The MOH is continuing to establish a quality procurement system with the technical assistance of SCMS.

However, there are times when shortages of critical commodities do occur. In order to ensure that essential

commodities are available as the MOH brings its procurement system in-line, CDC will provide, on an

emergency basis, commodities for the PMTCT program to ensure that there is no break in service delivery.

The PMTCT national program continues to scale up not only in number of sites but also scope of services.

During FY08, PMTCT will be fully integrated into ante-natal care. Additionally, to address the increased

demands in M&E as the program is scaled up, the CDC will provide support for data entry and training in

statistics to MOH staff, and support for the senior program officer at CDC to oversee the PMTCT activities

and the MOH cooperative agreement and coordinate with other partners in country for the overall PMTCT

program. Support for this activity will also be provided with funds remaining from the previous fiscal year.

Although the activity is funded via a USAID mechanism, CDC is the technical lead and therefore

responsible for the targets as listed.

Funding under AB prevention will support a portion of the CDC Medical Epidemiologist who will have

extensive responsibilities related to the MARCH behavior change project funded through USAID but with

technical oversight by CDC. During the transition to an NGO and process of further integration with the

Ministry of Health, the Medical Epidemiologist will provide coordination, review of materials and activities for

appropriateness of content and public health messages and will have primary responsibility for design and

implementation of the public health evaluation of the MARCH-infused life skills curriculum in secondary

schools.

See Activity Numbers 15952.08, 15949.08, and 16336.08

The role of the CDC GAP country office is understood to be "coordinating grant activity and consultants,

ensuring utilization of available resources, and providing feedback to OGAC on program design and need

for reorientation". In addition the CDC Office will continue to implement priorities established in the national

strategic plan. In-house program staff will work closely with TA provider, CDC Atlanta, NBTS, and other

partners to support donor motivation, recruitment and retention. Additionally, CDC will support data

reporting, implementation of the PEPFAR M&E tool and SOPs for NBTS, implementation of a

hemovigilance system, and advocacy on policy issues such as blood safety regulatory legislation for

transfusion services and structure of the national transfusion system. CDC will also monitor the

management of the procurement systems by SCMS for the NBTS. CDC will liaise with the PEPFAR public

affairs officer to highlight donation activities and promote a positive public image for altruistic, regular

voluntary blood donation and support a social marketing initiative that will improve the quality and quantity

of public education.

This funding supports a blood safety project officer in the CDC office to implement the above actvities.

Although the activity is funded via a USAID mechanism, CDC is the technical lead and therefore CDC is

responsible for the targets as listed.

CDC will continue to coordinate with CDC Atlanta to provide technical assistance for implementation of a

safe water initiative as part of the package of services for basic palliative care. The CDC/WHO Safe Water

System (SWS) will be implemented in Guyana on a national level. This system combines household-level

chlorination, safe storage vessels, and a program of behavior change communication (BCC) regarding

water and hygiene practices. The Ministry of Health, in collaboration with CDC and Proctor and Gamble, is

obtaining a grant to import the flocculent-disinfectant PuR® for use as a complement to the safe water

system. Because PuR® can remove heavy metals and still leave chlorine residuals, it is an effective

disinfectant for Guyana's "black water" where ordinary chlorination products are not effective. PuR® also

flocculates out parasites and so provides protection against certain waterborne agents of opportunistic

infections.

The products will be sold in country using a social marketing model. The production and distribution of the

products will be done by a private company, who will recover those costs through social marketing of the

SWS in the general population. CDC will cover the costs of the development of the product label, product

name and behavior change communication materials. BCC materials and the products will be available to

all individuals in the HIV care and treatment program throughout the country in coordination with the

standard package of services.

The CDC Guyana Office will support TB services in Guyana by funding a locally engaged staff medical

officer. The position already exists in the CDC staffing matrix but was not filled in FY06 or FY07. As TB/HIV

services are an area of focus for the CDC Office and a current weakness of overall HIV services in Guyana,

this position will be filled in FY08. The medical officer's role will be to provide technical assistance and

organizational leadership to better integrate TB/HIV services in Guyana. The officer will liaise with the

Guyana MOH, the National TB Program, the CDC Division of TB Elimination, PAHO, and other donor

agencies to improve communication, linkages, and standards for diagnosis.

The CDC Guyana Office will support technical assistance to TB/HIV services in country. TB care in Guyana

is in a transitional phase to do changes in the portfolios of several major donors including World Bank,

Global Fund, and CIDA. In addition, in FY08 PAHO will receive USG funds to strengthen TB/HIV services in

conjunction with the roll out of the Integrated Management of Adult Illness (IMAI) initiative at the level of the

regional and district health centers. Specific needs for TA will be defined by CDC in close consultation with

the MOH and other partners. Specific activites TBD pending annual meetings of National TB Program in

November, 2007.

CDC technical assistance in FY07 focused on systems support for treatment programs in Ministry of Health

(MOH) centers and at Georgetown Public Hospital Corporation (GPHC). In FY08, CDC will emphasize

capacity building for grants management and ongoing support to infrastructure development activities for

the MOH as it expands its care and treatment activities. CDC will support efforts to improve care for patients

with HIV/AIDS and to address treatment issues in the public sector regarding opportunistic infections and

sexually transmitted diseases, and also provide coordination for treatment activities under the MOH

cooperative agreement. The CDC Senior Program Development Officer supported through these funds will

liaise with the MOH outpatient treatment system and other partners to ensure linkages between treatment

and other services and to limit redundancies between program areas. In FY08 CDC will fill the currently

vacant position for a locally-engaged staff medical officer. This physician will assist the Senior Program

Officer as liaison to the MOH and would eventually take on these responsibilities on full time basis. This

position will thus provide program support and also afford an opportunity for building the capacity of a local

physician in HIV treatment programs. CDC will assist MOH to capitalize on connections to the diaspora

through twinning with Guyanese physicians at universities and hospitals abroad, to allow for an exchange of

clinicians and help offset Guyana's sever human resource shortages. The CDC Guyana Office will assist

MOH to organize activities around clear objectives and rigorous monitoring and evaluation to ensure best

use of funds available.

Over the last three years CDC provided HIV rapid test kits and consumables to all VCT and PMTCT sites,

QA oversight to all HIV rapid testing sites, leadership, technical assistance, and policy support for the

establishment of the NPHRL, and technical and reagent support to referral and regional laboratories. In

FY07 CDC changed from purchasing and distributing directly HIV rapid test kits, consumables, and

reagents for CD4, hematology and chemistry to providing funding to the SCMS for this activity. CDC will

continue to fund SCMS for these products and work closely with SCMS on reagent forecasting,

procurement orders, and audits of distribution of these items at program sites. CDC will continue to provide

Quality Assurance (QA) oversight for HIV rapid testing for the referral and regional hospital laboratories that

support the HIV program, working in collaboration with I-TECH, ASCP, EU, MOH and the Care & Treatment

Partner (TBD-CoAg), based on the country specific laboratory assessment tool developed in collaboration

with MOH and FXB in FY07. All QA activities will transition to the NPHRL after it is completed (expected

July 2008). CDC will continue to provide an in-country technical liaison for the NPHRL design to the

CDC/Atlanta technical review team; the CDC will also continue to provide over site of the contract for the

NPHRL construction project; construction started in August 2007. CDC will continue to provide technical

and policy support to the MOH for development of the staffing structure, maintenance and equipment plans

for the NPHRL while the construction is in progress. The CDC, through a Personal Service Contract (PSC),

will provide a senior laboratory advisor to assist the MOH to establish procedures and policies and set up

the initial operation of the NPHRL. The Advisor will also provide guidance to the laboratory director in both

technical and managerial areas and support training activities and provide overall technical expertise on

laboratory management to the MOH. The PSC activity is funded with both GAP and GHAI funds and is

found in Activity #12745.08. In collaboration with the Clinton Foundation, which will provide technical

support for the procurement of DNA PCR equipment and provide reagents for its operation, the CDC will

continue to assist the MOH in the implementation of early infant diagnosis. This function will transition to the

NPHRL during FY08. The office will continue to provide coordination and support for special studies as well

as assistance with planning the laboratory processes for surveillance surveys during 2008. All CDC

activities are coordinated by a physician-laboratory specialist working from the CDC office and serving as

liaison to MOH on all issues related to laboratory infrastructure.

