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.
Years of mechanism: 2007 2008 2009
With FY09 funds, USG technical staff will be supported (salaries, travel, administrative support) to provide
technical assistance, in collaboration with program management staff and HQ technical staff, for the design,
implementation, and evaluation of PEPFAR-funded interventions aimed at preventing mother-to-child HIV
transmission. This technical assistance is provided in consultation with relevant ministries (Family, Women,
and Social Affairs; Health; Fight Against AIDS), non-governmental organizations, multinationals, and
bilateral organizations.
Ongoing specific activities will include:
1. Supporting the implementation and coordination of PMTCT activities among donors and partners (e.g.
UNICEF, UNAIDS, UNDP, and PEPFAR-funded partners, and technical ministries)
2. Providing laboratory support at Projet RETRO-CI for quality point-of-service HIV testing with quality
assurance at PMTCT sites, purchasing of laboratory commodities and supplies, training of peripheral-site
staff, supervision, and quality-assurance services
3. Participating in the PMTCT working group and assisting the MOH to develop innovative approaches for
rapid scale-up, including:
• A district approach with strengthening of PMTCT monitoring and evaluation at the district and site levels, in
collaboration with Retro-CI/SI, Measure Evaluation, the MOH M&E unit (DIPE), and other key partners
• Early infant HIV diagnosis by PCR, in collaboration with Retro-CI/Lab and CDC HQ
• Routine HIV counseling and testing in ANC services
• Rapid testing in labor-and-delivery services
• Linkages with care and treatment
4. Providing technical assistance to the MOH and national experts to complete the validation, dissemination,
and regular updating of PMTCT policies and guidelines, with anticipated revisions related to couples
counseling, HIV testing algorithms, infant feeding, and reaching women during and after labor
5. Establishing a regular exchange involving EGPAF, ACONDA-VS. Columbia-ICAP, the CDC/USAID
country team, and other key partners to follow PMTCT activities, focusing on major points such as
commodities management at the central and the district levels, longitudinal postnatal follow-up of
mother/infant and linkages with pediatric care, and coordination with other partners (UNICEF, PATH,
UNFPA, WFP, ANADER, Care International, and PLWHA organizations)
6. Assisting EGPAF, ACONDA-VS, Columbia-ICAP, and a new PMTCT partner to develop new
partnerships with the public and private sectors, FBOs, and CBOs to expand PMTCT activities nationwide
New/Continuing Activity: Continuing Activity
Continuing Activity: 15160
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15160 5161.08 HHS/Centers for US Centers for 7066 5554.08 CDC-RETRO-CI $96,000
Disease Control & Disease Control GHAI
Prevention and Prevention
10133 5161.07 HHS/Centers for US Centers for 5554 5554.07 CDC-RETRO-CI $100,097
5161 5161.06 HHS/Centers for US Centers for 3605 3605.06 CDC & RETRO- $353,563
Disease Control & Disease Control CI (Base)
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
implementation, and evaluation of PEPFAR-funded behavioral interventions aimed at influencing HIV-
related behaviors, with primary emphasis on efforts to promote abstinence, fidelity, delay of sexual debut,
partner reduction, and related social norms. This technical assistance is provided in consultation with the
Ministry for the Fight Against AIDS, other technical ministries (Education, Health, Social Affairs, Human
Rights, Youth and Sport, etc.), non-governmental organizations (NGOs), multinationals, and bilateral
organizations.
- Participation in the behavior change communication (BCC) technical group and assistance, in
collaboration with JHU/CCP, in the harmonization and standardization of BCC tools.
- Support for implementation of the life-skills curricula
- Identification of opportunities for targeted BCC.
- Supervision of official needs assessments.
- Coordination of activities among donors and partners, including UNICEF, UNAIDS, UNDP, and PEPFAR-
funded partners Care International, FHI, PSI, ANADER, JHU/CCP, and the ministries responsible for
Education, Social Affairs, Health, and AIDS coordination.
- Development of a communications strategy, in coordination with JHU/CCP and REPMASCI (network of
media professionals and artists against AIDS in Cote d'Ivoire), to promote HIV prevention.
PEPFAR CI will continue to support RIP+ (network of PLWHA organizations), REPMASCI, and COSCI
(NGO collective against HIV, representing more than 400 organizations). PEPFAR CI will also continue to
support faith-based organizations (ARSIP, an interfaith alliance of religious leaders), youth organizations,
and other community activists and leaders in mobilizing their communities for the promotion of abstinence,
fidelity, delay of sexual debut, and partner reduction in their communities.
Continuing Activity: 15167
15167 5162.08 HHS/Centers for US Centers for 7067 5383.08 CDC & RETRO- $550,000
10132 5162.07 HHS/Centers for US Centers for 5383 5383.07 CDC & RETRO- $349,878
5162 5162.06 HHS/Centers for US Centers for 3605 3605.06 CDC & RETRO- $302,461
* Addressing male norms and behaviors
* Reducing violence and coercion
Table 3.3.02:
implementation, and evaluation of PEPFAR-funded behavioral interventions designed to influence HIV-
related behaviors, with a primary emphasis on sexual prevention for HIV-positive, at-risk, and highly
vulnerable populations, such as professional and transactional sex workers, uniformed services and ex-
combatants, truckers, and prisoners. This technical assistance is provided in consultation with the Ministry
for the Fight Against AIDS, other technical ministries (Education, Health, Social Affairs, Human Rights,
Youth and Sport, etc.), non-governmental organizations (NGOs), multinationals, and bilateral organizations.
and other community activists and leaders in mobilizing their communities for the promotion of a
comprehensive ABC approach to HIV prevention.
Continuing Activity: 15168
15168 10345.08 HHS/Centers for US Centers for 7066 5554.08 CDC-RETRO-CI $50,000
10345 10345.07 HHS/Centers for US Centers for 5383 5383.07 CDC & RETRO- $15,000
Table 3.3.03:
With FY09 funds, USG technical staff will be supported (salary, travel, administrative support) to provide
implementation, and evaluation of PEPFAR-funded interventions designed to ensure a safe supply of blood
in Cote d'Ivoire. This technical assistance is provided in close consultation with relevant ministries (Health,
Fight Against AIDS) as well as NGOs, multinationals, and bilateral organizations.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.04:
implementation, and evaluation of PEPFAR-funded interventions designed to promote the safety of medical
injections in Cote d'Ivoire. This technical assistance is provided in close consultation with relevant ministries
(Health, Fight Against AIDS) as well as NGOs, multinationals, and bilateral organizations.
Table 3.3.05:
implementation, and evaluation of PEPFAR-funded interventions designed to strengthen care and support
programs for people living with HIV/AIDS in Cote d'Ivoire. This technical assistance is provided in close
consultation with relevant ministries (Health, Fight Against AIDS) as well as NGOs, multinationals, and
In the area of adult care and support, the country team will provide ongoing technical assistance to support
the integration and scale-up of prevention, diagnosis, and treatment of HIV/AIDS and opportunistic
infections, including TB, malaria, and STIs; provision and distribution of cotrimoxazole for all HIV-positive
patients; basic pain management; insecticide-treated bed nets; interventions to improve hygiene and water
safety; and psychosocial support.
Continuing Activity: 17297
17297 17297.08 HHS/Centers for US Centers for 7066 5554.08 CDC-RETRO-CI $75,000
Program Budget Code: 09 - HTXS Treatment: Adult Treatment
Total Planned Funding for Program Budget Code: $15,594,132
Total Planned Funding for Program Budget Code: $0
Table 3.3.09:
implementation, coordination, and evaluation of PEPFAR-funded interventions designed to improve
treatment services for people living with HIV/AIDS in Cote d'Ivoire. This technical assistance is provided in
close consultation with relevant ministries (Family, Women, and Social Affairs; Health; Fight Against AIDS)
as well as NGOs, multinationals, and bilateral organizations.
Continuing Activity: 15171
15171 5168.08 HHS/Centers for US Centers for 7067 5383.08 CDC & RETRO- $575,000
10350 5168.07 HHS/Centers for US Centers for 5383 5383.07 CDC & RETRO- $658,391
5168 5168.06 HHS/Centers for US Centers for 3605 3605.06 CDC & RETRO- $1,004,379
implementation, and evaluation of PEPFAR-funded interventions designed to improve the lives of orphans
and other vulnerable children (OVC) and families affected by HIV/AIDS in Cote d'Ivoire. This technical
assistance is provided in close consultation with relevant ministries (Family, Women, and Social Affairs;
Health; Fight Against AIDS) as well as NGOs, multinationals, and bilateral organizations.
