Dominican Republic Focuses on Health Workforce Systems to Achieve an AIDS-Free Generation
USAID/Dominican Republic has awarded IntraHealth International a two-year associate award to build on CapacityPlus’s achievements in the Dominican Republic.
Critical to the country’s efforts to improve access to high-quality HIV services is a focus on the health workforce and the systems used to manage and support these valuable human resources. The new project, Improving HIV Service Outcomes through Strengthening Human Resources Management, will refine key systems at the Ministry of Public Health, Ministry of Public Administration, hospitals, and other institutions. HR management is the integrated use of systems, policies, and practices that provide the range of functions needed to plan, produce, deploy, manage, and sustain the health workforce.
Overview of new project
Distribution of health workers. With support from IntraHealth, national stakeholders will improve the distribution of health workers so that they are strategically deployed to provide HIV services where they are most needed. The project will use the Workload Indicators of Staffing Need (WISN) approach to build the evidence base that will inform these decisions. WISN calculates the number of each type of health worker (such as nurses and pharmacists) that are needed in a particular health facility, based on the facility’s workload.
- Performance management system. The project will finalize and support implementation of a national performance management system to improve HIV care and treatment.
- Maternal and child health. The third activity focuses on improving HIV services for maternal and child health at priority hospitals, strengthening the information system for perinatal care, and ensuring its use in clinical management.
Strong leadership
Dr. Sonia Brito-Anderson serves as chief of party. A public health specialist and trained OB/GYN with over 25 years of experience in service delivery and managing technical staff, Dr. Brito-Anderson is a recognized leader in national development of health systems, strengthening the supply chain workforce, performance-based financing, and contraceptive access. As CapacityPlus country director, Dr. Brito-Anderson led activities in partnership with the Ministry of Public Health to strengthen the HR management systems needed to create an enabling environment for health workers to perform effectively.
Key CapacityPlus results
The Office of Health Systems in USAID’s Global Health Bureau selected CapacityPlus’s collaboration with the Dominican Republic as one of its Top Ten Health Systems Strengthening Cases. CapacityPlus supported the Ministry of Public Health in a process of payroll reform, which revealed nearly 10,000 ghost workers (individuals receiving a salary but not working). The Ministry began a phased approach to clean its payroll by reclaiming the salaries of the ghost workers, resulting in savings of over $9 million annually to date. These savings are being used to improve HIV and other health services by hiring new health workers, increasing salaries by 10%, 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. This reinvestment is contributing to improved service delivery and increased use of services. 
Other CapacityPlus highlights in the Dominican Republic:
- The coverage of HIV-related health services—such as early detection as well as family planning and prenatal care for HIV-positive women—rose in numerous regions. Increasing coverage of these services at the primary level resulted in improved coverage up the chain, with more HIV-positive individuals referred for treatment and contraceptive options at the secondary level and more HIV-positive pregnant women and their infants being cared for.
- Prevention of mother-to-child transmission (PMTCT) services in ten hospitals supported by CapacityPlus are now enhanced, thanks to a revision of national protocols, new systems for supportive supervision and performance management, supervisor and health worker trainings to improve quality of services, strengthened HR management policies and systems, and more strategically distributed health workers.
- A new national Health Career Law 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.
- Operational manuals for key health cadres, with detailed job descriptions, titles, and salary structures, have professionalized practices for hiring, salaries, and performance management and improved recruitment of health workers.
- A Presidential Decree supported professionalization and integration of the health commodities supply chain workforce.
- HR managers built their skills in leadership and management.
Sharing successes
On February 25, CapacityPlus hosted an end-of-project event, “Sharing Successful Experiences,” in Santo Domingo. Mayra Minaya, the Ministry of Health’s director of human resources, spoke on behalf of the minister of health, Dr. Altagracia Guzman, and lauded the ten participating hospitals as well as the project’s technical assistance. Other notable remarks were provided by Dr. Luis E. Felix Baez, director of the General Directorate of Control of Sexually Transmitted Infections and AIDS (DIGECITSS); Georgina Rodriguez, subdirector of the National Institute of Public Administration, and Francisco Zamora, director of the USAID/Dominican Republic Health Office. CapacityPlus’s Gisela Quiterio, technical manager, led the main session where hospitals presented on their respective PMTCT programs, the actions they had undertaken to improve them, progress on their goals, challenges, and future commitments.
The new project is taking this work further and continuing to support the Dominican Republic’s goal of achieving an AIDS-free generation.
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Photos 1 and 2 by Wendy Tactuk; photo 3 courtesy of Sonia Brito-Anderson
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