Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011

Details for Mechanism ID: 7378
Country/Region: Guyana
Year: 2010
Main Partner: University of Washington
Main Partner Program: I-TECH
Organizational Type: Implementing Agency
Funding Agency: HHS/CDC
Total Funding: $70,000

Background of Hinterland Initiative:

The Hinterland regions of Guyana (regions 1, 7, 8, and 9) are home to some of the most significant health and development challenges that Guyana faces. Those communities inhabiting the hinterlands of Guyana - mostly indigenous Amerindians but other races as well - continue to struggle with health issues including tuberculosis, malaria, parasitic infections, diarrhea, chronic diseases, and HIV infection. However, challenges go beyond the health sector and include problems such as lack of food security and safe water, lack of access to economic markets, and lack of access to education. Physical infrastructure, such as roads, water and energy supply, is underdeveloped and most hinterland inhabitants are without adequate transportation to basic social services. The poor physical infrastructure coupled with semi-nomadic lifestyle and cultural and occupational challenges also affect access to health services in these communities.

Prevalence rates indicate that there are significantly lower levels of HIV in the hinterland communities than those found in the coastland regions. However, hinterland communities are home to pockets of high risk groups, such as miners, loggers, commercial sex workers, and military personnel posted to hinterland camps, among others. The dominant mode of transmission is through heterosexual contact and mother to child transmission. The risk for the majority of Hinterland residents is through the bridging of populations, meaning people who are at higher risk providing links with other people who have lower risk behavior. In addition to these occupational risk factors, there are also specific cultural norms and practices within Amerindian communities that place this group at higher risk; these include sexual intercourse in younger ages, multiple sex partners, and high levels of alcohol consumption.

Institutions from various sectors of Guyana have implemented and are currently implementing projects addressing some of these health and development challenges in the hinterland regions, one at a time. These entities include various Government of Guyana bodies such as the Ministry of Health, Ministry of Amerindian Affairs, Ministry of Education, and Ministry of Local Government; various international organizations such as UNDP, UNICEF, IDB, and the World Bank; and numerous NGOs, CBOs, FBOs that have undertaken work to address some of these risk factors, including some specifically focused on HIV/AIDS. In partnership with CDC, the Ministry of Health (MOH), through Guyana's National AIDS Programme Secretariat (NAPS) and Regional Health Services (RHS), provides mobile health services including HIV/AIDS services to the hinterland communities, including those in regions 1 and 9. The roving medical team currently supported by CDC/PEPFAR provides counseling and testing, and care and treatment services.

The mission of the Hinterland Initiative is to expand health services, specifically HIV/AIDS services, to the Hinterland regions of Guyana (regions 1 and 9) by strengthening existing partnerships, and building new partnerships to curb the HIV epidemic in remote regions of the country. The Hinterland Initiative seeks to realize Guyana's goal of making access to HIV/AIDS services universal and equitable by promoting better coordination and integration of multiple partners and NGOs that currently provide clinical and non-clinical services in the hard to reach interior regions of the country. By expanding HIV/AIDS services to the remote regions of Guyana through synergistic and coordinated efforts, the Hinterland Initiative seeks to realize an opportunity to strengthen the local capacity of the Hinterland communities to deliver sustainable health care services and to build platforms for the delivery of other health services.

Background of I-TECH at the University of Washington (UW):

The I-TECH headquarters at UW offers I-TECH Guyana and its partners and stakeholders access to a wide network of resources throughout the world and to technical specialists at UW and through its technical partner, the University of California, San Francisco (UCSF). I-TECH at UW is housed in the Department of Global Health which employs over 300 faculty, fellows, and research scientists involved in global health research and training in over 50 countries. The global I-TECH network works through 10 offices in the Caribbean region, Africa, and Asia on activities that contribute to the achievement of PEPFAR. From headquarters and the network, I-TECH is able to provide technical assistance and support to its offices on a wide ranging set of skills and technical support in a wide range of areas. I-TECH has developed a number of training materials through its Caribbean Regional program, including a training package on stigma and discrimination in the health sector that will be adapted for the activities in this proposal.

Background of I-TECH Guyana:

I-TECH has been working in collaboration with the MOH Guyana and CDC GAP since 2005 in order to support capacity building in Guyana. The overall goal of I-TECH's work in Guyana is to coordinate and ensure high quality training in HIV and AIDS care and treatment nationwide in alignment with national policy and international standards. I-TECH is based at the MOH's Health Sciences Education Unit (HSEU), and collaborates closely with the HSEU to achieve its goals. In collaboration with the HSEU, I-TECH has developed three in-service curricula for Nurses, Pharmacists, and Medex. These standardized curricula are based on national treatment guidelines and include high quality facilitiation materials. The most recent curriculum, HIV Basics for Medex, was developed largely by HSEU staff. I-TECH is committed to continued capacity development of the HSEU in curriculum development. I-TECH collaborates with MOH on an award-winning website ( The website assists communication between MOH and the public, the press, and implementing partners. I-TECH is also promoting collaboration between various governmental and non-governmental training stakeholders. This is facilitated by regular meetings of the Guyana National Training Coordination Committee, production of a training calendar, and introduction of a standardized national training database, TrainSMART. I-TECH Guyana has developed strong partnerships with the MOH, FXB Guyana, GPHC, St. Joseph's Mercy Hospital, Professional Councils (Pharmacy, Nursing, and Dental) , and the Guyana Red Cross. These groups collaborate with I-TECH Guyana on curriculum development and capacity building sessions for several categories of health care providers. For this project, I-TECH will build a strong relationship with the Regional Health Department in Region 1, the NWCF and its partners, including Youth Challenge International, and with the Ministry of Education, UNICEF, and the Adolescent Health Unit through the Health Promoting Schools Initiative.

Background of Northwest Care Foundation (NWCF):

A recent welcome development in region 1 was the formation of the NWCF, a non-profit organization focused on HIV service delivery. NWCF evolved out of a community-driven need to improve HIV and AIDS treatment services. NWCF is also seeking to expand VCT, PMTCT, and OVC services, train community health personnel in HIV and AIDS, implement holistic assistance programs for PLWHA, and combat stigma and discrimination. The NWCF represents a partnership of the public and private sectors with community leaders to improve care and treatment for Amerindians, especially those living in the riverain areas. With its interest in promoting the health of communities of region 1, the NWCF, cased in Mabaruma, will continue to subcontract for I-TECH Guyana to partner with to implement community mobilization, care, and treatment services among residents of region 1.

Goals and Objectives:

The overall goal of the Guyana Hinterland Initiative project of I-TECH Guyana is to reduce incidence of HIV and improve capacity of the health care system in Region 1 to provide high quality care for HIV and other high-burden conditions. This project has three objectives: improving the knowledge and skills of MOH Region1 staff to care for people with HIV and AIDS and other high burden conditions through an effective and replicable training program; increasing community participation in health promotion through a training program developed within the existing framework of the Community Integrated Management of Childhood Illness (C-IMCI) strategy to improve prevention of HIV infection and uptake of VCT and PMTCT services, and; improving the quality of care in Region 1 RHD through training and enhanced resources for supervision.

These objectives will be met through partnering with NWCF, CDC, other relevant PEPFAR partners, and existing/ongoing I-TECH Guyana activities.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $70,000

Programming responding to yellow-lit activities- Guyana PEPFAR Interagency team has adopted OGAC Prevention Technical Working Group recommendations for the sexual prevention portfolio.

The activities for FY10 support the overall focus of the project by scaling up prevention efforts; training Community Health Workers to improve long term care and case management; making better use of the existing referral network; improving community engagement; and strengthening local capacity to assume ownership in the longer term.

In FY10, I-TECH Guyana with NWCF will continue updating and will complete the database of trainers, trainees, and training activities; continue to consult with stakeholders in RHD of Region 1; continue quarterly supervision visits for monitoring, support, evaluation, and training at Mabaruma/Moruca and Port Kaituma/Matthews Ridge; expand training of remaining CHW in Moruca and Mabaruma using HIV Basics; recruit and train 1,000 community health volunteers from across region 1; continue CHV outreach, including travel for health promotion to small communities; identify contractors for renovation and installation of computers and purchase equipment and hardware for the establishment of a training and learning resource center for health education at NWCF; and continue to support supervisors to travel by river and land to visit CHW and monitor their practice on a regular basis.

Subpartners Total: $0
Northwest Care Foundation: NA
Cross Cutting Budget Categories and Known Amounts Total: $70,000
Gender: Gender Based Violence (GBV) $10,000
Human Resources for Health $60,000
Key Issues Identified in Mechanism
Increasing gender equity in HIV/AIDS activities and services