USG technical staff contributes to the development and implementation of policies and programs pertaining
to OVC populations and ensures the ongoing development of programs to improve service-delivery
systems. USG staff provides technical support to partners to expand quality services for OVC and their
families and provides technical assistance in program design, supervision, and monitoring and evaluation of
PEPFAR-supported OVC activities.
Continuing Activity: 15162
15162 5164.08 HHS/Centers for US Centers for 7066 5554.08 CDC-RETRO-CI $160,000
10347 5164.07 HHS/Centers for US Centers for 5554 5554.07 CDC-RETRO-CI $376,530
5164 5164.06 HHS/Centers for US Centers for 3605 3605.06 CDC & RETRO- $273,423
Table 3.3.13:
implementation, and evaluation of PEPFAR-funded HIV counseling and testing interventions. This technical
assistance is provided in close consultation with relevant ministries (Health, Fight Against AIDS) as well as
NGOs, multinationals, and bilateral organizations.
USG technical assistance contributes to the strengthening of national guidelines and adoption of routine
testing policies at health facilities. USG staff consults with the national CT technical working group, expert
HIV laboratory committee, and other technical forums to assure the quality of decentralized HIV CT
services. USG staff are providing ongoing technical assistance for the inspection and supervision of HIV
testing services performed at peripheral sites.
USG staff will provide assistance in implementing the new national whole-blood finger-prick rapid testing
algorithm. Other activities will include technical assistance to the Ministry of Health and other partners to
improve the quality and monitoring of counseling and testing through evaluation of existing CT services.
USG staff will provide technical assistance to strengthen training for professional health workers,
professional counselors, lay counselors, and lab technicians.
Continuing Activity: 15170
15170 5166.08 HHS/Centers for US Centers for 7067 5383.08 CDC & RETRO- $105,000
10348 5166.07 HHS/Centers for US Centers for 5383 5383.07 CDC & RETRO- $96,750
5166 5166.06 HHS/Centers for US Centers for 3605 3605.06 CDC & RETRO- $79,067
Table 3.3.14:
With FY07 funds, Projet RETRO-CI, the CDC-MOH collaborative USG-funded project, will continue its
support to the tiered MOH national public health laboratory system and will reinforce the institutional
capacity and the coordination role of the national HIV, TB, and malaria programs in building sustainable
national infrastructure, managerial and technical workforce capacity and expanding services to provide
quality diagnostic testing, clinical laboratory monitoring of treatment, and surveillance.
While building capacity at the national reference laboratories, RETRO-CI will continue to provide HIV
reference testing and quality assurance to support quality services within the national laboratory network. A
major and expanding activity is the progressive transfer of competence and technologies to the designated
national reference laboratories to provide the minimum package of HIV laboratory services at all levels
nationwide. RETRO-CI's technical assistance will support achievement of both PEPFAR country goals and
national strategic plan goals. In support of the effort to scale up HIV testing, RETRO-CI will complete the
assessment and operationalization of a simplified rapid HIV testing algorithm and the assessment and
operationalization of the new CDC Rapid HIV Testing Logbook. In support of the scale-up of early infant
diagnosis, RETRO-CI will provide DNA PCR services for conventional and DBS whole-blood specimens.
RETRO-CI will continue to support the laboratory component of strategic information activities, including
HIV testing and analysis of the 2007 national antenatal sero-prevalence survey and sentinel surveillance of
transmitted and emerging HIV drug resistance as part of the treatment program evaluation. These activities
will be implemented in collaboration with the MOH national HIV and TB programs (PNPEC and PNLT), the
national reference laboratory (LNSP), the national TB reference laboratory (Institute Pasteur CI), the UFR of
Pharmacy and Medicine, the national training institution of health care workers (INFAS), the National Blood
Bank, the WHO, HHS/CDC/HQ, CDC international laboratory cooperative agreement partners, and all
relevant PEPFAR implementing partners and stakeholders.
