limiting our capacity to fully maximize our dollars in Angola.

Following its establishment in 2002, the CDC office has grown and today consists of two U.S. direct hires (USDH): a Director, and

a Deputy Director for Operations, and, for the first time in years, both positions were filled in FY08. In addition to the two direct

hires, additional support staff consists of six locally engaged staff and four technical staff. Technical staff consists of a soon to be

filled vacant slot for an SI/M&E officer, a soon to be filled HIV/TB Coordinator position; a soon to be filled Surveillance officer

position; and an Epi-Data Manager. These individuals are all paid with PEPFAR funds. Under consideration is the desire to

expand the duties of the SI/M&E officer to include broad SI responsibilities across all of the USG agencies (CDC, DOD, and

USAID), and to also serve as an expert SI/M&E advisor to the Angolan National Aids Program

In addition to PEPFAR related activities, the CDC office also co-implements with USAID the President's Malaria Initiative (PMI),

for which a Third Country National (TCN) malaria Resident Advisor is assigned to Angola, and the Avian Influenza Initiative. CDC

also provides technical and logistical assistance to the Government of Angola (GoA) as needed to address present or emerging

outbreaks and health threats, such as cholera, hemorrhagic fevers, sleeping sickness, and assists in the establishment of a

haematology society in Angola at the request of the Minister of Health.

The USAID Mission in Angola has a technical and administrative staff of 23, including 4 USDHs. The 6-person health team is

managed by a TCN under the direct supervision of a USDH Supervisory General Development Officer with the support of a USDH

Program Officer. A senior FSN, the HIV/AIDS Program Management Specialist, is the focal point for the program and will function

as the deputy PEPFAR coordinator. This position will be filled in FY09.

The strategic foci of USAID's program in Angola, as embodied in the FY07 USG Angola Operational Plan, are Governing Justly

and Democratically; Investing in People: Health; and Economic Growth. In FY 2008, the funding for USAID's program elements

under Investing in People was distributed as follows: Malaria ($18,900,000); Family Planning and Reproductive Health

($2,700,000); Maternal and Child Health ($1,300,000); Tuberculosis ($400,000); and HIV/AIDS as detailed in the Mini-COP

($4,400,000).

The Programs seek to increase the number of Angolans benefiting from quality health services and commodities to reduce the

incidence of selected diseases. The major focus of PEPFAR's HIV/AIDS portfolio is prevention. The USAID PEPFAR program

offers a package of technical assistance, services and commodities that permits greater numbers of Angolans to demand and

obtain increased access and use of high quality information, education and communication (IEC) material, counselling, and care.

USAID focuses on both technical assistance to provide immediate improvements in service delivery, and longer-term system and

institutional improvements that can sustain and enhance these gains.

The current USAID staffing for the Angola PEPFAR program includes 2 program management specialists (including the TCN PSC

health team leader) and 1 support staff. The HIV Program Specialist (LES) is dedicated to work 100% on PEPFAR. In addition,

the Health Team Leader will devote 25% of his time to PEPFAR and 1 Health Team Program Assistant (LES) will devote 33% of

her time to PEPFAR activities. There is a USAID/M&E specialist that devotes a portion of his time to HIV/AIDS data.

Salaries, related benefits and administrative costs for USAID staff are estimated at $380,000. Staff contract costs represent the

bulk of the cost of doing business; the TCN contract costs are notably high because of the exorbitant housing costs, often paid 1-2

years in advance. Components of maternal and child health programming (e.g., ante-natal care services that contribute to VCT,

PMTCT, and care and treatment interventions) and other infectious disease programming (such as tuberculosis) are closely

integrated with HIV/AIDS programming. Staffing reflects this integration; the work of all contributes to the success of the PEPFAR

Program within the health program, as per the anticipated implementation mechanisms.

The staffing structure reflects USAID's current program management and implementation needs. The future staffing profile may

be adjusted if there is a significant change in the strategy or increase in funding.

USAID's mission in Angola provides technical and managerial support for other health programs in addition to PEPFAR. USAID

provides technical assistance to the President's Malaria Initiative (PMI), which is a shared effort with CDC under USAID

leadership.

USAID ICASS costs directly related to HIV/AIDS programming is $44,000 based on prorating ICASS costs across GHCS funding

sources. However, the real ICASS cost is thus disproportionately paid through other funding sources (notably malaria, which is by

far the largest GHCS program for USAID) and not from HIV/AIDS GHCS or GHAI.

The current DOD staffing for Angola includes one coordinator for humanitarian assistance (LES). He will devote 50% of his time to

the monitoring and coordination of DHAPP activities. He will serve as the focal point for the program on USG team. $100,000 is

budgeted in FY09 for his salary, travel, ICASS and travel to Angola of the DOD Point of contact at HQ. As the still-born relations

between the Angolan Armed Forces (FAA) and DOD continue to improve, there is still a need for considerate amounts of field

trips in/out of Angola for experience/knowledge exchange and routine consultation meetings with the health staff of the FAA.

Although the FAA coordinates on a regular basis with the Angolan institutions responsible for defining and coordinating efforts to

fight HIV (i.e., GFATM Country Coordinating Mechanism (CCM), the INLS, and the MoH), it acts independently and with relative

autonomy from these institutions. Historically, the political influence the FAA has possessed, allowed it to define its needs and

implement its programs without accountability to national health organizations. Currently, the Military is a member on the CCM

and attends the INLS partner meetings. They are beginning to work together with other parts of the Government. To increase

coordination among these actors, DOD's major implementing partner, Charles Drew University (CDU), has promoted greater

communication and coordination across Angola's institutions, while still respecting the FAA's security concerns.

Table 3.3.19: