Program area: ARV services

Funding Mechanism: HHS

Partner: Center for Diseases Control and Prevention

Level of funding:$

Summary: With Fiscal Year (FY) 2008 funding, CDC will continue to strengthen the system of HIV care and

treatment in Haiti by focusing on assisting the Ministry of Health (MOH) and stakeholders, to plan,

coordinate and supervise different QA/QI programs. This activity will build on CDC's efforts to hire care and

treatment and information technology (IT) regional specialists. This activity will also add to the MOH's efforts

to provide human resources and logistic support to reinforce departmental directorates for better

coordination and supervision at the departmental level. Allocated resources will be used to hire CDC

regional specialists, as well as to cover logistic costs and per diem for their travel and participation in

training (both within and outside of the country).

Background:

As the treatment program is expanded, the United States Government (USG) is reinforcing coordination,

supervision and QA/QI at all levels. Resources are given to the MOH departmental directorates to build a

team that could oversee and supervise the treatment program at the departmental level. Regional hospitals

are being reinforced with mobile teams that the USG expects to become the technical arm of the

departmental directorates in mentoring and supervising peripheral sites. In addition, HIVQUAL has provided

resources to work with the MOH to launch a standard national system of QA/QI with adequate tools to

collect data and ensure continued improvement in the provision of treatment services. CDC will reinforce, at

the departmental level, the technical capacity for coordination, training, and mentoring particularly in the

regional public departmental hospitals which suffer from serious lack of human resources.

So far, three physicians, specialized in internal medicine, have been hired to fill the care and treatment

specialist positions in three departments (South, Grand'Anse and South East) working under the

supervision of the CDC/Haiti care and treatment specialist. These regional specialists have been very active

in making rounds within the internal medicine and infectious disease units of HIV care at the departmental

hospitals. They are providing technical support (hands on training and supervision) to expand care and

treatment to satellite sites and are working with the departmental staff to coordinate the program. As the

QA/QI program is rolled out through HIVQUAL, these specialists will play an important role in its

implementation. Treatment program funds have been used to support the costs of in-country travel for these

specialists. Funds have also been used to support training costs outside of the country as well.

With FY 2008 resources, three new treatment regional specialists will be hired and based in three additional

departments: North, Artibonite and North West. The resources planned through this activity narrative will be

used to cover salaries of the six regional specialists as well as their travel costs for supervising and

participating in training in and outside of the country for continuing education purposes. Part of these

resources will be used also to cover travel costs for health professionals from the MOH and other partners

who will be invited to participate in PEPFAR's international gatherings.

ACTIVITIES and EXPECTED RESULTS

ACTTIVIY I: Funding will support salaries of the six care and treatment specialists (three old and three

new), as well as their logistic costs and per diem for in-country travel for supervising and mentoring

activities, and for international travel to participate in international conference and training. Logistic support

will include procurement and maintenance of new vehicles that will be assigned to each department.

ACTIVITY 2: Funding will be used to support international travel for guest partners to participate in

international conferences and trainings.

ACTIVITY 3: Resources will be used to procure training material and equipment to support training sessions

held by the regional specialists.

ACTIVITY: 4 CDC will ensure linkages of these activities to those supported by PEPFAR and the Global

Fund to improve coordination at central and departmental levels and HIVQUAL to expand in Haiti a national

QA/QI system for care and treatment.

INTEGRATED ACTIVITY FLAG:

This activity also relates to the Ministry of Health (MOH) and the National Public Health Laboratory (NPHL)

narratives in Laboratory Infrastructure, and to the following President's Emergency Plan for AIDS Relief

(PEPFAR) program areas conducted by the Association of Public Health Laboratories (APHL) and the

United States Agency for International Development's (USAID) Energy team: prevention of mother to child

transmission (PMTCT), anti-antiretroviral (ARV) Services, palliative care, and counseling and testing (CT).

SUMMARY: This activity will strengthen the Ministry of Health's (MOH) national laboratory network capacity

by helping to establish pediatric diagnostic testing using 2 methods: the standard dried blood spot

polymerase chain reaction (DBS PCR) and the alternative ultra-sensitive protein 24 (p24) antigen assay.

CDC will also help establish a quality assurance/quality control program (QA/QC) for such testing as well as

provide assistance in selecting/developing the laboratory information management system (LIMS). The

Laboratory Technical Working Group at the Office of the Global AIDS Coordinator (OGAC) led by CDC

Global AIDS Program (GAP) International Laboratory Branch and other United States Government (USG)

senior staff recommends the use of DBS PCR (Amplicor Deoxyribonucleic acid (DNA) PCR) testing for early

infant diagnosis (EID). This recommendation was endorsed by the World Health Organization (WHO) and

the United Nations Children's Fund (UNICEF)/CDC in May 2006.

ACTIVITY AND EXPECTED RESULTS:

Activity 1: At no direct cost to the USG Haiti, the CDC/GAP International Laboratory Branch at the CDC HQ

will continue to provide technical assistance to Groupe Haitien d'Etude du Darcome de Kaposi et des

Infections Opportunistes (GHESKIO), NPHL and Partners in Health (PIH) laboratory personnel to monitor

the performance of the partners in conducting EID by DBS PCR test, as well as the ultra-sensitive p24

antigen tests. GHESKIO, the NPHL, and the PIH lab staff will continue to receive refresher training for

method validation, data analysis, results reporting, and troubleshooting. GHESKIO, NPHL and PIH will

enroll in the CDC QA/QC proficiency testing program for EID by DBS PCR, run by CDC Atlanta

laboratories. CDC Atlanta will also provide oversight to the NPHL /ASCP QA/QC program in CD4,

hematology and blood chemistry and assist the NPHL and to oversee the International Training and

Education for HIV (I-TECH) LIMS program (computer and paper-based reporting system) at 10 ARV sites.

The involvement of CDC Atlanta will help to standardize laboratory program activities globally.

Activity 2: CDC/Haiti will support five staff from NPHL and/or the public health laboratory network to attend a

two-week study tour at selected institutions in HIV/AIDS related laboratory subjects. CDC will support an

additional five national laboratory network staff for an external study tour on maintenance and repair of

automated and basic laboratory instruments. CDC will support the USG laboratory team staff to travel within

the country for supervisory visits, and to monitor and evaluate the progress of the program. Given the weak

human capacity in clinical laboratory science, CDC/Haiti recognizes the value of hands-on learning gained

through site visits to laboratories with similar conditions. CDC/Haiti thus will support the NPHL laboratory

network staff and USG laboratory staff to attend scientific workshops, conferences and/or site visits to

similar PEPFAR countries.

Activity 3: This funding supports CDC/Haiti's full time, US direct hire (USDH) Laboratory Section Chief. This

is not a "new position" but rather a change of hiring mechanisms for the person who is currently in the

position.

TARGETS:

•One GHESKIO, one NPHL and one PIH lab staff trained in early infant diagnosis

•Three pediatric diagnosis labs established and operated in the country.

•GHESKIO, the NPHL and PIH participated in the DBS PCR QA/QC program

•Laboratory Information System program guided and implemented

•Ten members of NPHL and its laboratory network and the USG laboratory team trained in laboratory

methods and participated HIV-related laboratory scientific conferences

•One Laboratory Section Chief (USDH) hired

EMPHASIS AREAS:

-NPHL and ASCP activities for QA/QC in CD4, hematology and blood chemistry

-NPHL and I-TECH activities for LIS (computer and paper based)

-Early Infant Diagnosis (Implementation in the country)

INTEGRATED ACTIVITY FLAG:

Activities in this narrative are related to Institut Haitien de l'Enfance (IHE), International Training and

Education Center on HIV (I-TECH), and TULANE narratives in strategic information; I-TECH in policy and

systems strengthening and in counseling and testing (CT); prevention of mother to child HIV transmission

(PMTCT); anti-retroviral (ARV) services; palliative care; and policy analysis and systems strengthening.

SUMMARY: Funding has been earmarked this year to acquire offshore technical assistance for the country

team in the area of monitoring and evaluation. Emphasis will be put on shaping up the Monitoring and

Evaluation (M&E) plan for the next five years as well as on data usage. The country office will continue to

provide a selected range of support to the United States Government (USG) implementing partners in order

to sustain their capacity to develop HIV/AIDS strategic information system. This supply-driven support will

enable the USG to leverage the impact of its overall contribution to the national HIV/AIDS program. It

encompasses: (i) hands-on technical assistance to collaborating partners by USG regional health

information officers already established in Haiti's 10 regional departments. They will coordinate partner

interventions and provide support in those skill-intensive domains in short supply in the country; (ii) cross

technical assistance among sites within the concept of "Centers of Excellence" and; (iii) sponsorship of

participation of local indigenous staff at international forums, workshops, and seminars with the objective of

developing in-country expertise in strategic information (SI). The emphasis areas are IT, USG database and

reporting systems. The primary beneficiaries are the MOH staff, community based organizations (CBOs),

non-governmental organizations (NGOs), and other implementing organizations.

BACKGROUND: The USG has directly supported SI efforts since 2005 to ensure greater coordination of

activities including: 1) maintaining highly skilled professionals in the field that would not be otherwise

available; 2) consolidating investments in information technology and guaranteeing availability of data for

strategic information purposes. Five regional health information officers (RIOs) have been hired and

detailed to the regional departments of the country with each RIO covering more than one department. They

are seconded by the Ministry of Health (MOH) regional departments and travel throughout their assigned

region to provide support to the MOH, the sites, and local partners in health information systems

management, commodity and drug information management, and overall project management to ensure

that mechanisms are in place for the collection, processing, and analysis of data for decision making. RIOs

currently support 128 sites throughout the country.

In Fiscal Year (FY) 2006 and FY 2007, funding was provided to support participation of local personnel at

international forums, workshops, and seminars with the objective of fostering a new breed of local SI

professionals, capable of filling their responsibilities within the established SI system. Several of those who

attended offshore courses are now taking part as trainers or mentors to the ongoing M&E training programs.

ACTIVITES AND EXPECTED RESULTS: Activity 1: At no cost to the country team, CDC headquarters will

provide a range of technical assistance to the country team to support the formalization of an M&E plan, the

formulation of PHE themes and elaboration of corresponding protocols, and the use of data for decision

making using the various databases in place.

Activity 2: CDC Haiti will provide hands-on assistance through RIOs and cross-assistance among

participating sites. The five RIOs will travel throughout their assigned departments to support departmental

directorates, sites, and community-based local partners. To encourage best practices and foster sharing of

experiences, RIOs will encourage cross assistance among the sites, a practice by which the most

experienced field personnel at the referral sites travel to assist other personnel at peripheral sites.

The CDC, through the RIOs, will provide leadership in the development, rolling out and maintenance of the

data management system aimed at supporting the national HIV/AIDS program. Additionally, CDC will

establish local area and regional networks for sharing of information within and between entities

participating in the program and located in their coverage area; provide hands-on assistance and on the job

training to health care providers, field data personnel, and regional authorities to enable them to perform

data collection, reporting and processing duties; support the data quality assurance process and participate

in field data validation visits and quality assurance circles; lead reengineering effort to establish work and

data flow suitable to the easy collection of data in all sub-systems related to the development of the

program; participate in the establishment and maintenance of a management by objective system with

regular monitoring of established targets and by involving the sites, departmental directorates and partners;

and maintain good relationships, interface and coordinate efforts with local authorities, facility personnel,

and all USG partners developing interventions in their assigned areas.

Activity 3: The USG team will support the development of in-country SI expertise through sponsorship for

field personnel to international workshops. Such sponsorship in FY 2005 and FY 2006 led to greater

involvement and leadership from sponsored professionals. Opportunities will be sought to train people in

management of community-based information systems. Among other areas of interest are: M&E, HIV/AIDS

surveillance, tuberculosis (TB)/HIV surveillance, information technology, survey methodologies and

techniques for conducting Behavioral Surveillance Surveys (BSS), antenatal surveys and incidence reports,

and projections and estimation techniques.

Specifically, the USG team will regularly update the list of prospective training opportunities; identify

potential candidates in collaboration with the MOH and partners; work with selected participants on scope of

work to ensure application of workshops or seminar contents upon return; facilitate registration for

participants; support the logistics registration, room and boarding; and maintain a database of participants.

TARGETS:

150 of local organizations provided with technical assistance for SI

30 individuals trained in SI including M&E, surveillance and HMIS

EMPHASIS AREAS:

•Training

•Human resources

•Quality assurance / quality improvement and supportive supervision

•Monitoring, evaluation or reporting (or program level data collection)

•HIV Surveillance systems

•AIS, DHS, BSS or other population survey

TARGET POPULATIONS:

•Other MOH staff

•Implementing organizations

•Program managers

Activity Narrative: •Women

•Health care providers

COVERAGE AREAS:

•National

KEY LEGISLATIVE ISSUES:

Increasing gender equity in HIV/AIDS programs

The CDC Global AIDS Program (GAP) office opened in Port au Prince, Haiti in 2003 as a co-located office

on the USAID Mission campus. Since the inception of the President's Emergency Plan for AIDS Relief

(PEPFAR) program in Haiti in 2004, CDC's management and technical staff have worked in close

collaboration with the Population Health and Nutrition Unit (PHN) of USAID to jointly manage the planning

and implementation of the PEPFAR program. CDC's technical and managerial expertise has provided

assistance and training (including financial management) to both the Ministry of Health (MOH) and the

United States Government (USG)'s institutional partners. As CDC Haiti does not operate within a larger, in-

country agency context for its administrative support service, it has sole operational and financial

responsibility for its own contingency planning, meeting US security requirements, provision of workspace

(including internet access), recruitment and training of employees and housing support for USG Direct

Hires. This is in addition to costs incurred as CDC technical experts, located in the field as well as in Port-au

-Prince, work with USG partners to implement activities as outlined in the Country Operational Plan (COP).

Cost of Doing Business: IRM Tax

New HHS/CDC IT Policy Implementation: We anticipate additional costs associated with the move to the

NEC but no estimates are currently available until we actually move in for additional costs that may/may not

be required (particularly in the IT area, as we will be co-located in a secure Chancery for the first time,

which may have special computer/IT requirements). However, Management & Staffing funding in the

amount of $45,500 is included in this budget to support the mandated HHS-CDC IT conversion for CDC

Haiti management and administrative personnel.

Background: The CDC Global AIDS Program (GAP) office opened in Port au Prince, Haiti in 2003 as a co-

located office on the USAID Mission campus. Since the inception of the President's Emergency Plan for

AIDS Relief (PEPFAR) program in Haiti in 2004, CDC's management and technical staff have worked in

close collaboration with the Population Health and Nutrition Unit (PHN) of USAID to jointly manage the

planning and implementation of the PEPFAR program. CDC's technical and managerial expertise has

provided assistance and training (including financial management) to both the Ministry of Health (MOH) and

the United States Government (USG)'s institutional partners. As CDC Haiti does not operate within a larger,

in-country agency context for its administrative support service, it has sole operational and financial

responsibility for its own contingency planning, meeting US security requirements, provision of workspace

(including internet access), recruitment and training of employees and housing support for USG Direct

Hires. This is in addition to costs incurred as CDC technical experts, located in the field as well as in Port au

Prince, work with USG partners to implement activities as outlined in the Country Operational Plan (COP).

CDC and USAID, in a coordinated effort to ensure adequate technical coverage and avoid duplication of

human resources, have a complementary roster of technical advisors that is based on core institutional

competencies and experience. As of September 2007, thirty-seven (37) CDC staff members are 100%

supported by the PEPFAR budget, including (4) vacancies (one audit specialist; one procurement

assistant; one secretary; and regional care and treatment specialist). Of these 37 staff, three (3) are US

Direct Hires (USDH), including the Chief of Party, the Deputy Director, and the Laboratory Section Chief.

The fourth is a "CDC Personal Services Contractor (PSC)" who is the Prevention Section Chief. The

remaining staff, including 2 technical experts, is Locally Engaged Staff (LES). The Port-au-Prince CDC

office houses both professional (technical, financial, Information Technology (IT) staff, procurement and

inventory management) and support (secretaries and drivers) staff.

Approximately 30% of the staff, both professional and support oriented, are located in small, regional offices

throughout the country (e.g., Cap Haïtien and Saint Marc, in the north; Les Cayes; Jacmel; Jeremie, in the

south) in association with the MOH's Regional Departmental hospital system. The decentralization of CDC

staff at the regional department level is a reflection of CDC's lead role in PEPFAR care and treatment

implementation, and the need to institutionalize PEPFAR activities at the local MOH level to the maximum

extent possible. Moreover, given the ongoing security concerns in Haiti, the USG Team recognizes the

crucial need for program implementation to continue unhindered at the regional department level,

regardless of security situations which may occur in the capital. Decentralization is designed to permit

program implementation to continue, even if critical events result in further security interruptions, and other

management challenges.

In order to better implement the PEPFAR program with a goal of long-term program integration and

sustainability, CDC Haiti will undertake the following management activities in FY 2008: continue ongoing

USG team-building to assess specific training and development needs of our current employees; continued

staff recruitment for vacant field positions, especially care and treatment and health information specialists

to be located at the regional departmental level; continued attention to staffing needs within our technical

areas as well as identification of possible staffing gaps between CDC and USAID; continue to develop the

prevention section to work jointly with USAID counterparts in the area of prevention strategies for high risk

populations, with a Personal Services Contract(PSC)/Public Health Advisor, hired in FY 07, as Section

Chief; continue current warehouse operations, including laboratory storage, in partnership with the

Partnership for Supply Chain Management System (PSCMS) until they can fully undertake safe reception

and timely distribution of PEPFAR commodities throughout the country while maintaining the cold chain.

The current CDC warehouse was new in 2006, having been established when we were asked to leave the

US Embassy warehouse in 2005. The Airport Road site however, while in a better part of the insecure ‘red'

zone, is still subject to periodic security concerns; we expect to secure a new facility much nearer the new

Embassy construction area at Tabarre.

For the first time since the beginning of the PEPFAR program in 2004, CDC has a full roster of US Direct

Hire and PSC staff (total 4), and the Management and Staffing account will have to support salaries and

benefits (including housing) for these staff, requiring additional resources from previous years when there

were only 1-2 US staff. The Haiti PEPFAR team as part of the pilot for the "staffing for results" analysis

during FY 07 concluded that additional expertise is needed to fully coordinate activities for people with both

TB and HIV. This is the only new technical position being requested for CDC staffing in FY 08, although

CDC expects to provide housing costs for the new PEPFAR coordinator and SI Liaison. CDC also expects

to fill approved FY 07 vacancies which have never been staffed. (Note: a procurement assistant was

advertised and selected but was unable to secure a local security clearance; vacancies an

auditors/financial analyst and a secretary were held in abeyance due to a shortage of M&S funding during

FY 07. They will be filled in FY 08).

The move to the New Embassy Compound (NEC), which is scheduled for occupancy on March 29, 2008,

will be a costly one for all tenant agencies. In addition to the expected OBO Head Tax, levied on agencies

to "pre-fund" embassy construction, CDC was required to purchase in FY 07 fourteen (14) "desk units" for

the current professional staff at $24,000 a unit. Additional FY 08 Management and Support funding is

required to purchase desk units for support and logistics staff, in addition to new staff. These "desk units"

are provided by OBO and must be installed during the embassy construction process. Finally, the CDC

motor pool, initially procured in 2004 at the beginning of the program and which is used extensively in the

field on very difficult roads, is wearing out. In FY 08, we will purchase a new Lightly Armored vehicle (LAV)

and three non-armored vehicles.

Funds are reserved for staff training, travel for field program supervision and technical coordination in and

outside of Haiti. Commodity procurement includes purchase of additional office equipment. Infrastructure

expenses include security and related office upgrades, administrative expenses, including ICASS, as well

as internet costs. Logistics include staff overtime and vehicle maintenance, insurance and fuel.

Cost of Doing Business:

OBO Head Tax: The CDC/Haiti estimated Overseas Building Office (OBO) Head Tax, a pro rata budget

support to defray the costs of construction of the New Embassy Compound (NEC), nearing completion on

the other side of Port-au-Prince, is $300,000. The NEC schedule is currently on track and initial move-in

dates are schedule for March 29, 2008. With FY 2007 Management and Support funding, CDC was

mandated to purchase from the Overseas Building Office (OB0) approximately $322,000 for furniture and

furnishings for 14 "desk units" (4 hard wall office and 10 cubicles) for key staff.

New HHS/CDC IT Policy Implementation: We anticipate additional costs associated with the move to the

NEC but no estimates will be available until we actually move in for additional costs that may/may not be

required (particularly in the IT area, as we will be co-located in a secure Chancery for the first time, which

may have special computer/IT requirements). However, Management & Staffing funding in the amount of

$45,500 has been considered in formulating this budget (see separate activity narrative for IRM tax) to

support the mandated HHS-CDC IT conversion for CDC Haiti management and administrative personnel.

Activity Narrative: Funding to support the HHS/CDC IT conversion for program personnel is included in their respective

programs.

Early Funding Request:

Per instructions from CDC Headquarters, Posts are requested to include early funding requests in their

FY08 Country Operating Plans (COPs), so that adequate Management and Support funding will be in place

until the first Congressional Notification is approved/processed, which is estimate to be on/about April, 30

2008. During this period, the CDC Haiti office requires $2,538,600 (combined GHAI and Core funding) to

support the costs of salaries and benefits, administrative costs, overhead costs ("cost of doing business")

and some transitional funding for the planned move to the new embassy compound, scheduled for March

2008.

Background:

The CDC Global AIDS Program (GAP) office opened in Port au Prince, Haiti in 2003 as a co-located office

on the USAID Mission campus. Since the inception of the President's Emergency Plan for AIDS Relief

(PEPFAR) program in Haiti in 2004, CDC's management and technical staff have worked in close

collaboration with the Population Health and Nutrition Unit (PHN) of USAID to jointly manage the planning

and implementation of the PEPFAR program. CDC's technical and managerial expertise has provided

assistance and training (including financial management) to both the Ministry of Health (MOH) and the

United States Government (USG)'s institutional partners. As CDC Haiti does not operate within a larger, in-

country agency context for its administrative support service, it has sole operational and financial

responsibility for its own contingency planning, meeting US security requirements, provision of workspace

(including internet access), recruitment and training of employees and housing support for USG Direct

Hires. This is in addition to costs incurred as CDC technical experts, located in the field as well as in Port au

Prince, work with USG partners to implement activities as outlined in the Country Operational Plan (COP).

Cost of Doing Business:

ICASS. The CDC/Haiti estimated ICASS bill for FY 2008 is $600,000, per estimates received form the US

Embassy Port-au-Prince Budget and Finance (B&F) staff. The PEPFAR program is the only program-

funded activity in the CDC Haiti office, and we are totally supported by the US Embassy, through ICASS, for

the "full package" of ICASS services. These services include: motor pool for US personnel, GSO housing

and maintenance for US personnel, Payroll and related HR activities for LES personnel, diplomatic pouch

services for US personnel, airport expediting services for US personnel and visiting TDYers, accounting and

vouchering for both US and LES personnel, provisioning of drinking water and residential water for US

personnel, mandatory armored shuttle service to/from office for US personnel, and regional security support

for US personnel and TDYers.