In FY08, activities will be based on lessons learned from the implementation of FY07 activities. A principal
activity will be the collaborative development of a five-year strategic laboratory plan that will serve as the
basis for the development of a sustainable national laboratory system. In addition, RETRO-CI will
concentrate on the following priority activities in an effort to scale up quality lab services supporting HIV
prevention, care, and treatment programs:
Support of laboratory networks and integrated laboratory services by:
1. Supporting the rapid scale-up of HIV testing services to improve access at CT, PMTCT, TB/HIV, and care
and treatment sites throughout the country. This support will consist of:
- Implementing at all PEPFAR-supported medical and non-medical sites simplified whole-blood finger-prick-
based rapid-testing algorithms
- Assessing the proficiency of non-laboratory professionals (nurses, midwives, lay counselors) to perform
HIV rapid-testing algorithms and related QA activities
- Providing recommendations for any changes needed in the national HIV testing policy based on these
assessments
2. Supporting expansion to access of biological monitoring for patients on ART at all levels by conducting
and promoting field validation of simple technologies at the point of care where appropriate
3. Supporting the MOH by creating a specimen referral system from sites without laboratories to regional
laboratories. This will include a system for the timely reporting of site laboratory results to the reference
laboratory
4. Implement the logbook for HIV rapid testing developed by CDC at all HIV testing sites to standardize
reporting of results.
5. Providing TA for the roll-out of early diagnosis of HIV infection in HIV-exposed infants at 6 weeks-12
months (at least 6 weeks after cessation of breastfeeding) by DNA PCR using dried blood spot specimens
at all PMTCT sites and immunization clinics. This will be achieved by:
- Transferring DNA PCR technology using DBS to three central laboratories (CeDreS, IPCI, CIRBA)
- Providing test kits and supplies for testing up to 10,000 HIV-exposed infants
- Collaborating with the MOH to review and change policies on early infant diagnosis to reduce the need for
costly DNA PCR testing by performing early HIV rapid testing on infants before 12 months.
6. Provide TA to build appropriate reference testing capabilities and facilities within the LNSP. This will
include providing assistance for the coordination of an external quality assessment program for HIV
serology in collaboration with ASCP for the development of a laboratory quality system.
7. Providing TA to the national TB program for the provision of HIV CT at all TB centers. This will include
training of CAT and CDT staff on HIV testing and QA/QC and training and coaching of TB supervisors for on
-site supervision of CT services.
8. Supporting ART clinical laboratory monitoring for HIV-infected patients at the infectious diseases
department (SMIT) and outpatient clinic (USAC) of the university teaching hospital of Treichville, Mèdecins
Sans Frontières (MSF), and other treatment sites according to national guidelines by providing lab services
for: full blood count (FBC), CD4 + T-cell count, full chemistry including but not restricted to liver enzymes
(transaminases), renal function test (creatinine), glucose, lipids, amylase and serum electrolytes, HIV RNA
viral load, Hepatitis B and C virus serology.
Technical assistance in laboratory quality assurance by:
1. Monitoring the performance of laboratory sites for the accuracy of HIV testing and ART clinical laboratory
monitoring:
- Continue TA for an initial assessment of laboratory staff at new PEPFAR-supported sites and periodic on-
site supervision at all sites with progressive transfer of competencies to the regional and district levels
- Organize an external quality assurance (EQA) program for HIV serology through a two-year cooperative
agreement with the national reference laboratory (LNSP)
- Support the EQA/PT program for CD4 testing in collaboration with LNSP and CeDReS
- Identify, with LNSP, and support a suitable partner to establish and pilot a QA program (including
EQA/PT) for hematology and clinical chemistry
2. Transferring competencies for and decentralizing supervision of HIV testing sites to regional supervisors
by creating a national pool of supervisors; implementing a national guide for supervision, related
Activity Narrative: standardized supervision forms, and checklists
3. Providing TA to develop the overall QA program, including but not limited to the definition of QA
standards for all laboratory categories.
Provide training by:
1. Continuing to support the improvement of pre-service training institutions, including updating curricula,
provision of lab equipment and supplies, and training of staff
2. Continuing to support the national HIV and TB programs for in-service trainings (HIV and CD4 testing,
laboratory quality management, and maintenance of basic equipment)
3. Supporting the implementation and rollout of standardized training materials, including the
comprehensive WHO/CDC HIV rapid-testing training package and the WHO/CDC/IUATLD/APHL/RIT direct
TB smear microscopy training package.
Additional activities:
RETRO-CI will:
1. Continue to support the lab component of strategic information activities, including evaluating the national
care and treatment program for emerging ARV drug resistance in patients at 12 months of treatment to
assess the effectiveness of current ARV drug regimens
2. Implement a threshold survey for transmitted drug resistance among pregnant women at selected ANC
sites
3. Validate new HIV incidence surveys and targeted evaluation studies to:
- Validate simple and easy-to-use new technologies for CD4 testing +/- complete blood count (Auricare
NOW, FACSCount CD4Abs/CD4%) to evaluate their appropriateness in laboratory programs.
- Validate rapid nucleic acid technologies for quantification of viral load (real time PCR)
- Assess the feasibility of new methodologies (dried tube serum) for EQA for HIV serology.
- Assess the suitability of newly available commercial cell stabilizers for CD4 count and full blood count
- Assess the residual risk of window-period HIV infections using nucleic acid techniques (NAT) and pooling
strategies (cross-referenced CNTS mechanism 4933)
4. Apply to be a WHO regional HIV Drug Resistance Collaborative Center. This will enable RETRO-CI to
provide TA to other PEPFAR and regional countries with limited resources for implementing drug-resistance
surveillance
5. Collaborate with ASCP and CLSI in evaluating, developing, improving, and maintaining their laboratory
quality management system (managerial and technical) in compliance with CAP and ISO 15189
requirements with the goal of accreditation. This will be two- to three-year process. RETRO-CI will serve as
an advisory body for supporting the accreditation of national and regional laboratories, thus evolving its role
at the national and regional level as a center of excellence for training and QA.
6. Collaborate with the National Public Pharmacy (PSP), the Supply Chain Management System (SCMS),
and PEPFAR implementing partners to improve the supply-chain system
7. Provide TA for training of staff on inventory and stock management.
Laboratory commodities and equipment will be purchased directly and are projected to total $1,526,765;
staff salaries and administrative costs to support 26 RETRO-CI laboratory affiliated positions make up the
balance.
Continuing Activity: 15163
15163 5170.08 HHS/Centers for US Centers for 7066 5554.08 CDC-RETRO-CI $3,001,933
10135 5170.07 HHS/Centers for US Centers for 5554 5554.07 CDC-RETRO-CI $1,302,719
5170 5170.06 HHS/Centers for US Centers for 3605 3605.06 CDC & RETRO- $948,607
Construction/Renovation
Health-related Wraparound Programs
* TB
Estimated amount of funding that is planned for Human Capacity Development $95,000
Estimated amount of funding that is planned for Education $50,000
Table 3.3.16:
The PEPFAR Cote d'Ivoire USG interagency team was built on the platform of the CDC Projet Retro-CI,
which was established in 1988 as research collaboration between the CDC and the Cote d'Ivoire Ministry of
Health to study the HIV epidemic in West Africa. In 2000, Projet Retro-CI expanded its mission to include
programmatic activities as part of the CDC Global AIDS Program, and with the advent of PEPFAR in 2004,
the mission of the Laboratory, Strategic Information, and administrative staff became focused almost
exclusively on support of PEPFAR programmatic activities. In the absence of a bilateral USAID mission in
Cote d'Ivoire, the CDC platform (including administrative, management, technical, and motor pool staff) has
been used to develop an interagency team structure that is fully integrated and without redundancy. While
the CDC serves as the primary administrative mechanism for the hiring of local and international technical
and administrative staff, the Cote d'Ivoire USG interagency team is continuing to leverage USAID
contracting mechanisms as needed to expedite the hiring of staff and provide senior USAID administrative
program support.
In its efforts to ensure program performance at a reasonable cost, optimizing USG human and financial
resources, the PEPFAR USG CI team continues to implement a coordinated interagency approach that
includes: 1) weekly PEPFAR CI (interagency) Executive Team meetings; 2) capitalizing on laboratory and
informatics expertise at Projet Retro-CI through direct technical assistance and service to our implementing
partners; 3) providing management and technical assistance to all PEPFAR-funded partners via an
integrated team of project managers and technical advisers, regardless of funding agency; 4) joint agency
staffing positions; 5) hosting regular program reviews of all implementing partners that combine portfolios
from all in-country agencies; and 5) leveraging USAID contracting mechanisms for fast-track and longer-
term positions in order to address staffing needs in-country.
These steps have helped to facilitate optimal management, coordination, and performance of USG-funded
activities and have resulted in capitalization of technical strengths, improvements in coordination, and better
compliance with USG financial requirements.
With a significant increase in the number of implementing partners and activities supported by PEPFAR
Cote d'Ivoire in FY 2008 — along with a near-tripling of the PEPFAR CI budget from FY06 to FY08 - the
need for additional staff to responsibly manage the PEPFAR portfolio is evident. In FY08, an evaluation of
operational, support, and logistical processes, systems, and needs resulted in a revision of support tasks
assigned to new staff hired from approved FY07 plus-up and FY08 positions. The human capital cost for
PEPFAR Cote d'Ivoire's management and operations increased in FY08 and is anticipated to stabilize with
support staffing needs to be filled for FY09. A large percentage of the management and operations budget
is driven by ICASS and OBO charges associated with the construction, maintenance, and operation of the
U.S. Embassy compound, as well as with increased services provided by the Embassy in support of
increased PEPFAR activities. The costs of goods and services continue to increase, due in part to lingering
effects of the recent politico-military crisis coupled with fluctuating USD rates and increasing transactional
costs. Security in Cote d'Ivoire remains a concern, and general operations costs for the PEPFAR in-country
team reflect additional expenses for security and communications.
In conjunction with regular step/performance increases, overall PEPFAR interagency salary costs have
increased with the hiring of multiple senior positions - Care and Treatment Branch Chief (FSN 12),
Prevention Branch Chief (GS-13), Laboratory Branch Chief (FSN 12), acting Associate Director for Science
(GS-14 equivalent) - and the successful recruitment of a number of program manager, technical adviser,
and administrative support staff positions in FY08.
PEPFAR CI has been working closely with the PEPFAR LE Staff Interagency Working Group and U.S.
Embassy CI Human Resources to develop CAJE grading for leadership and adviser positions that better
reflects the responsibilities and competencies of PEPFAR technical and managerial positions in CI. In
FY09, 10 new PEPFAR interagency positions are anticipated (described in detail in the Management and
Staffing program area summary).
While CI appears to be moving toward stability after a long crisis, the security situation remains of concern,
and the post remains a critical-threat and "adults-only" post. Coupled with French-language requirements,
this continues to create challenges in filling international positions. In addition, retaining LES staff continues
to be a challenge as a result of salary limitations, CAJE classifications, and growing competition with other
donors and implementing partners for a limited pool of highly competent technical staff. A critical operations
management position was vacant for much of FY08 after the incumbent retired. This left the Operations
Branch (which provides procurement, shipping, IT, warehousing and other logistical support for the overall
PEPFAR program) with many challenges. However, it also allowed for a clearer picture of operational and
support needs and of ways to restructure the Operations Branch in order to become more efficient and to
better support the implementation of the PEPFAR CI program. At the end of the FY08, four key
administrative LES were hired.
Despite efforts since FY07 to implement appropriate preventive "mental health" strategies to protect staff
from burn-out associated with living and working in a chronically high-stress environment, these continued
to be difficult to implement due to staff shortages, newly hired staff, and a rapidly expanding program.
Two years after conducting a Staffing for Results (SFR) exercise and consolidating a unified functional
interagency organizational structure that promotes one cohesive PEPFAR team, leverages CDC and
USAID institutional strengths, and streamlines costs by eliminating redundancy, the USG in-country team
continues to review and revise program implementation and oversight in response to priorities and
emerging needs. In implementing SFR, PEPFAR staff, regardless of hiring agency, continue to report
functionally to their Branch Chief, who in turn reports to the CDC and/or USAID heads as appropriate. The
PEPFAR Country Coordinator is the spokesperson for the overall program and is the primary contact with
OGAC and the U.S. Embassy front office. The CI program has been without a full-time Country Coordinator
since July 2008; pending recruitment of a permanent Coordinator, the DCM and/or Ambassador lead
weekly PEPFAR Executive Team meetings and coordinate with CDC and USAID leadership in the
development of PEPFAR programs in Cote d'Ivoire.
Activity Narrative: The PEPFAR Executive Team is composed of the CDC Country Director and USAID Focal Point, CDC
Deputy Director, USAID Senior Program Manager, CDC Associate Director for Science, and senior
management (Branch Chiefs) from the Program Management, Strategic Information, Laboratory,
Prevention, and Care and Treatment branches. The interagency team continues to meet weekly to discuss,
review, and coordinate the implementation of PEPFAR program activities and make interagency policy
decisions. In addition, representatives from the Executive Team (PEPFAR Coordinator, USAID Focal Point,
CDC Country Director, and CDC Deputy Director) meet at least twice a month with the U.S. Ambassador
and DCM to discuss program activities and issues.
Since August 2008, the USAID Focal Point has been supported by a seasoned USAID Consultant who
provides senior project management expertise to the growing project management team. This position,
which also acts as Deputy to the USAID Focal Point, is working to strengthen USAID management in-
country and is the key contact with USAID/West Africa oversight and support staff. While USAID does not
have a bilateral mission in Cote d'Ivoire, USAID program activities receive support through the USAID
Western Africa Regional Program based in Accra, Ghana.
In order to continue to best implement the PEPFAR vision and goals in Cote d'Ivoire, the executive staff and
in-country team members collaborate on a regular basis in the implementation of the PEPFAR CI program.
The SFR exercise conducted in 2007 allowed for the development of a clear organizational structure with
which to support technical program implementation and oversight while allowing for capacity building,
growth, and upward mobility for LES. A total of 34 new positions were determined to be essential and were
approved for FY07 and FY08, of which 20 (18 LES and two USAID contractors) were filled in FY08 (two
from COP 2007, 15 of 17 from FY07 plus-up funding, and three of 15 FY08 positions). Following staffing
needs evaluations in each branch, and based on the SFR exercise, several of the 34 positions (in
administrative and logistical support) have been re-evaluated in order to better serve the PEPFAR program,
including moving two approved administrative/support positions to the Laboratory Branch. The structure of
the interagency branches has been strengthened as a result and will better serve to implement program
activities in-country.
For FY09, the following 10 new positions are proposed: one Project Manager for the USAID and CDC
portfolios, two Laboratory Technicians (for the Clinical Diagnostics and Serology units), one Health
Management Information Systems Adviser (USAID-funded), one Logistics/Commodities Adviser (USAID-
funded), two administrative assistants (for USAID senior management, to be funded through CDC, and for
the Associate Director for Science), two Public Health Evaluation positions (Data Manager and PHE
Coordinator), and one Public Health Adviser who will focus on human resource development and will also
have signature authority on government documents (GS 12/13).
The USG PEFAR team is co-located in two offices, with a majority based at the Ministry of Health University
Hospital in Treichville while a growing number of staff are based at the Embassy. In 2009, seven
administrative positions from the Operations Branch will relocate to the Embassy. This will help reduce
administrative redundancies and contribute to more efficient procurement, HR, shipping, and warehouse
activities. Discussions are also under way about moving the Project Management, Care and Treatment,
Prevention, and Strategic Information branches to the Embassy in 2009. If 50 members of the PEPFAR
team are moved to the Embassy, additional OBO charges will accrue. Because of the billing cycle for OBO
charges, charges for the 50 additional staff members located at the Embassy would not occur until 2010.
FY09 funds will be supplemented by FY08 carryover funds to cover certain operations costs, including
required security upgrades at the CHU (University Hospital) Treichville facility and costs associated with
possible staff moves to the Embassy.
Continuing Activity: 15173
15173 10352.08 HHS/Centers for US Centers for 7067 5383.08 CDC & RETRO- $3,933,000
10352 10352.07 HHS/Centers for US Centers for 5383 5383.07 CDC & RETRO- $2,996,921
Table 3.3.19:
