CDC will use reprogrammed funds to support translation of family-planning materials for Prevention with

Positives activities.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.09:

With FY09 funds, CDC-Retro-CI will strengthen Cote d'Ivoire's response to the dual epidemic of HIV and TB

by supporting the national TB program through the procurement of equipment and supplies, including: 1) a

digital radiography system for the Adjame Tuberculosis Center, the largest TB diagnosis and treatment

facility in the country, which treats more than 25% of Cote d'Ivoire's TB patients; 2) a digital radiography

system that will be placed in a mobile unit to serve five to 10 district TB centers outside of Abidjan; and 3)

25-30 fluorescent LED microscopes to support more effective and efficient TB diagnosis via smear

microscopy.

In addition, FY09 funds will support USG technical staff (with salary, travel, administrative support) to

provide technical assistance, in collaboration with program management staff and HQ technical staff, for the

design, implementation, and evaluation of PEPFAR-funded interventions designed to strengthen the

national TB/HIV program. This technical assistance is provided in close consultation with relevant ministries

(Health, Fight Against AIDS) as well as NGOs, multinationals, and bilateral organizations.

The country team will provide ongoing technical assistance to support the integration and scale-up of

routine HIV counseling and testing services at TB facilities, improved screening of HIV patients for TB, joint

care of HIV and TB at joint-care facilities, improved monitoring and evaluation of integrated HIV/TB

services, strengthening of centralized and decentralized TB diagnostic services, and surveillance of multi-

drug resistant TB.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15169

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15169 10346.08 HHS/Centers for US Centers for 7067 5383.08 CDC & RETRO- $90,000

Disease Control & Disease Control CI (Base)

Prevention and Prevention

10346 10346.07 HHS/Centers for US Centers for 5383 5383.07 CDC & RETRO- $15,000

Disease Control & Disease Control CI (Base)

Prevention and Prevention

Table 3.3.12:

PEPFAR provides financial and technical support to strengthen Cote d'Ivoire's capacity to respond to the

HIV/AIDS epidemic. In the realm of strategic information (SI), the primary technical contribution of the USG

is implemented by the strategic information staff of Projet Retro-CI, which was created as a collaboration

between the Ministry of Health (MOH) and CDC. Retro-CI is a key partner in the development of the Three

Ones principle of one national monitoring and evaluation (M&E) system, promoting coherent health

management information systems (HMIS) and HIV surveillance.

During the past three years, the Retro-CI SI team has assisted national authorities and PEPFAR partners to

coordinate, develop, and implement comprehensive SI activities that provide key data for decision-making

in the fight against HIV/AIDS. These activities have included development of policies and guidelines on

HIV/AIDS surveillance, M&E, and HMIS. Retro-CI has conducted annual antenatal care HIV surveillance

surveys and an AIDS Indicator Survey. In addition, the Retro-CI SI team has participated in the

harmonization of national HIV/AIDS indicators and the national development of data collection tools for the

tracking of facility-based and community-based HIV activities.

With two PEPFAR principal technical assistance partners - Retro-CI and Measure Evaluation - supporting

Cote d'Ivoire's progress toward one national M&E system, the lack of a clear repartition of roles and

responsibilities has sometimes drawn criticism. In response, the government of Cote d'Ivoire and the two

PEPFAR partners have convened meetings and are continuing consultations to clarify roles, using the

World Bank framework for a functional national HIV M&E system. In FY09, based on the national M&E plan:

• CDC/Retro-CI will focus on collecting, verifying, and analyzing data, including 1) routine HIV program

monitoring, 2) surveys and surveillance, 3) national and sub-national HIV databases, 4) supportive

supervision and data auditing, and 5) HIV evaluation and research.

• Measure Evaluation will focus on people, partnerships, and planning, including 1) organizational structures

with HIV M&E functions, 2) human capacity for HIV M&E, 3) partnerships to plan, coordinate, and manage

the HIV M&E system, 4) the national multi-sectoral HIV M&E plan, 5) the annual national HIV M&E work

plan, and 6) advocacy, communications, and culture for HIV M&E.

• Dissemination and use of data from the M&E system to guide policy formulation and program planning and

improvement are considered cross-cutting; these will be shared appropriately among HIV/AIDS

stakeholders.

PEPFAR will also continue to provide support for the M&E capacities of partners, including key government

agencies active in the HIV/AIDS response.

With FY09 funds supplemented by $474,000 in FY08 carryover funds, Retro-CI will directly support the

building and strengthening of one national M&E system and the conversion of data to useful information

through the three components of strategic information — monitoring and evaluation, health management

information systems, and surveillance.

Routine HIV Monitoring

Retro-CI M&E activities will aim to collect and aggregate data to provide information to support the

management of the PEPFAR Cote d'Ivoire program. Retro-CI has developed a national SI strategy for

PEPFAR Cote d'Ivoire and will provide technical assistance to PEPFAR-funded implementing partners to

ensure that they have the capacity to meet PEPFAR reporting requirements. This activity will include the

provision of French-language SI materials and training, the preparation of reports aggregating the results of

PEPFAR implementing partners, and the presentation of written and oral reports to national partners and

stakeholders. The USG team will provide all PEPFAR-funded partners with data-management software for

data storage and decision-making.

Evaluation and Data Quality

The USG will continue to use the data quality audit (DQA) process, including onsite supervision and partner

performance evaluation. Retro-CI's data quality and use team will support public health evaluations, basic

program evaluations, and management of other PEPFAR data. These data quality assurance activities will

be done in collaboration with the MOH Direction of Information, Planning, and Evaluation (DIPE).

HMIS

The national M&E system lacks expertise in health information systems. Retro-CI SI will provide continued

technical assistance to the Ministry of AIDS (MLS) and other PEPFAR-funded partners, including the MOH,

the Ministry of National Education, and the Ministry of Family, Women, and Social Affairs, to implement a

fully functional M&E system that will improve routine data reporting. This will include revision, dissemination,

and implementation of national strategies in strategic information. With CDC HQ technical assistance, Retro

-CI will assist in:

- Implementing a national-scale ART patient monitoring system using adapted WHO ART patient monitoring

forms and an electronic ART monitoring tool.

- Designing or adapting software, databases, and computer applications that support specific HIV/AIDS

program activities (counseling and testing, PMTCT, OVC, etc.).

- Designing a national data repository on HIV/AIDS. This secure data repository will respect WHO privacy

and confidentiality guidelines and will aim to be a one-stop provider of HIV/AIDS data at the individual and

aggregate levels.

- Addressing confidentiality, privacy, and security in the management of data related to HIV-infected

individuals. This will include the development of a national unique identifier.

- Promoting data for decision-making by using data visualization and by building GIS core competencies

that will address PEPFAR and national needs.

- Improving HIV-related data quality and use by developing national policies and guidelines, by training

government and implementing partner personnel, and by supervising data collection and management

activities.

In addition, the Retro-CI SI team will provide support in informatics to a variety of governmental and

nongovernmental organizations. Specific activities will include:

- Training in the use of data-management and statistical software packages such as Epi Info, CRIS, MESI,

and PMS.

Activity Narrative: - Assisting the MOH/DIPE with its next-generation nationalHMIS, which integrates HIV indicators with other

health-outcome measures.

- Assisting with the development and implementation of a national M&E system while supporting PEPFAR

prevention, care, and treatment goals. This assistance will include the translation of software programs and

training materials, supervision, and development of quality-assurance guidelines.

- Working with the national SI technical working group to develop recommendations to facilitate the

integration of data collection in the field, in order to reinforce linkages between different HIV-related

services. This technical assistance will complement SI activities funded through cooperative agreements

with the MLS, the MOH, and other partners to create a functional national M&E system.

Surveillance and Surveys

For the past two decades, Retro-CI surveillance activities have provided the main source of country-level

HIV/AIDS data in Cote d'Ivoire. To promote knowledge transfer to the host government, Retro-CI will assist

the MOH and MLS (ministries in charge of the country's HIV surveillance system) and other PEPFAR

partners by:

1. Providing technical and logistical assistance to the MOH to support the development and execution of a

dissemination plan for the 2008 national antenatal HIV surveillance survey (ANS). With FY08 funds, 63

health personnel are being trained, blood samples are being collected at 45 sites (30 rural, 15 urban ) and

tested at the Retro-CI laboratory, and data is being entered into a database.

2. Providing technical and logistical assistance to the MOH to conduct the 2009 national antenatal HIV

surveillance survey and supporting the development of the national HIV/AIDS second-generation

surveillance plan. Retro-CI staff will procure laboratory and study supplies, supervise data and sample

collection at peripheral sites and testing at the Retro-CI laboratory, and assist with data entry, analysis, and

dissemination through written reports and oral presentations.

3. Conducting further analyses, in support of decision-making, of available surveillance and program (CT,

PMTCT, ART) data in the form of a data-triangulation exercise to describe the patterns that drive the HIV

epidemic in Cote d'Ivoire as well as the impact of the response. Technical assistance for protocol

development and implementation will be provided by CDC headquarters.

4. Providing technical and logistical assistance to the MLS to implement a population-based HIV survey

(either a behavioral surveillance survey or a DHS) to assess the impact of prevention, care, and treatment

interventions. This assistance will include sample collection for anonymous HIV testing at selected sites,

transport of samples, testing at the Retro-CI laboratory, data management and analysis, a written report,

and dissemination of the results through a variety of media (i.e., paper reports, CD-ROM, Web site).

5. Providing technical and logistical assistance to the MOH and to Abt Associates, in collaboration with the

WHO and other partners, to disseminate the service provision assessment (SPA) findings through a

workshop, training, written reports, and a CD-ROM started in FY07.

6. Providing technical assistance as needed to support a variety of in-country partners with the

implementation of public health evaluations (PHEs) and targeted evaluations. This assistance will include

support for the evaluation of HIV drug resistance, the investigation of recent HIV infections, and the

evaluation of nutrition and food support strategies (breastfeeding, OVC food support, nutrition as palliative

care). During these evaluations, Retro-CI will procure laboratory and study supplies, collect samples at

peripheral sites, transport specimens for testing at the Retro-CI laboratory, manage and analyze data, and

disseminate results through a communication plan. Technical assistance will also be sought from CDC HQ

to conduct the initial assessments, development of protocols and guidelines, and planning of activities.

Regional Support

Retro-CI will collaborate with other African francophone countries to support the development of their

strategic information capacities, drawing on more than 20 years of Retro-CI experience in monitoring,

evaluation, surveillance, and health management information systems. Retro-CI's application development

team has translated English-only software (Epi Info, TIMS) in French. Retro-CI's data management team

continues to manage data related to tens of thousand of patients, an activity that has supported the

publication of more than 300 peer-reviewed articles. With Retro-CI's support, Cote d'Ivoire is developing a

nationwide harmonized longitudinal patient monitoring system that includes data from 31,576 patients living

with HIV. Drawing on this extensive experience to assist other African francophone countries, Retro-CI will:

1. Organize regional workshops and training in French related to strategic information.

2. Support the development and implementation of health information systems in French.

3. Provide countries with French-speaking experts for technical assistance in strategic information.

Retro-CI will promote sustainability by continuing to enhance the capacity of health information systems and

health information workers. The number of M&E staff will be increased with the initiation of an M&E

fellowship program. In collaboration with the MLS, Retro-CI will also provide scholarships to M&E

champions for master's and doctoral programs related to M&E. The PEPFAR quarterly strategic information

meeting, which is a routine communication platform to facilitate the exchange of information among

stakeholders, will be co-organized with the Direction of Planning and M&E within the MLS, with the objective

of transitioning this function to effective management by the government of Cote d'Ivoire by 2010.

New/Continuing Activity: Continuing Activity

Continuing Activity: 19138

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

19138 19138.08 HHS/Centers for US Centers for 7067 5383.08 CDC & RETRO- $0

Disease Control & Disease Control CI (Base)

Prevention and Prevention

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $1,000,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17:

In April 2009 reprogramming, FY09 funds made available for development of a Partnership Framework are

being allocated to CDC/Retro-CI to support HQ technical assistance and local logistics related to framework

development.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.18:

The PEPFAR Cote d'Ivoire USG interagency team was built on the platform of the CDC Projet Retro-CI,

which was established in 1988 as research collaboration between the CDC and the Cote d'Ivoire Ministry of

Health to study the HIV epidemic in West Africa. In 2000, Projet Retro-CI expanded its mission to include

programmatic activities as part of the CDC Global AIDS Program, and with the advent of PEPFAR in 2004,

the mission of the Laboratory, Strategic Information, and administrative staff became focused almost

exclusively on support of PEPFAR programmatic activities. In the absence of a bilateral USAID mission in

Cote d'Ivoire, the CDC platform (including administrative, management, technical, and motor pool staff) has

been used to develop an interagency team structure that is fully integrated and without redundancy. While

the CDC serves as the primary administrative mechanism for the hiring of local and international technical

and administrative staff, the Cote d'Ivoire USG interagency team is continuing to leverage USAID

contracting mechanisms as needed to expedite the hiring of staff and provide senior USAID administrative

program support.

In its efforts to ensure program performance at a reasonable cost, optimizing USG human and financial

resources, the PEPFAR USG CI team continues to implement a coordinated interagency approach that

includes: 1) weekly PEPFAR CI (interagency) Executive Team meetings; 2) capitalizing on laboratory and

informatics expertise at Projet Retro-CI through direct technical assistance and service to our implementing

partners; 3) providing management and technical assistance to all PEPFAR-funded partners via an

integrated team of project managers and technical advisers, regardless of funding agency; 4) joint agency

staffing positions; 5) hosting regular program reviews of all implementing partners that combine portfolios

from all in-country agencies; and 5) leveraging USAID contracting mechanisms for fast-track and longer-

term positions in order to address staffing needs in-country.

These steps have helped to facilitate optimal management, coordination, and performance of USG-funded

activities and have resulted in capitalization of technical strengths, improvements in coordination, and better

compliance with USG financial requirements.

With a significant increase in the number of implementing partners and activities supported by PEPFAR

Cote d'Ivoire in FY 2008 — along with a near-tripling of the PEPFAR CI budget from FY06 to FY08 - the

need for additional staff to responsibly manage the PEPFAR portfolio is evident.

Currently, there are three CDC USG FTEs in-country funded from GHCS funds (Country Director, Deputy

Director for Operations, and Prevention Branch Chief). One of four USG direct-hire positions remains

vacant (Senior Medical Adviser/Associate Director for Science). It is anticipated that the latter position will

be filled in FY09. CDC funds two ComForce contractors out of GHCS funds (Strategic Information and

Program Management Branch Chiefs).

For FY09, the PEPFAR CI team proposes to add an additional USG direct hire through CDC (Public Health

Adviser). This position will focus on human resource development for PEPFAR staff in-country. It will also

reduce the burden on the CDC Country Director and Deputy Director by allowing for an additional USG

signature authority for specific documents.

Cote d'Ivoire continues to have one of the highest ICASS costs in the African Region. This is partly due to

the high cost of doing business in Abidjan and the expense of operating a newly constructed embassy. The

compound was inaugurated in 2005, and operating costs were high due to construction failures and the cost

of fuel to run two generators rather than running directly off the national power grid. Although operating

costs have leveled in the past year, ICASS charges were higher than anticipated as a result of the

increased demand for services in 2008, with a limited Embassy staff to assist. ICASS services provided

include HR processing (21 positions hired in 2008), procurement, contracts, and financial and other services

needed to support the interagency PEPFAR program at post.

Embassy staffing in HR, General Services Offices, Health Unit, and Budget and Finance Office provide

invaluable support to the PEPFAR program. Percentages of staff workloads on behalf of the PEPFAR

program by the various Embassy sections are as follows: GSO/Procurement 60%, Budget/Finance 60%,

Health Unit 40%, HR 75%, and Warehouse 30%.

Although Cote d'Ivoire is emerging from its lengthy politico-military crisis, agencies at post remain

significantly downsized. As one of the few agencies that has remained in-country, CDC bears a significant

burden of the cost-sharing for operating one of the largest embassies in West Africa, as well as paying for

the actual space in the Embassy used in support of the interagency PEPFAR team.

FY09 funds will be supplemented by FY08 carryover funds to cover certain operations costs, including

required security upgrades at the Treichville facility and costs associated with possible staff moves to the

Embassy.

Along with growth in the PEPFAR program in Cote d'Ivoire, the CDC portion of ICASS costs will increase as

a direct result of the need for increased office space and workstations at the Embassy, as well as increasing

demands in support of the PEPFAR program for Embassy services with associated ICASS charges. Total

ICASS charges for FY09 are projected to be $ 1,694,000. The ICASS services that are used frequently

include HR processing, procurement, contracts, and financial and other services needed to support the

interagency PEPFAR program at post.

OBO costs in FY08 were paid from country budget allocations, and this will continue in FY09. The OBO

charges (projected to be $383,572 in FY09) apply to the total number of existing authorized positions for

each U.S. agency, including both filled and vacant positions (for all "persons" employed by the agency -

FTEs, LES, PSCs, and temporary appointees). The fully integrated interagency PEPFAR staff currently

numbers 111 (this includes vacant positions), including 26 staff associated with the Retro-CI laboratory, and

the team anticipates hiring 21 additional staff in FY09. The OBO charges are rated per person and based

on the type of office space allocated to each position. Currently, CDC supports the PEPFAR Coordinator,

the USAID Focal Point, the USAID Senior Program Manager (Deputy Focal Point), the CDC Deputy

Activity Narrative: Director, and four members of its management and support staff in the Embassy space. A majority of

PEPFAR staff continue to be based at the Ministry of Health/Retro-CI site in Treichville. However, office

space there is at capacity, and expansion at this site is not an option due to limitations on construction

authority for CDC. With the available space at the Embassy, the interagency team plans to move at least

seven additional administrative staff to the embassy in FY09.

As CDC overseas operations have rapidly expanded, CDC HQ has found it difficult to keep up with the need

to provide support to the field. Support for PEPFAR CI information technology requirements continues to be

a challenge in-country as a result of satellite limitations, electrical power outages, and a need to offer IT

support to a growing staff without an increase in IT support staff. In a much-needed effort to address the

growing IT needs for CDC operations overseas, the CDC HQ-based Information Technology Services

Office (ITSO) has established an annual support cost per workstation and laptop at each location, as well as

for satellite connectivity, equipment evaluation for budgeting and replacement purposes, and training for

LES IT staff. The projected FY09 cost for IT infrastructure services and support provided by HQ is

$381,041. This includes funding to provide a base level of connectivity for the primary CDC office to the

CDC Global Network, keep IT equipment refreshed or updated on a regular three- to four-year cycle,

expand the ITSO Global Activities Team in Atlanta, and fully implement the ITSO Regional Technology

Services Executives, a structured cost model that represents what is considered the "cost of doing

business" for each location.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15166

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15166 10542.08 HHS/Centers for US Centers for 7066 5554.08 CDC-RETRO-CI $1,732,153

Disease Control & Disease Control GHAI

Prevention and Prevention

10542 10542.07 HHS/Centers for US Centers for 5554 5554.07 CDC-RETRO-CI $1,244,818

Disease Control & Disease Control GHAI

Prevention and Prevention

Table 3.3.19: