Meeting Notes Peace Corps Headquarters Peace Corps and Foundation for Global Health Service November 18, 2011 Updates: PEPFAR is in the process of notifying Congress now. As a quick history, PEPFAR worked out with Congress that the latter would hold back from earmarking funds but PEPFAR would notify Congress of big buckets of funding. There are 4-5 Congressional notifications (CN) annually. The fourth CN is expected to go to Hill just before or just after Thanksgiving. The GHSP is a smaller line item in a multi-page document with multi-million dollar programs. Prior to passing the CN to Congress, PEPFAR must get “clearance” form the inter-agency deputy principals (DPs). PEPFAR had intended to put the CN into “clearance” yesterday, giving the DPs 24 hours to raise questions. The CN then would go to Congress. As of 11am yesterday (and likely 2:30pm since Buck did not update us), clearance had not been sent out. Once the CN hits the hill, Congress has 10 working days to raise questions. There is no vote needed but the staff reviews. If no questions are asked, assent is presumed. Buck obtained clarity of the mechanism by which federal money will be provided to FGHS. The process can be fast tracked and non-competed through a specific grant mechanism. NIH has pledged 3 Fogarty fellows to become GHSP PCV, fully funded by NIH at $46,000/ year. Discussion of broad roles and responsibilities top guide overarching MOU (Matrix): PC provided an excel matrix with 3 columns and 5 major categories in rows with subcategories to help outline the division of work. This matrix was intended to help determine roles and responsibilities to provide as a basis for MOU. A series of Y/N fell under the PC and FGHS columns. The PC will send this to us. Major Program Element Financial and other inputs Country and Site selection Volunteer recruitment and Selection Orientation, Training and Support Monitoring and Evaluation Peace Corps FGHS Major category we felt was missing was Strategic Direction for the growth and expansion of the program. The following is a discussion of each major program element: Financial and Other inputs:  Public Funding -> Funding from OGAC to PC for 1) to support headquarters and field based activities PC will undertake, and 2) to develop sub-agreement to FGHS.  Private Funding -> fully vested in FGHS.  In-kind contributions -> o For PC, possible is commitment by Fogarty to commit three fully funded fellows. o For FGHS, would want sabbatical option. Will take some time. There is some concern among inter-agency colleagues that need to be some older people. We agree there is a commitment to see a diversity across the spectrum of working life. o Will need to think about in-kind donations of equipment, teaching tools.  Need host site contribution. Common practice for receiving institution to receive housing. Standard template for site MOU Country and Site Selection:  Country Selection: Shared responsibility but PC needs to have ultimate say b/c this is specific ally a PC program, and they need to ensure there is bandwidth to accept and manage the PCV. Additionally, the PC is already engaged in specific country agreements. o Hope for a short list today of 5 (See below)  Receiving Site/ Site Selection: Shared responsibility of choosing final sites. For PC always suitability overlay and safety and security will be important.  Receiving Institution/ Site Development: PC would be engaged for things PC routinely looks at, but there needs to be an entity (likely FGHS) that keeps an eye on relationship between the PCV counterpart and faculty. We will need to clarify the role of who and how to support the clinical side and work. o A clinical or site mentor will need to ensure constant and very clear communication with PC office o Some of this position and relationship will matter as to whether PCV are at MEPI institution or simply in MEPI countries. We will adjust to ensure academic support. o This will vary across countries also as countries we select will have different inputs Volunteer Recruitment and Selection  Marketing of GHSP Service Opportunity: Likely we will not need to market much after launch but will need to manage expectations of expected vast interest Use existing PC and existing medical channels such as AMA, AAMC etc. Recruitment: o We will need to create a series of parameters of what types of positions the program is prepared to support and then will need to ask countries/ sites to choose among the choices. This will create an “Invitation to Participate (ITP)” of the countries. o PC will then post the specific jobs for what is needed e.g. “there is a specific need for following posts in this site. Please apply.” There will be a set position description. Screening – o FGHS will look over ALL the initial applications to decided who meets the technical and educational requirements to be successful. FGSH will need to assess ability to teach, certify applicants educational attainment/boards/ licensure o Interviews – FGHS can do interviews if we feel important and create a short-list. o PC will receive the short list and then the PC screens will apply. Per PC, for PCRV it takes 2-3 months to select someone once PC receives short list. The PC though made notes that medical clearance and background checks may take actually longer here because, unlike PCR, these applicants will not be former volunteers. o TIME SENSITIVE QUESTION – how long will it take? Is there a fast track? Can Director Williams help push a modified policy for this initial year as suggested? PC will take care of expediting visas, work permits and reciprocal licensure Final selection will be PC but based only on the absolute short list o     Orientation, Training and Support:  Pre-Departure Training: Likely be bifurcated training, with: o Stateside education including a crash course and refresher in tropical medicine, and health education in resource limited settings. This will be by the FGHS. o In-country orientation which may include some centralized training before sent to sites and some within the site  Includes primer on PCV’s medical care, housing, banking, cultural competency  How to do language?  All already exists somewhat in PCR program  In Country at Arrival -> see above  In Country Ongoing o Translators will be needed to help with patient rounding. How do we ensure? Is this site specific? Do we ask sites to contribute o We need a designated person on-site to serve as a first point of contact for very basic things -> this should be part of the PC-site MOU. Should be a mid-level person.   Close of Service: There was a lot of discussion around this topic as timing of loan forgiveness payment was identified here by PC. FGHS expressed concern for accruing interest and debt while serving and could we discuss mechanisms that would allow a modified payment system. PC is concerned this creates a very different circumstance for the GHSP PCV than a standard PCV. This then led to discussion of whether funds could be used for mortgage payment and/or family support. The PC was very worried about this. It became clear there was a different interpretation of the role the FGHS could play as a private partner. PC, fairly, needs parity across its volunteers. The FGHS though is interested in ensuring recruiting the best people of all training levels. No support for mortgage or family will reduce the opportunity to recruit mid-level and senior faculty. The PC is going to discuss this in more detail and get back to us. Currently though, the recommendation and requirement is that the pool be limited for this first year to eligible applicants who are single. Returned Service: co-owned. Monitoring and Evaluation:  Annual Volunteer Survey: co-owned  Overall project evaluation: co-owned  Discussion raised that we need to evaluate at 1) PCV level, 2) site level, 3) Admin level which includes both FGHS and PC and that there will be different markers of interest.  M&E will need to be parsed out. How do we do this? Who owns the data? How do we approach it?  Tom asked if there are models to look to base off this? What models can we use to determine as performance indicators? o Need to see what other indicators the country is following? o Determine good M&E tools to use? o Anne Slenny?  QUESTION – who owns the data and how do we negotiate reporting and publication? Strategy and Growth: Not discussed Site Selection: We were joined by Africa Region Director, Dick Day. He outlined the PC capability to deploy to certain countries. The top countries listed from a PC perspective inclue: Uganda Malawi Namibia (not MEPI) Tanzania Zambia ** Malawi - Also change in leadership in Malawi but strong candidate on the table. Malawi has constituent college, teaching hospital where have had volunteer. NEPI country. ** Uganda – offers the possibility of the five medical schools. Latched onto idea of transformative education. Well managed. Solid operation and workable. Where within the system would need to be discussed. ** Tanzania – Christian medical collage in MEPI. Five schools in total. Muhimbili established in Dar, and 2 private schools I Dar, and 2 in Moshi, and Ogando (sp?). Stable. Good leadership ? Zambia but many initiatives already in Zambia. The Zambia USG team is a little unsure of any new initiatives as are first starting the new mothers program there. Fitz pointed out that there are two new universities and one of their biggest missions is to expand faculty. Kenya – significant security concern throughout the country currently. PC is currently cutting the number of volunteers going to country. There is also concern leading up to presidential elections. Botswana – well resourced, doing well. Excellent medical school. However, the Dean is leaving so a small concern the timing may be a bit wobbly now. Ethiopia - difficult operating environment right now b/c the government is ill at ease. All three directors will turn over in Ethiopia so no institutional capacity to put people in. PC has change in leadership right now. PEPFAR Ethiopia dynamic is very challenged right now. Autocratic trends being witnessed in Ethiopia and so not harmonizing with US agenda. Fitz feels very, very needy and AAU, the MEPI partner, is very responsive and playing a critical leadership role. Also NEPI country. If politically viable, worth considering. There was consensus that this first years is a proof of concept and we should keep it streamlined. At DP meetings, there was a sense that the program should be informed by MEPI and NEPI but necessarily within the actual institutions. Fitz points out that there may be advantages going through the institutions since they already have partnerships and certain principles in place. There is a goal for early December to decide the counties. Admittedly, there is little element of competition in this current model of selection (Malawi, Uganda, Tanzania +/- Botwsana). We will need to discuss with the countries 1) whether they would like the program and 2) if so, which institutions. OGAC would expect us to defer to recipient government priority to decide where to place people. Inevitably will have to go through MOH. During the meeting, there was disparate discussion of how engaged to be with the MOH. Some MOH may be a bit complicated and perhaps better to go through the organizations. Dick Day offered that planning needs to be through MOH and administration but the programming side will be through the institution which will be in nuts and bolts. Country directors will be integral to this. Will need to be staff support for country directors to help launch program. There are two levels of site selection we need to consider 1) political entry level questions, 2) institutional placement issues. We also must account for the fact that schools are Ministry of Education and hospitals are MOH. Need to talk to PC and PEPFAR about how to approach at country-by-country basis. Most important quality and success negotiation will be with school, dean and vice-chancellor. Quality and nature of placement will be on that level once ministries have dealt with introduction Question - We also need to decide if MDs pair with RNs? Will it be different for year one than future years? Of note, NEPI is through MOH. Question - What is the saturation point of number of volunteers in country? TIME SENSITIVE ACTION ITEMS: 1. need to establish the process of soliciting needs from institutions and order of approach. 2. Need to find a time to schedule a conference call to further discuss site selection. Goal is for very early December. MOU: For PC, most of its MOUs are for the placement of vounteers. (We were given a terms of assignment MOU as reference). MOU will determine what are overarching principles and what can be determined through later committee and working groups. MOU is generally a scope of ground rules we agree to but actual activities and resources are identified in a scope of activities that feeds the MOU. Types and Scope of Activity: Certain, inherently governmental functions PC cannot parse out. Final selection for example will be important to keep in PC. ACTION ITEMS FROM MEETING: [ ] PC to revise the MOU and matrix then send out soft copies [ ] FGSH to populate current MOU draft by early next week [ ] Request to have all pay attention to Statement of Purpose in MOU -> note, we would like it be permissive [ ] We need to establish a conference call for 1) country selection and 2) to set time table for GHSP development and deployment Time sensitive outstanding questions: [ ] Who has or how do we address data ownership? [ ] What are the full limitations on the FGHS stipend use?