CapacityPlus’s Partnership with the Dominican Republic Lauded as a Best Practice in Health Systems Strengthening
On December 22, the Office of Health Systems in USAID’s Global Health Bureau announced its Top Ten Health Systems Strengthening Cases. CapacityPlus’s collaboration with the Dominican Republic was chosen from among more than 145 submitted cases.
USAID launched the call for case studies to share the nature and impact of its investments in health systems strengthening, and to stimulate an exchange of information, experiences, and ideas about how to engage in this work. The top ten case studies demonstrate field examples of health systems strengthening efforts that improved systems performance and health impact, especially in the areas of the Ending Preventable Child and Maternal Deaths and AIDS-Free Generation initiatives. 
CapacityPlus supported the Dominican Republic Ministry of Health in a process of payroll reform and increased transparency in budgeting practices. The process revealed nearly 10,000 ghost workers—individuals who receive a salary but are not working—who represented approximately 30% of the Ministry’s budget. The Ministry began a phased approach to clean its payroll by reclaiming the salaries of the ghost workers, resulting in savings of over $6 million annually.
These savings are being used to improve HIV and other health services through hiring of new health workers, increasing salaries by 10% to provide more equitable remuneration and increase motivation, eliminating user fees, and investing in other health sector reforms, such as setting up a better procurement process for HIV testing kits and antiretroviral drugs.
In turn, this reinvestment is contributing to improved service delivery and health status. As a few examples, over three quarters of women who were tested for HIV in hospitals supported by CapacityPlus received their results on the same day (compared to just over half the previous year); the number of pregnant women who know their HIV status in supported hospitals increased by 15%, and the number of family planning, prenatal, postpartum, and laboratory visits (including HIV testing) jumped by 517% in one region (from 1,981 to 12,237 visits). To learn more, read this and other case studies on USAID’s special website section.
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Photo by Wendy Tactuk (health worker in the Dominican Republic)
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