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 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.
