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 15 positions including one ASPH Fellow, two fewer

than last year. The positions include 3 FTE, 1 PSC, and 10 LES; 8 staffs are supported under Management

and Staffing and six 6 support specific program areas. The staffing mix for M&S in FY09 includes two US

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

as 6 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, and janitor. CDC also has an American Schools of Public Health (ASPH) Fellow who provides

support in various program areas. The Program staff includes one FTE Medical Epidemiologist who

provides technical support primarily to SI, adult care and other prevention. 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 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 other program officers focus on blood safety, 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: $423,320;

PMTCT: $44,221; other prevention: $23,100; Blood Safety 20,142; Palliative Care/TB: $31,174; HIV/AIDS

Treatment Services: $192,395; Laboratory - $90,000; and SI - $78,354.

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, FXB 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

oversight of the recently constructed National Public Health Reference Laboratory during the warranty

phase and also the Senior Laboratory Advisor will provide technical and managerial support in capacity

building.

However the COP guidance outlines several key steps to assist country teams with the process of thinking

through staff positions with the team in mind rather than a particular agency. Further, the guidance from

OGAC promotes rational approaches to replacing staff vacancies, reducing redundancies, and leveraging

the comparative advantages of each agency. CDC, for example, conducts its business using a very

different model than USAID.

As a result, CDC offices can end up with more program area technical experts (e.g., physicians, lab

specialists, program development officers) compared to USAID. USAID, on the other hand, may have more

portfolio and grants managers with less direct responsibility for direct program implementation. This can

result in a lop-sided number of management and staff positions, often with CDC having comparatively more

staff.

Here in Guyana, a relatively small program, CDC staff out number USAID staff by about 4 to 1. Therefore,

CDC has the greatest contribution to the overall country management and staff (M&S) numbers. For FY

2008 the combined country amount budgeted for M&S was 8.6%. For FY 2009, despite the elimination of

two positions by CDC, and no growth by USAID, the overall percentage for M&S actually increased to

11.5%. Staffing footprints for countries with small budgets like Guyana are particularly sensitive to funding

reductions. As such, M&S reductions must accompany budgetary reductions in order to maintain budget

levels within the 7% earmark. Obviously a net reduction in CDC staff by two LES was not nearly enough to

compensate for a 20% decrease in the overall country budget. CDC must therefore make further reductions

in staff over the next few years.

Therefore based on assessment of the CDC office, conversations with other USG agencies, the maturity of

the overall program in country, and other criteria and considerations related to SFR, CDC envisions

continued efforts to reduce its staffing footprint. We have mapped out a hypothetical staffing footprint by

position for the CDC office, current compared to future. The actual time table for transitioning various

positions will depend on program priorities, work load, training needs, and other factors. However, we

anticipate that in 2 years we will be much closer to the desired staffing footprint.

The total estimated cost of doing business is budgeted for $429,866 in 2009 which covers ICASS and

CSCS and ITSO. In FY09 guidance was provided to allow these costs to be budgeted under M&S ; The

CSCS charge for FY09 is substantially lower than in previous years (FY07=$240,133).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

Activity Narrative: 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.

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 6 LES -$423,320; Travel-$61,300; Office and

Residential Leases and Utilities-$164,685; Local security guard service for the office and residences-

$65,640; Building maintenance, office supplies and equipment and servicing-$64,600; Miscellaneous costs

for training, renewing licenses, support for Ambassador's Grant, and appreciation awards-$68,885; ICASS-

$260,000; CSCS/OBO-$61,366; ITSO-$108,500; Non-ICASS Security - $75,000. Total M&S $1,437,263.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12733

Continued Associated Activity Information

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

System ID System ID

12733 3216.08 HHS/Centers for US Centers for 6274 3828.08 CDC Program $910,000

Disease Control & Disease Control Management

Prevention and Prevention

8086 3216.07 HHS/Centers for US Centers for 4689 3828.07 CDC Program $934,401

Disease Control & Disease Control Management

Prevention and Prevention

3216 3216.06 HHS/Centers for US Centers for 3828 3828.06 CDC Program $949,334

Disease Control & Disease Control Management-

Prevention and Prevention Base

Table 3.3.19: