Dominican Republic's Health Sector Reinvests Savings from Ghost Workers to Improve Care

The Dominican Republic is reinvesting $6.2 million into its health sector, thanks to a Ministry of Health payroll analysis that revealed 10,000 ghost workers, or individuals who receive salaries but no longer work for the ministry. The ministry is using the annual savings from its ongoing payroll clean-up to hire new health workers, increase salaries for doctors and nurses by 10%, and raise health workers’ retirement benefits from 60% of their last salary levels to 100%. 

The IntraHealth International-led CapacityPlus project worked with the Dominican Republic’s Ministry of Health to reform its payroll and create more transparent budgeting practices. The 10,000 ghost workers revealed through this process represented about 30% of the ministry’s budget. 

These annual savings are helping the ministry to improve HIV and other health services, eliminate user fees, motivate and retain health workers, and invest in other health sector reforms, such as a better procurement process for HIV testing kits and antiretroviral drugs. 

Already, newly hired health workers are increasing access to health services in their communities, thanks to the freed-up funds: 

  • Over 75% of women tested for HIV in hospitals supported by CapacityPlus now receive their results on the same day (compared to just over half the previous year). 
  • The number of pregnant women who know their HIV statuses in these hospitals has increased by 15%. 
  • The number of family planning, prenatal, postpartum, and laboratory visits (including HIV testing) has jumped by 517%—from 1,981 to 12,237 visits—in one region.   

On December 22, the US Agency for International Development’s Global Health Bureau named this collaboration between CapacityPlus and the Dominican Republic one of its Top Ten Health Systems Strengthening Cases, choosing it from among more than 145 submitted cases. Read the winning case studies at

Funding for the IntraHealth-led CapacityPlus project comes from the US Agency for International Development

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