ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

1.Pre-service training been clearly elaborated as a priority for FY09. HIV content will be integrated into the

pre-service HIV/STI core course for medical, nursing, pharmacy and medical technology students of the

University of Guyana and the pre-service Medex training course.

2.The Ministry of Health has requested I-TECH to develop a curriculum for training of health sciences tutors.

3.The database tracking HIV-related training will be customized for the various training organizations.

4.No new in-service HIV curricula will be developed given that priority cadres have been completed.

Human resource capacity remains the single largest obstacle to establishing a stable and quality HIV/AIDS

program in Guyana. Appropriate and coordinated training is essential to reduce the shortage of skilled

workers in the health sector. To improve upon the quality of pre-service training of health care providers, I-

TECH will continue to support the MOH and University of Guyana to integrate HIV/AIDS into pre-service

training programs. I-TECH has already initiated the process of integrating the approved HIV/AIDS content

into the pre-service nursing curriculum and it proposes to continue this activity by supporting the upgrade

and integration of similar content into: 1) the HIV/STI core course for medical, pharmacy, medical

technology and nursing students within the Faculty of Health Sciences at the University of Guyana; and 2)

the pre-service Medex training program within the Health Sciences Education Unit (HSEU).

Additionally, I-TECH will work with the HSEU to develop a training program for tutors of the nursing schools

and of the Medex and community health worker programs of the Ministry of Health. This is in direct

response to the serious shortage of qualified HCW trainers in Guyana. I-TECH will facilitate the

development of a Health Sciences Tutors curriculum to rapidly produce trained educators for the Ministry of

Health's training divisions. The main objective of this initiative is to impart to new and existing pre-service

tutors knowledge in educational psychology and adult learning methodology. Additionally skills in curriculum

development, measurement and evaluation in education and education administration will also be

developed. The six-month part-time curriculum will be created to facilitate the participation of senior nurses

without adversely affecting their daily schedule. Emphasis will be on training tutors from the Linden and

New Amsterdam nursing schools. I-TECH will support this work through a partnership between local and

Seattle-based curriculum developers, drawing upon existing training and faculty development resources

from I-TECH's global network but with the majority of the work being executed locally.

Since July of 2007, the Guyana National Training Coordination Centre (GYNTCC) is located within the

Ministry of Health Annex, Liliendaal. This co-location facilitates a strong relationship between the GYNTCC

and the Health Sciences Education Unit (HSEU). Through this collaboration I-TECH will build HSEU

capacity to maintain a database of health care providers and their relevant training received to date. In

2008, I-TECH introduced TrainSMART, a web-based database that tracks the numbers of HIV-related

training events, trainers and trainees in Guyana. It includes data from I-TECH, PEPFAR training partners

and the Government of Guyana. This data can be used for various purposes including reporting, assessing

coverage gaps and/or duplication of training provided to the health workforce, and supporting rational

planning for training interventions. I-TECH will intensify its efforts to have the database customized to

include pre-service training and the type of reports commonly required in Guyana. Finally to assure the

integrity of the database across time as it transitions into the national system, I-TECH will develop protocols

and paradigms for the management and use of the database that are consistent with internationally

accepted standards.

I-TECH will continue to support the national HIV/AIDS website. The site, which has been operational since

fall 2005, serves as a primary communication tool and a resource for health professionals, donors,

implementing partners and the general public. Funding supports the Webmaster who provides continual

improvement to and maintenance of the site. I-TECH through the Guyana National HIV Training and

Coordination Committee (GYNTCC) will also maintain a national training calendar so events are timely, not

redundant and do not overlap.

Funding is from HHS/HRSA and in-country oversight resides with the CDC Office which provides technical

and administrative support.

Deliverables/Additional Targets:

•HIV/AIDS content integrated into core pre-service curriculum for medical, pharmacy, medical technology

and nursing students at UG and Medex at HSEU.

•Training of Health Sciences Tutors

•Training Database updated to track human resources and training and upgraded to provide customized

reports for MOH and other stakeholders

•HIV/AIDS website

•Training calendar updated on a quarterly basis

Proposed New Activities

1.Expanded training of Medex in the interior of Guyana in HIV/AIDS:

Medex are critical HCWs in the remote areas of Guyana and have not been primary targets for standardized

HIV training. In FY08, I-TECH developed an in-service HIV/AIDS training curriculum that was piloted with a

limited number of accessible Medex. The crucial role of the Medex in the health management of several

dispersed hinterland communities places many of them at a training disadvantage as they cannot readily

leave their communities for long periods of time. Consequently, I-TECH proposes to work along with HSEU

to provide in-service HIV training to all in-service Medex in three clusters across the 10 regions. Likewise

both to promote the integration of their new knowledge and skills into clinical practice and to establish a

system for sustainable clinical quality assurance, I-TECH will work with HSEU and the MOH/NAPS to

develop a standardized program for mentoring Medex in the field using both on-site and distance education

approaches.

Deliverables/Additional Targets:

Activity Narrative: •All Medex trained with the HIV/AIDS for Medex standard curriculum developed by I-TECH at a regional

level.

•A program for mentoring Medex in HIV/AIDS management in the field implemented.

2.Development of standardized STI curriculum for Physicians, Nurses, and Medex.

Quality STI treatment services are an important component of HIV prevention and treatment programs.

Training in STI management may lead to improved services, resulting in reduced HIV transmission in

Guyana. Since being established less than two years ago, the national STI program, has been conducting

training sessions for HCWs at many care and treatment sites with a single trainer. To ensure sustainability

and high quality of training, the National Aids Programme Secretariat (NAPS) of the MOH has requested

assistance from I-TECH with the development of an STI curriculum for in-service HCWs consistent with the

standards and format of the previously-developed standardized HIV curricula for training of Nurses,

Pharmacists and Medex.

Deliverables/Additional Targets:

•Standardized in-service STI curriculum for Physicians, Nurses and Medex.

3.Expanded training of Nurses and Medex in computer literacy.

There is increasing availability and use of training resources, patient management tools, such as the

Guyana Health Information System (GHIS), and other systems in an electronic format. The MOH has

recognized the importance of computer literacy for all its nurses and Medex and views the training of MOH

staff as a priority to improve efficiency. I-TECH proposes to compliment the limited MOH resources for this

training with the provision of 4 desktop computers and to fund the training costs for 100 nurses and Medex

in the next year.

Deliverables/Additional Targets:

•MOH IT training room furnished with 4 additional computer systems

•100 computer-literate nurses and Medex

New/Continuing Activity: Continuing Activity

Continuing Activity: 12726

Continued Associated Activity Information

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

System ID System ID

12726 8492.08 HHS/Health University of 6272 4792.08 ITECH $324,458

Resources Washington

Services

Administration

8492 8492.07 HHS/Health University of 4792 4792.07 ITECH $294,458

Resources Washington

Services

Administration

Emphasis Areas

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $200,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Program Budget Code: 19 - HVMS Management and Staffing

Total Planned Funding for Program Budget Code: $2,169,763

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

In FY09 the total Emergency Plan commitment to Guyana will be just over $19 million with the inclusion of Track One funding. The

Management and Staffing costs are close to the earmark of 7%, but exceeds this earmark by XXX% (down from 2.7% in FY07

and 1.4% in FY08). The Emergency Plan is nearly entirely staffed now, as outlined in the functional staffing chart. The PEPFAR

program in Guyana is managed and staffed by an experienced group of experts in health and development. From the beginning of

the PEPFAR program in Guyana the USG agencies have worked under the leadership of the Chief of Mission to collaboratively to

set goals, develop strategies to achieve these, and identify the appropriate partners. The Guyana PEPFAR team continues to

work in this fashion.

It was expected that in FY07 Guyana would receive a Management and Staff team visit to assess the country staffing level and

assist the country to identify staffing needs and various options to meeting those. This team visit has still not occurred, but is still

seen as a critical activity.

Although the formal SFR has not been conducted, the Guyana team continually assesses the staffing needs within each agency

and has made changes that reflect a move to appropriate staffing and support at current and level funding. This includes the

elimination of some positions at the CDC office and a change of hiring mechanism for an SI officer at USAID. CDC has also

changed the focus of the PSC position to reflect the higher priority for technical assistance at the NPHRL. USAID and CDC

continue to share the SI activity and have agreed that CDC is the lead agency and will support the senior SI officer while USAID

will employee an SI officer; the two officers will work together as the PEPFAR Guyana SI team.

Under the leadership of the US Ambassador, the USG team meets on a bi-weekly basis to facilitate the plan's design,

implementation, and monitoring and evaluation. In addition, the full USG team and all its implementing partners meets on a

monthly basis with key officials from the Ministry of Health and institutional contractors to review progress and coordinate efforts.

There are four USG implementing agencies making up the Country Team for Guyana's Emergency Plan: USAID, DHHS/CDC

Global AIDS Program, Peace Corps and DOD. Each agency within this initiative operates from a different technical expertise and

administrative system, but is committed to coordinating their efforts.

DOS

In FY08, the PEPFAR program in Guyana will continue to follow the leadership of Ambassador Jones. The hiring of an FSN

PEPFAR Coordinator is proposed. Staffing will also continue to include a part-time PEPFAR public affairs officer. Funds for the

Ambassador's Fund will once again be allocated to CDC who will maintain the role as coordinator of the Ambassador Funds and

will manage and coordinate the process in FY08 in collaboration with USAID and DOS.

USAID

In FY09, the USAID will oversee approximately $XXX million in Emergency Plan-funded programming in the following COP

Program areas: 1) PMTCT; 2) AB; 3) Condoms and Other Prevention; 4) Palliative Care; 5.) Counseling and Testing; 6) OVC; 7)

ARV Drugs; 8) Strategic Information; and 9) System Strengthening. In addition, USAID will provide in-country support and

oversight for the Track 1 Injection Safety and Red Cross AB initiatives which is managed out of USAID Washington and

scheduled to phase out in FY09..

The USAID Mission is led by the Mission Director and includes program portfolios in Health, Democracy and Governance, and

Economic Growth, where expanded teams collaborate across development sectors to increase cross-fertilization. USAID operates

out of the US Embassy and relies on the USAID Regional Contracting and Controller Officers from Santo Domingo. The health

portfolio underwent a program assessment in FY08 and now follows the new five-year strategic objective (2009-2013) and signs

annual, bilateral strategic objective agreements with the Government of Guyana. The programmatic portfolio also follows

guidance approved in the Mission Performance Plan as well as tracks program implementation and impact through the Mission

Management Plan. A cognizant technical officer is assigned to each contract, and a technical lead is also assigned for each

USAID-Washington contract or field support mechanism that USAID/Guyana utilizes.

HHS/CDC

In FY08, the CDC Guyana office will oversee approximately $XXX million in Emergency Plan-funded programming in the following

COP Program Areas: 1) HIV/AIDS Treatment: ARV Services; 2) Palliative Care: Basic Health Care and Support; 3) Strategic

Information; 4) Laboratory Infrastructure; 5) Abstinence and Be Faithful Programs; 6) Condoms and Other Prevention Activities; 7)

Palliative Care: TB/HIV; 8) Treatment Services. In addition, the CDC Guyana office will provide oversight for the Track 1 Blood

Safety initiative ($1,250,000) which is managed out of CDC Atlanta. CDC Guyana will also continue its direct technical support,

where appropriate, to USAID, the Peace Corps and the Military Liaison Office (MLO).

Peace Corps

After returning to Guyana in 1995, Peace Corps has played an active role in providing volunteers for Education and Health sector.

Every Peace Corps volunteer in Guyana has been trained in combating HIV/AIDS. Peace Corps has a distinctive advantage since

most volunteers are in small villages and can provide one-on-one service. Currently, 67 Peace Corps volunteers are involved in

ABC program, PCMTCT, OVC, and palliative care, but they are not funded under PEPFAR. However, four Crisis Corps

Volunteers are funded under PEPFAR. In order to support these volunteers, it will be imperative for Peace Corps to have a core

of two positions focused on facilitating efficient program implementation and oversight.

DOD

The Department of Defense will have its first health sector in-country presence, with continuing support from the Military Liaison

Officer at the US Embassy and a DOD technical support team located in Florida at Southern Command. DOD will continue to

implement directly through the partnership with the Guyana Defense Force (GDF) to strengthen human capacity, their

organizational structure, and finalize a written policy to run HIV/AIDS programs.

DOL

The Department of Labor does not have an in-country presence, but the Department of State Economic Officer in collaboration

with the PEPFAR coordinator serve as the point of contact for the involvement of DOL. Their programs are implemented directly

by the International Labor Organization.

Table 3.3.19: