PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Continuing Activity
Preparations are underway to train clinical teams and supervisors from 3 of the 10 regions of the country as
a pilot exercise for the implementation of the IMAI. After the pilot phase, the IMAI strategy will be rolled out
in remaining regions taking into account learned lessons from the pilot. The roll out of the IMAI strategy will
compensate for health workers turnover and expand the number of facilities providing integrated HIV
services. Limited human resources in the health sector is the greatest threat to sustainable HIV services in
Guyana. The regional health model and IMAI initiative will shift tasks involved in HIV care into the overall
health care system. This shift will better integrate HIV care into primary care and ease the need for
specialists physicians who are in critically short supply in Guyana. Formative and integrated supervision of
HIV program activities will continue to be a priority as HIV services are decentralized. In the regional health
model, the regional coordinator has a crucial role in ensuring smooth functioning of public health programs
such as HIV and TB. The regional HIV coordinator is most often an administrator with previous clinical
training (as a doctor, clinical officer or nurse) who has the responsibility of coordinating all HIV program
activities in the region. A regional HIV coordinator with clinical training is necessary to supervise HIV clinical
services at health facilities in the region All regional HIV coordinators will be trained for 1 week in HIV
program management to include: planning for scale-up, coordinating region-level training, recording and
reporting using the national patient monitoring system, performing site visits and identifying/solving facility-
level problems. This training will precede IMAI clinical training for clinical teams in the region. PEPFAR-
supported clinicians providing treatment services will also serve as a support system to mentor the MOH
regional coordinators in the field. Regional coordinators will be expected to participate in the 2-week basic
IMAI clinical course in order to become completely familiar with the clinical and operational protocols used
at regional hospital and health centre level. Supervisory site visits will start immediately after IMAI clinical
training, and will continue monthly for 3-6 months, after which the frequency will shift to quarterly. This
activity covers funds for transportation to health facilities within the region and communication via phone,
radio or mobile phone with facilities and regional offices. The IMAI tools for regional HIV coordination
include standardized case management observation and exit interviews that will be included as part of the
routine reports submitted by regional HIV coordinators to regional and national offices. Quantification of this
data in a subset of regions will be done as part of an evaluation of the quality of care during scale-up of
integrated HIV services in those regions. At the regional level, the HIV management team should be
strengthened by additional staff whose major responsibility will be coordinating support supervision activities
at the regional level: communicating with region HIV coordinators, reviewing reports, solving regional-level
problems, and coordinating support for regional coordinators. Coordinators at all levels will be trained in
reporting via the standardized patient monitoring system (covered in the Patient Monitoring concept paper).
This activity also covers the cost of meetings that will be held quarterly in each region, to allow regional
coordinators to exchange experiences with each other.
New/Continuing Activity: Continuing Activity
Continuing Activity: 12723
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
12723 8562.08 U.S. Agency for Pan American 6270 4774.08 Pan American $200,000
International Health Health
Development Organization Organization
8562 8562.07 U.S. Agency for Pan American 4774 4774.07 Pan American $200,000
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $100,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Estimated amount of funding that is planned for Education $50,000
Water
Table 3.3.09:
Continued Activity
During FY08 PAHO provided key technical support to Guyana's National TB Program (NTP) including
revision of of the National TB Strategic Plan to incorporate the components of the new "Stop TB" strategy
and adaptation of generic WHO Integrated Management of Adult Illness (IMAI) materials for the Guyana
context. During FY08, PAHO will continue to work with national counterparts to implement the new STOP
TB Strategy, expand quality DOTS services, and use the new IMAI materials to roll out the strategy in all 10
regions. PAHO will update the TB Program guidelines and provide technical assistance to implement further
plans for decentralization of TB program into Primary Health Care facilities through the IMAI. PAHO will
seek opportunities to improve the management skills and capabilities of the national TB leadership team as
well services at the Chest Clinic in Georgetown. Technical assistance will be provided to improve the patient
care flows and the information flows between the TB care sites and HIV clinics, to implement VCT in TB
clinics and to strengthen the M&E (forms, data collection, reporting and analysis) for decision making.
PAHO will provide assistance to the NTP to make efficient use of resources from the Global Fund project in
the implementation of planned activities.
PAHO will continue to strengthen TB/HIV collaborative activities within the National Tuberculosis Program.
As a part of its regional health model, which decentralizes health services to the regional level, tuberculosis
nurses at all MOH regional hospitals and health centers with outpatient TB clinics will be trained in TB/HIV
co-management.
TB nurses will be trained to offer HIV testing to all TB patients and suspected patients, offer cotrimoxazole
prophylaxis, counsel patients on prevention, assess clinical stages for TB/HIV co-infected patients, and
refer patients for ART when necessary. Regional TB coordinators will be included in IMAI training for
regional HIV coordinators and will receive training and funding for site visits to facilities with out-patient TB
clinics. During these visits, regional TB coordinators will offer support to TB nurses, monitor progress, and
assess the need for supplementary trainings. These activities will strengthen linkages between TB and HIV
treatment systems, enhance co-infection services in outer regions, and help integrate TB/HIV management
into the greater healthcare system for maximum sustainability. PAHO will coordinate closely with PEPFAR
Guyana partners and other stakeholders to ensure efficient, synergistic activities.
Continuing Activity: 12722
12722 8498.08 U.S. Agency for Pan American 6270 4774.08 Pan American $100,000
8498 8498.07 U.S. Agency for Pan American 4774 4774.07 Pan American $100,000
Health-related Wraparound Programs
* TB
Estimated amount of funding that is planned for Human Capacity Development $20,000
Program Budget Code: 13 - HKID Care: OVC
Total Planned Funding for Program Budget Code: $1,254,536
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
The Government of Guyana and civil society have recognized the need to ensure greater protection and care for orphans and
vulnerable children; however there is currently no differentiation of children by circumstances. In Guyana, there are an estimated
22,000 OVC, due not only to HIV/AIDS. Additionally, a 2006 survey of institutions has revealed that 600 of these children are
living in child residential institutions. Given the relatively low number of children residing in institutional care, there is a joint
commitment from donor agencies and the Government of Guyana to integrate these children back into a home environment, while
limiting the further institutionalization of children through sound legislation and the provision of community-care options and foster
care. To ensure the smooth transition from residential care to the family unit training and placement of child development
specialists or persons in related field within government and non-government institutions will be undertaken. These efforts will be
strengthened by measures to also target children who do not receive adequate parental care as one of the steps needed to
prevent children from entering institutional care.
Over the past year, efforts to reintegrate children with their families have proven to be particularly challenging. Attempts to
contact the majority of parents/guardians were futile, and those who were contacted were found to be in acute socio-economic
difficulties and not in a position to provide the desired shelter. Consequently, only thirty seven (37) of the six hundred (600)
children in institutional care could be reintegrated. Hence other community care and foster care options will be vigorously
explored.
To date, UNICEF has worked closely with the Government through the Ministry of Human Services and Social Security and
institutional care providers as partners in the solution. There is a shared vision and commitment as seen by the voluntary
"signing" of the standards to ensure compliance by all stakeholders for standardizing and monitoring care being provided within
institutions, developing a foster care system as well as a community based OVC care system, and ultimately the elimination of
institutional care. UNICEF is collaborating with a number of key governmental and non-governmental institutions including the
Ministry of Human Services and Social Security (MHSSS), MOH, GHARP, AIDS Relief and other agencies working on OVC
issues for the development and implementation of a multi-sectoral approach to OVC in Guyana. Progress to date has included,
the development of a national OVC policy framework to guide programming and to protect OVC, development of a national draft
Plan of Action, an approved minimum standards of care for institutions developed and distributed to orphanages, draft legislation
for the protection of all children, a child protection unit established in the MHSSS, capacity building of service providers including
the MHSSS, strengthening the monitoring and evaluation systems, the establishment of a National child protection Information
and Monitoring database and the establishment of an OVC Inter-Agency Coordinating body whose mandate is to oversee the
tabling of the NPA in Cabinet and the implementation of the NPA. The establishment of this Committee was a joint effort
between the Ministries of Human Services and Health to advocate for the tabling of the outstanding NPA, the OVC policy and the
Child Protection Bill. Hence UNICEF will continue to work with the Ministry of Human Services and Social Security, residential
care facilities for children, community and faith based organizations to reinforce minimum standards of care for children in
institutions, reintegrate children from residential institutions to their families or other community care options, and strengthen the
capacity of the MHSSS, through training of social workers and child care professionals, and, the maintenance and expansion of
the child database.
Birth registration will remain high on the agenda to ensure OVC access to education and health care services. However human
resource shortages at the Office of the Registrar have resulted in a backlog of birth registrations. In FY 08, efforts in this regard
included the incorporation of the importance of birth registration on PMTCT cards and the strengthening of the human resource
capability at the Registrar.
The MHSSS, the Ministry of Health, civil society organizations through the Global Fund and World Bank projects will continue to
provide OVC and their families with food items, school clothing, psychosocial support and public assistance. The continuation of
implementation of these activities is crucial as is their expansion and scaling up to reach more OVC.
As defined in Guyana's National Policy, and strengthened through PEPFAR support, a comprehensive response to orphans and
other vulnerable children includes the five global OVC strategies:
1. Strengthening the capacity of families to protect and care for OVC;
2. Mobilizing and supporting community-based responses to support OVC;
3. Ensuring access for OVC to essential services (Legal, Social Welfare Support, Psychosocial, Education;
4. Protecting the most vulnerable children through improved enforceable policy and legislation (Focusing on standardizing
institutional care and setting minimum standards of care.); and
5. Raising awareness, through advocacy and social mobilization, to create a supportive environment for OVC.
The policy equally emphasizes the importance of building community capacity to meet these obligations. In line with this policy
and that of PEPFAR guidance, all support will seek to ensure that the basic needs of orphans and other vulnerable children for
economic and food security, education, nutrition, health, and emotional well-being are met, despite the impact of HIV/AIDS. All
activities of the PEPFAR supported NGOs are directly linked to the National Plan of Action for OVC and fits into the PEPFAR five
(5) year strategy and align to the PEPFAR OVC guidance. While the activities done by the NGOs are aimed at the child and
caregiver/family levels, the program continues to work with the Government of Guyana to advocate for strengthening of those
services at the system level. The program is currently providing national level support to MHSSS, UNICEF and other partners to
expedite the roll-out of the Guyana OVC NPA. USG has also taken the lead in the development of technical guidelines, SOP and
training curricula which will all contribute to improving the quality of services. In an effort to scale up this effort the NGOs will be
leveraging support from other partners and the private sector. Our program is presently working with forty-six (46) Private Sector
Partners whom we collaborate with to support the needs of the children in the five key areas. Focus will also be made on the
economic empowerment of older OVC through innovative models for public/private alliances, including Global Development
Alliances.
In support of the UNGASS mandate which has identified UNICEF as the lead organization for monitoring OVC activities, UNICEF
will be a strong partner in improving the policy and legislation, establishing mechanisms for monitoring and information exchange,
and ensuring access to essential services. This will bridge neatly with community programs already supported by UNICEF as well
as the GHARP activities. In order to scale up the community based programmes, UNICEF will work closely with the Ministry of
Human Services to establish ‘OVC Village Care points' across the country to ensure that members of the community play a
greater role in the protection of children. Making use of previously trained volunteer social workers and other groups active in
communities. UNICEF will support the implementation of a comprehensive care package to children at the village level. Retired
professionals will also be approached to actively volunteer their time and skills to the OVC Village Care points. Personnel from
within the various relevant government ministries and departments will also be an integral part of this process.
As stated in the FY 08 semi-annual report, 838 OVC were being supported by the program. GHARP will increase its coverage by
concentrating on the recruitment of children, through linking closely with high probability sources for case finding. Such partners
will be Government social service offices, PMTCT sites, treatment sites, PLWHA support groups, and palliative care providers.
GHARP will collaborate with MOH, NAPS and other partners to formalize SOPs for referrals from the respective sites/agencies.
The estimated target for FY 09 will be 950 OVC.
GHARP, through its ten NGO/ FBO partners will continue to deliver services to address the "core" needs of OVC, through
interventions at the child, caregiver/family levels. These include children's access to the same quality of education with special
emphasis on ensuring that girl children have equal opportunities, vocational training, medical care, targeted nutritional support,
basic food support (including community gardens and leveraging other GOG and donor program resources), psychosocial
support, and economic opportunity/strengthening. Efforts will be coordinated with the Government and other civil society
programs, to ensure continuity of care and the responsible reporting of the support provided to each OVC. Efforts will be made to
improve the quality of OVC services through linkages with the National AIDS Program Secretariat, the private sector, MOLHSSS
and other donor agencies.
Recognizing that there is a need to sustain OVC efforts beyond the life of the project, GHARP, through its NGO network, will work
in collaboration with the Ministry of Health supported NGOs to increase OVC access to community services and resources by
targeting community committees as well as professionals/skilled individuals to support vulnerable families. Youth participation in
national or local level planning and service delivery will be promoted and facilitated. Through community mapping exercises,
areas of potential linkages with other HIV/AIDS and development programs will be identified.
AIDS Relief, as part of its family-centered approach to care and treatment, will continue to strengthen linkages with ongoing care,
treatment and prevention programs at the private, public and community levels to ensure timely access to treatment services.
Children in the program born to HIV+ mothersare being incorporated in the program as part of the family-centered package of
care. In FY 09, focus will continue to be placed on strengthening clinical and laboratory monitoring of pediatric patients enrolled in
pediatric care and/or ART programs. In addition, education seminars related to counseling children and adolescents infected with
HIV, will continue with care providers and counselors.
These efforts will be coordinated with other PEPFAR partners, UNICEF and the GOG to improve the quality of life and establish
sustainable income generation for orphans and their families.
Table 3.3.13:
Continuing Activity but reduced to level of oversight and minimal technical assistance.
In FY07, PAHO served as lead technical agency to assist the Ministry of Health to adapt the WHO format
national patient tracking and monitoring system to the Guyana context. The system is being rolled out in all
existing ARV treatment sites. The system is now the national monitoring system for all HIV/AIDS care in
country. As part of the IMAI initiative, PAHO will provide support to the roll out of the system in all district
hospitals (19) and a limited number of health centers meeting criteria to provide ARV. PAHO will also
support the WHO HIV Drug Resistance (HIV-DR) tracking initiative. This includes Early Warning Indicators
to be obtained from the Patient Monitoring System and cohort analysis. PAHO will continue to support and
supervise the work provided by contract data entry clerks and clinic staff working on the roll out of the
Patient Monitoring System.
The PAHO Surveillance Officer will continue to work closely with CDC (the SI technical lead for the USG
team), USAID, and other partners to coordinate activities in support of the MOH Surveillance Unit including
funding and training for backfilling of registries, mentorship for Surveillance Unit staff and technical
assistance for data analysis and reporting. Site visits for ongoing monitoring will coincide with visits for
monitoring other programs such as the malaria initiative. This coordination will assist in the integration of
HIV care into the overall health system.
Continuing Activity: 12724
12724 8275.08 U.S. Agency for Pan American 6270 4774.08 Pan American $125,000
8275 8275.07 U.S. Agency for Pan American 4774 4774.07 Pan American $250,000
Program Budget Code: 18 - OHSS Health Systems Strengthening
Total Planned Funding for Program Budget Code: $1,429,860
The initiatives in health systems strengthening will enhance the existing foundation and continue to build on programs currently
being implemented. In FY07 and 08 there was an ever-increasing focus on policy and system strengthening across the
workplace, private, public, and NGO/FBO sector in order to increase these sector's capacity in leadership, administration, financial
management and transparency; as well as technical strength. PEPFAR plays an important role in the 3 Ones Principle and will
support the implementation of Guyana's harmonization tool to improve division of labor, coordination, maximization of resources
and sustainability.
Guyana has no restrictions on migration and accepts this phenomenon as a positive value shared widely throughout society. The
country is thus faced with a dilemma: on the one hand the need to provide quality health services with sufficient staff and on the
other hand, the individual's right to move to different shores as a positive value. Second to this is the phenomenon of internal
migration. The global initiatives (addressing specific disease oriented programs) have led to internal migration from the public to
the NGO and private sectors, competing for already scarce human resources. When hiring with additional incentives occurs in
service settings, this usually leads to motivation of a small number of staff and de-motivation of those not benefiting from access
to additional incentives.
The most recent report by World Bank of human resource depletion globally, noted that Guyana suffers from the highest rates of
out-migration or "brain drain" of any other country. The challenges cannot be solely solved by a massive scaling up of the training
programs. Guyana has a small population base from which to recruit and train the health workforce and any single qualified
professional leaving the public sector potentially takes years to replace, particularly in specialized treatment categories and the
upper echelons of management and administration. A more concentrated effort will be made in FY09 to address the human
resource depletion by collaborating with the MOH and other partners to streamline and harmonize Human Resource policies, look
to task-shifting, and to integrate functions of counseling and testing into current staffing responsibilities. In addition, great strides
with the staffing and training database, will allow for increased staff planning, placement, and pre and in-service training needs.
The overarching objective of PEPFAR's support to MOH, PAHO, ITECH, and AIDSTAR will be to strengthen the HIV/AIDS human
resource system (within the broader ministries of the GOG and civil society organizations) and create conditions that foster
retention, effective performance, and supportive supervision. For HIV/AIDS there is the TIMS (Training Information Management
System) which tracks all health care workers who are involved in the HIV program, and support for the system is being provided
by ITECH. ITECH will continue to collaborate with the University of Guyana, Health Sciences Education Unit to build the capacity
of the GOG to monitor, evaluate and plan for the training needs of Health Sector staff. While concurrently PAHO will establish a
Human Resources Planning and Development Unit within the MOH to address migration issues, as well as the retention and
recruitment of health providers, with increased technical assistance from AIDSTAR who will also reach out to the NGO sector.
The Government of Guyana, donors and civil society have recognized that there is a need for a legal framework to regularize the
functioning of NGOs. At the program level, PEPFAR will utilize the services of Community Support and Development Services
Inc. to support the NGO and FBO community with the contracting of entities to provide targeted assistance in developing sound
governance and administrative processes. It is envisaged that this assistance will enable civil society to take on an incrementally
deeper responsibility, currently held by international organizations, of providing institutional capacity building assistance that will
continue to be needed in Guyana in the future. AIDSTAR in partnership with CSDS will continue to facilitate the annual work and
M&E plans for each of the PEPFAR supported NGOs as well as continue on-site technical assistance and supervisory visits on a
quarterly basis. PEPFAR will also collaborate with UNAIDS to align reporting systems with the goal of achieving one National
M&E framework.
The Ministry of Labour, as the lead Agency will be supported by the International Labor Organization and AIDSTAR for the
development of policy and workplace programs within the private sector and work place settings. The goal will be to develop and
implement on-site performance improvement and monitoring systems that improve specific performance outcomes, implement
local solutions, strengthen relationships between supervisors and clinic managers, improve the consistency of supervisory visits
and motivate clinic staff as essential partners in the monitoring and feedback mechanism.
With PEPFAR funding, UNICEF is will remain vigiliant in advocating for the policy and legislation for OVC, working with the GOG
through the Ministry of Labor, Human Services and Social Security to ensure that the OVC National Plan of Action and the OVC
National Policy Framework are enforced. This will also be addressed in the Transitional Compact with the GOG. These
documents emphasize the need for vulnerable children to have access to essential services, including HIV care and treatment.
The program will continue to work with the GOG to strengthen those services at the system level. UNICEF, along with financial
support from the GFATM will be addressing two policies/draft legislations: the Child Protection Law and the establishment of a
foster care system from within the Ministry of Labor, Human Services, and Social Security.
In relation to both policy and setting a stage for a strong National response, is the need to focus on reduction of stigma and
discrimination. Currently, as reported in the Guyana AIDS Indicator Survey of 2005 (GAIS), only 20% of men and women
expressed acceptance on all four measures stigma. Hence, there is a need for stigma and discrimination to be a key part of all
our programs as well as incorporated into the institutionalization/introduction of a sound policy environment. Wherever possible,
the program will build on USAID's additional mandate in Guyana for increased democracy and governance, as well as gain
support from our UN Family and other Caribbean partners that have invested in sound legislation as well as mitigation of the
HIV/AIDS epidemic. Efforts will also be made to ensure that persons living with HIV and AIDS are involved in the development of
programs and policy at all levels.
Table 3.3.18:
In FY06-08 PAHO focused on strengthening the capacity of the National AIDS Program Secretariat since a
2004 assessment conducted by the Caribbean Health Research Council (CHRC) noted that insufficient
human and technical ability as well as inadequate emphasis on its mandate of coordination and
management weakened the national response to HIV/AIDS. Currently, PAHO continues to assist the
Ministry of Health in strengthening NAPS to take the lead in implementing all health-related aspects of the
National HIV/AIDS Strategic Plan, including the implementation of the GFATM project. Also, in FY07 PAHO
has been able to make significant strides in the development of a human resource unit within the Ministry of
Health, including staffing and initial work on strategy documents and policy positions.
A considerable amount of work was undertaken in the past to analyze workforce issues and develop a
National Health Plan 2003-2007. This plan, released in March 2003, contains important recommendations
on Health Services and Workforce Development Strategies. In FY07, PAHO will dedicate more effort to the
MOH and its human resource unit with a primary focus on fields most relied upon by the HIV/AIDS program.
PAHO will support the MOH to establish a Human Resources Planning and Development Unit (HRDU) with
the following functions:
• Steer the development of an integrated Human Resources for Health Plan which matches population
health needs and service delivery mandates with skills needed and appropriate budget levels for supplies,
equipment and pharmaceuticals
• Provide directions to the existing training department (Dept of Health Sciences Education) with the aim to
achieve synchrony between the identified service needs and the training activities
• Collect and systematize a database of stock, trends, and qualitative data on human resources that allows
forecasting needs and tracking the impact of interventions
• Build a consensus mechanism involving education, finance, donors, public service and local governments
in order to address this issue through a comprehensive and coordinated approach
Given the environment of out-migration and internal migration, PAHO will play a proactive role in defining
and responding to the main contributing factors by:
• Conducting studies on the main flows of different types of professionals and the consequences of these
flows in the health services and in the priority programs
• Implement and reinforce an "exit interview" procedure
• Facilitate international dialogues between major partner recipient countries of Guyana health staff and the
Guyana health services to provide more specific support to Guyana service needs development based on
staff losses
• Develop and pass regulation of contracting policies in the health sector as a way of balancing the
availability of critical human resources in the MoH and the other health providers and programs
• Determine critical path to scale up the main training programs and the establishment of an inter-sectoral
task force to devise a short term plan to address the ill effects of the identified bottlenecks. This will be done
in collaboration with the CDC ITECH activities for health sector training coordination and planning as well as
information system platform being developed currently
• Achieve consensus among development partners on incentive structures across the various priority health
and education programs they support. To date, a pilot performance-based incentive program is being
implemented and continuously evaluated and assessed for opportunities for strengthening the system as
well as expanding it
The main issue of concern for the MOH with recruitment and retention is the inefficient procedure for filling
new and vacant positions. It is too time-consuming and inefficient to guarantee adequate levels of staffing
and leads to the loss of good candidates. Other concerns include the lack of career prospects (flat pay
structure, poor working conditions), insufficient incentives through the current pay system, and insufficient
access to continuing and post-graduate education. PAHO will develop a coherent set of interventions
addressing the main factors identified:
• Design alternatives to build career paths adapted to the public health sector, rewarding performance,
acquired skills and experience
• Strengthen the continuing education system so it is linked to opportunities for career advancement
• Establish a dialogue with Ministry of Finance and Public Service Ministry to discuss ways for appropriate
salary grid and/or benefits packages and streamlining the appointment process
• Consult with partner community for staff, category-specific, needs, particularly in the area of incentives
which do not demand immediate remuneration issues
• Promote a cabinet approved Human Resources for Health Plan as the basis for staffing needs and
authorization to fill positions to avoid delays
• Determine staffing levels through workload indicators of staffing needs which should form an integral part
of the Human Resources for Health Plan
Continuing Activity: 14084
14084 3164.08 U.S. Agency for Pan American 6270 4774.08 Pan American $250,000
8204 3164.07 U.S. Agency for Pan American 4774 4774.07 Pan American $300,000
3164 3164.06 U.S. Agency for Pan American 2738 2397.06 Pan American $400,000
Estimated amount of funding that is planned for Human Capacity Development $200,000
