Dominican Republic

CapacityPlus supported the Ministry of Public Health’s efforts to strengthen human resources management (HRM) systems to enable its workforce to provide and sustain high-quality HIV/AIDS services, with particular emphasis on prevention of mother-to-child transmission (PMTCT) of HIV.

Highlights

• Strengthening PMTCT and related services through a new performance management system. CapacityPlus’s support contributed to the Ministry’s launch of its first official job description manuals for doctors, nurses, bioanalysts, and pharmacists, along with transformation to a team-oriented supportive supervision model at ten priority hospitals that has helped managers and health workers identify and address gaps in service delivery. These and other HRM interventions contributed to increased access to PMTCT and other services for HIV-positive pregnant women, including family planning and screening for tuberculosis and syphilis. For example, by extending HIV service hours and redistributing health workers to where they were most needed, 87% of pregnant women who were tested for HIV in select CapacityPlus-supported hospitals within the first six months of these interventions received their test results on the same day, a 58% increase from the year before. The Ministry is continuing to implement the performance management system in all nine health regions under the CapacityPlus Dominican Republic Associate Award led by IntraHealth, which began in March 2015.

• Conducting an analysis of the central and individual hospital payroll systems. As a result, the Ministry of Public Health took action to clean the payroll, eliminating 3,913 “ghost workers” and fully retiring 2,241 health workers, for a savings of $9.1 million per year. The Ministry is reinvesting the savings through the hiring of doctors, nurses, and area coordinators, and other strategies to increase access to primary health care services.The investment of savings from payroll cleaning, coupled with the elimination of user fees (a significant financial access barrier for the poor) and increased membership in national health insurance have led to improved coverage of primary health services in various regions of the country. For example, Region IV, a poor area bordering Haiti with a large immigrant population, witnessed a 500% increase over one year in the number of patient consultations (from 2,039 to 12,237) for HIV and syphilis prevention, family planning, and prenatal care. 

• Passing a new national Health Career Law. The legislation serves as a legal, technical, and administrative framework detailing the employment relationship between the government and health workers and classifies and ranks the salary and wage structure and job functions.

• With funding from USAID’s Bureau for Latin America and the Caribbean, supporting progress in strengthening the supply chain for HIV/AIDS and other commodities, including a Presidential Decree to professionalize and integrate the supply chain workforce, and development of a new supply chain management structure, job descriptions, and supervision manual for supply chain workers at all levels of the system.

Photo by Wendy Tactuk