CDC will continue to work in close collaboration with the MOH and all Emergency Plan (EP) partners to

strengthen and support strategic information activities including HMIS, surveillance, M&E, and

programmatic research. In FY08 CDC will emphasize improving SI systems in the MOH, improved

coordination between the national statistics unit and various program areas, and provide technical

assistance to the Government of Guyana technical committee for the DHS. The CDC Office will work with

partners to produce public health evaluations for the MARCH program, TB/HIV activities, and the treatment

program. An LES data manager and a portion of the CDC direct hire medical epidemiologist are supported

through this program activity.

CDC will continue to support the roll-out of the National Patient Monitoring System and provide technical

assistance to the MOH and other partners in utilization of the data for improving patient care and program

implementation.

CDC will assist the MOH in completion of the National Epidemiologic Profile begun in FY07. In addition,

CDC will collaborate with USAID and GHARP on assisting the GOG with operationalizing the National

HIV/AIDS M&E Plan and National Strategic Plan (NSP) on HIV/AIDS. Specific support to the MOH will be

short-term TA and targeted trainings in data management and surveillance, in addition to long-term financial

and technical support to PAHO to assist the MOH in implementing a sustainable and harmonized

surveillance system to monitor and measure all health care priorities.

Lastly, CDC will continue to work with all partners to strengthen routine program reporting with standardized

reporting systems that minimize redundant efforts for different reporting pathways. In recognition of the

human resource shortages that inhibit strong SI programs in country, CDC will assist with training and

mentoring of MOH staff.

The CDC programs and activities for the five-year PEPFAR program and beyond are made with the

intention of helping Guyana become a model for the Caribbean. Today Guyana is a leader in the region in

surveillance, care, and treatment, and the integration of the rapid test into the public health system. As

projects and programs mature, Guyana should be able to demonstrate that it is possible, in a resource-

constrained Caribbean nation, to stem the tide of the epidemic, prevent nearly all HIV-positive mothers from

passing HIV to their newborns, and ensure that life-saving ART treatment is available to all those in need.

PEPFAR will contribute to Guyana's leadership in training for physicians and public health practitioners,

particularly lab practitioners, in HIV/AIDS care, surveillance, program design/implementation, and services.

The current staff for the CDC GAP office is a total of 16 positions, six fewer than last year, as well as one

ASPH Fellow. The positions include 3 FTE, 1 PSC, and 12 LES; 10 staff are supported under Management

and Staffing and 6 support specific program areas. The staffing mix for M&S in FY08 includes two US direct

hire FTEs, the Director (physician) and Deputy Director for Operations (Public Health Advisor) as well as 8

Locally Engaged Staff (LES) administrative and support staff hired on Personal Service Agreements

(PSAs). The LES include the following: IT specialist, financial specialist, administrative officer, secretary,

receptionist, janitor and two drivers. CDC also has an American Schools of Public Health (ASPH) Fellow

who provides support in various program areas and falls under M&S in the staffing plan. In FY 08 we will

also recruit an IETA fellow for the summer session for program and management support as well as for

assistance in developing the Country Operational Plan. The Program staff includes one FTE Medical

Epidemiologist who provides technical support primarily to SI and Abstinence Be Faithful. The PSC position

supports Laboratory Infrastructure, specifically for the National Public Health Reference Laboratory

(NPHRL); this position was formally for a Monitoring and Evaluation Specialist but has been changed to a

Senior Laboratory Advisor to provide guidance and technical expertise to the MOH to assist in

strengthening the capacity of the NPHRL. The M&E function that was performed by the PSC will be

incorporated into the Medical Epidemiologist's position. The 4 LES program staff hired on PSAs includes a

senior program advisor, a Guyanese physician epidemiologist who serves as the technical point of contact

for the three cooperative agreements and provides primary technical support in all facets of Care and

Treatment Services and PMTCT. Two junior program officers focus on laboratory quality assurance,

palliative care/TB, and care & treatment services. They also provide targeted technical assistance and

monitoring of the cooperative agreements. The Data Manager supports the SI activities. Staff salary and

benefits by program area is: M&S: $524,000; PMTCT: $4,500; Abstinence Be Faithful: $70,000; Palliative

Care/TB: $14,800; HIV/AIDS Treatment Services: $45,900; Laboratory - $245,000; and SI - $89,400.

In addition to the skill sets required for operating and managing an office, the current level and mix of staff

are needed to provide technical assistance and guidance to local and international partners as they develop

their own capacity in technical, administrative, and management areas. The M&S staff provides a large

amount of technical support in the areas of financial management, grant writing and reporting, and

cooperative agreement management to the MOH. Support is also provided to other partners that include the

National Blood Transfusion Service, the AIDSRelief Consortium, a Treatment Services Partner (to be

determined) and ITECH. During the current and expected near-term, the CDC will continue to assist the

MOH and others in the development and implementation of national strategic plans as well as with

strengthening internal systems to implement and monitor program activities including administration of

cooperative agreements. CDC will continue to provide oversight and technical support to programs for

which SCMS provides procurement services as well as work with SCMS to implement a modern supply

chain management system. CDC will continue to provide contract oversight of the construction contract for

the National Public Health Reference Laboratory.

In order to support the vision of serving as a regional example of successful response and management of

the epidemic in the Caribbean, given the limited technical capacity in country and the constant drain of

young professional staff (approximately 89% of all college graduates migrate out of Guyana), the CDC will

need to remain at or near its current size for the next two to three years. As policies are developed and

programs come on line to ensure retention of key staff for the public sector (MOH and NBTS) and the public

non-profit sector (St. Joseph Mercy Davis Memorial Adventist Hospital etc.), the CDC will be able to scale

back programmatic and administrative staff. A premature scale back or departure would be a lost

opportunity to help Guyana move away from their growing dependence on Cuba and China for physician

and technical staff. Staffing could be affected if CDC merges some support services with the US Embassy,

a plan currently under assessment, or if the Embassy implements the consolidation of all USG agencies at

the Embassy (plan pending funding approval for OBO modifications).

The total estimated cost of doing business is budgeted for $501,750 in 2008 which covers ICASS and

CSCS. In FY08 guidance was proved to allow proportioning these costs to the appropriate program area;

the CDC budget has proportioned these charges to appropriate program areas. It is also noted that the

CSCS charge for FY08 is substantially lower than in previous years (FY07=$240,133) due to the data

provided by the Embassy for the size of CDC staff. It is expected that in FY09 the CSCS amount will go

back to the higher level. Other charges include the Non-ICASS Security charge ($75,000) and a per-

workstation charge for IT support from CDC headquarters. This is a new charge implemented by the CDC

Information Technology Services Office (ITSO) to cover the cost of Information Technology Infrastructure

Services and Support provided by ITSO. This includes the funding to provide base level of connectivity for

the primary CDC office located in each country and connecting them into the CDC Global network, keeping

the IT equipment located at these offices refreshed or updated on a regular cycle, funds for expanding the

ITSO Global Activities Team in Atlanta as well as fully implementing the ITSO Regional Technology

Services Executives in the field. The ITSO costs have been proportionally spread within the appropriate

program areas as a separate activity.

In addition to the salary, benefits and business charges, the M&S budget includes office related costs for

rent, utilities, security, office supplies, office equipment maintenance and replacement, and travel. In

addition to salary and benefits, M&S costs associated with two FTE staff includes residential rent, utilities,

make-ready of residences, residential furniture and appliance replacement, annual R&R air fare, and

expenses for a Permanent Change of Station (PCS) move for 1 FTE. Travel includes periodic trips to

Atlanta or Washington DC for policy or related meetings, attendance at international and regional

conferences, the annual CDC Global Health Meeting, and the annual PEPFAR Meeting as well as site visits

within Guyana.

M&S Budget Overview: Salary & Benefits for 2 US FTEs and 8 LES -$524,000; Travel-$51,400; Office and

Residential Leases and Utilities-$146,600; Local security guard service for the office and residences-

Activity Narrative: $65,600; Building maintenance, office supplies and equipment and servicing-$84,800; Miscellaneous costs

for training, renewing licenses, support for an IETA Fellow, and appreciation awards-$103,750; ICASS-

$275,000; CSCS/OBO-$38,350; ITSO-$45,500; Non-ICASS Security - $75,000. Total M&S $1,410,000.