During April 2009 reprogramming, funds made available for Partnership Framework development are being

allocated to a TBD partner to support technical, managerial, and logistical aspects of the required

consultative process.

New/Continuing Activity: New Activity

Continuing Activity:

Program Budget Code: 19 - HVMS Management and Staffing

Total Planned Funding for Program Budget Code: $7,493,723

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

The PEPFAR Cote d'Ivoire program continues to use innovative approaches to improve management and cost-efficient

operations for a rapidly expanding HIV/AIDS program in a country moving toward stability after several years of sociopolitical

crisis. CDC is the primary agency funding clinical services, such as antiretroviral treatment, TB/HIV, PMTCT, and laboratory

services, while USAID-funded activities are focused on supply-chain and commodities management, nutrition, and care for

orphans and vulnerable children. Both agencies contribute to health systems strengthening, prevention, and community-based

services as well as to USG program management.

Two years after conducting a Staffing for Results (SFR) exercise and consolidating a unified functional interagency organizational

structure that promotes one cohesive PEPFAR team, leverages CDC and USAID institutional strengths, and streamlines costs by

eliminating redundancy, the USG in-country team continues to review and revise program implementation and oversight in

response to priorities and emerging needs. In implementing SFR, PEPFAR staff, regardless of hiring agency, continue to report

functionally to their Branch Chief, who in turn reports to the CDC and/or USAID heads as appropriate. The PEPFAR Country

Coordinator is the spokesperson for the overall program and is the primary contact with OGAC and the U.S. Embassy front office.

The CI program has been without a full-time Country Coordinator since July 2008; pending recruitment of a permanent

Coordinator, the DCM and/or Ambassador lead weekly PEPFAR Executive Team meetings and coordinate with CDC and USAID

leadership in the development of PEPFAR programs in Cote d'Ivoire.

The PEPFAR Executive Team is composed of the CDC Country Director and USAID Focal Point, CDC Deputy Director, USAID

Senior Program Manager, CDC Associate Director for Science, and senior management (Branch Chiefs) from the Program

Management, Strategic Information, Laboratory, Prevention, and Care and Treatment branches. The interagency team continues

to meet weekly to discuss, review, and coordinate the implementation of PEPFAR program activities and make interagency policy

decisions. In addition, representatives from the Executive Team (PEPFAR Coordinator, USAID Focal Point, CDC Country

Director, and CDC Deputy Director) meet at least twice a month with the U.S. Ambassador and DCM to discuss program activities

and issues.

Since August 2008, the USAID Focal Point has been supported by a seasoned USAID Consultant who provides senior project

management expertise to the growing project management team. This position, which also acts as Deputy to the USAID Focal

Point, is working to strengthen USAID management in-country and is the key contact with USAID/West Africa oversight and

support staff. While USAID does not have a bilateral mission in Cote d'Ivoire, USAID program activities receive support through

the USAID Western Africa Regional Program based in Accra, Ghana.

In order to continue to best implement the PEPFAR vision and goals in Cote d'Ivoire, the executive staff and in-country team

members collaborate on a regular basis in the implementation of the PEPFAR CI program. The SFR exercise conducted in 2007

allowed for the development of a clear organizational structure with which to support technical program implementation and

oversight while allowing for capacity building, growth, and upward mobility for LES. A total of 34 new positions were determined to

be essential and were approved for FY07 and FY08, of which 20 (18 LES and two USAID contractors) were filled in FY08 (two

from COP 2007, 15 of 17 from FY07 plus-up funding, and three of 15 FY08 positions). Following staffing needs evaluations in

each branch, and based on the SFR exercise, several of the 34 positions (in administrative and logistical support) have been re-

evaluated in order to better serve the PEPFAR program, including moving two approved administrative/support positions to the

Laboratory Branch. The structure of the interagency branches has been strengthened as a result and will better serve to

implement program activities in-country.

A key operations management position was vacant for the majority of FY08 after the employee retired. This left the Operations

Branch (which provides procurement, shipping, IT, warehousing, and other logistical support for the overall PEPFAR program)

with many challenges as it tried to keep up with an expanding workload. During this time, however, a clearer idea of how to better

structure operational, administrative, and logistical support to the interagency team evolved, and resulting changes began in

October 2008. Examples of these administrative and operational process changes are: 1) dividing one position into two -

Associate Director for Operations (a GSO Team Lead position approved for FY08) and Associate Director for Management (from

a previously vacated position); 2) re-evaluating administrative systems and practices to reduce redundancies and inefficiencies

and developing better strategies for better compliance and greater efficiency; 3) reviewing and revising position descriptions for

operations and administrative staff from other branches to adapt to the changing needs of program implementation; 4) hiring

administrative support/office managers for each branch to bring stronger administrative support to each branch team; 5)

relocating seven Operations Branch team members (HR, procurement, warehouse/stock, and shipping) to the U.S. Embassy,

where they will be integrated into the relevant DOS teams (HR, GSO, FMO); and 6) cross-training Embassy staff who work on

PEPFAR support activities (in particular HR and finance) on PEPFAR requirements and special needs. To further reduce

redundancies and costs, discussions are under way among Embassy and PEPFAR in-country leadership to integrate several

administrative operations positions into the ICASS system. This would reduce costs for administrative support positions, allow for

more efficient processes, and give staff direct access to experts in HR, procurement, etc., who could also serve as back-ups

during heavy work periods or absences. Up to now, the operations staff has relied on their immediate PEPFAR colleagues, who

often do not have the skills or time to take on additional duties, to backfill during absences. These are delicate discussions and

are expected to continue until a solution with a clear benefit to all parties involved is evident.

The implementation of SFR has moved forward, with all senior management positions (Strategic Information, Laboratory, Care

and Treatment, Prevention, and Operations Branch Chiefs) filled in FY08 through a variety of hiring mechanisms (LES, USG

direct hire, and CDC-funded ComForce contracts). One of the two vacant USG FTE positions from FY08 has been filled

(Prevention Branch Chief), and the second is in the process of recruitment (Associate Director for Science/Senior Medical

Adviser; a contractor is currently acting in this capacity). Although FTE positions have been or are in the process of being filled,

challenges remain, as Cote d'Ivoire is a francophone country and remains an "adults-only" post, with continuing anxieties related

to the recent politico-military crisis. Progress has been made, in coordination with the LE Staff CAJE Workgroup, in the

recruitment of senior LES in leadership and/or technical and administrative positions, with a grading of positions that better

reflects the responsibilities and experience of the current and future employees. Challenges remain in finding LES with

appropriate experience and expertise. One example is the Highly Vulnerable Populations Adviser, position, which has been

submitted for recruitment twice over a six-month process because the applicants in the first recruitment phase did not meet the

qualifications needed for the position.

With regard to the staffing matrix, existing staff positions include the following: four technical leadership management positions

(CDC Country Director, CDC Deputy Director, USAID Focal Point, and USAID Senior Program Manager), 47 technical adviser

non-management positions (including 21 program area and 26 lab positions), five filled program manager positions, and 45

administrative/support staff positions. There are 106 existing LES positions and four third-country citizens working as contractors

in leadership positions (two USAID-funded and two CDC-funded).The only current PSC position (PEPFAR Country Coordinator,

USAID-funded) is vacant; recruitment is under way. Plans to convert the two contractors to PSCs in FY08 have been delayed as a

result of the "adults-only" post restriction. One of the four CDC FTE positions is currently vacant, and there are 13 vacant LES

positions, most of which were approved in FY08.

For FY09, the PEPFAR country team proposes to fund the following eight positions through CDC: (1) Project Manager, (2)

Laboratory Technician for the Serology Unit, (3) Laboratory Technician for the Clinical Diagnostic Unit, (4) Administrative Assistant

for the Associate Director for Science, (5) Administrative Assistant for the USAID Focal Point, (6) Public Health Evaluation

Coordinator, (7) Public Health Evaluation Data Manager, and (8) Public Health Adviser (GS12/13). The additional Public Health

Adviser will provide valuable assistance to the program by focusing on human resource development and will also have signature

authority on government documents.

The PEPFAR country team proposes to fund two new positions in Cote d'Ivoire through USAID: one Health Management

Information Systems (HMIS) Adviser and one Logistics/Commodities Adviser. USAID currently funds the following five filled

positions in Cote d'Ivoire: Senior HIV/AIDS Adviser (USAID Focal Point), Senior Project Manager (Deputy), two Project Managers,

and one Associate Director for Operations.

The USG PEPFAR CI team is co-located in two offices - a majority of staff are based at the Ministry of Health University Hospital

in Treichville, while a growing number of staff are based at the Embassy - and has an integrated management, administrative,

and motor pool staff to support the executive and project management teams, technical assistance sections, and Retro-CI

Laboratory and Strategic Information branches. Six administrative support LES (HR, two procurement, travel, warehouse, and

shipping) and one contractor (Associate Director for Operations) will be relocating from the Treichville facility to the Embassy. This

move will help the current staff to streamline its administrative practices and allow for more efficient procurement and logistical

support to the PEPFAR Cote d'Ivoire 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.

Table 3.3.19: