The CDC, through a Personal Service Contract (PSC), will provide a senior laboratory advisor to the MOH

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.

Due to the level of laboratory management experience of persons in Guyana, the MOH has asked for in-

country assistance for a limited period of time (3-5 years) to assist with putting into operation the NPHRL

including management and technical assistance. The PSC activity is also funded under Laboratory activity

#8110.

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.