The lack of training institutions for doctors, pharmacists, and laboratory technologists in Namibia contributes to a chronic shortage of health professionals who can provide comprehensive care and treatment services on the scale and at the level of quality that is required. The vacancy rate in the MoHSS is approximately 40% for doctors, 25% for registered nurses, 30% for enrolled nurses, and 60% for pharmacists. Since FY04, the USG has assisted the MOHSS to address this gap by providing supplemental personnel to the MoHSS through Potentia, which administers salary and benefits packages equivalent to those of the MoHSS. Both HHS/CDC and the MoHSS participate in the selection of health personnel who are then trained and provided with field support by I-TECH, HHS/CDC, and the MoHSS with USG funding. Beginning in FY06, Potentia also began supporting technical and administrative staff previously funded through I-TECH in order to streamline administration and reduce costs. This human resources strategy has been central to Namibia's success to date with meeting its prevention, care and treatment targets. As of August, 2006, Potentia supported a total of 117 staff and this number is projected to increase to 363 in FY07.

FY07 funding for PMTCT will cover salaries and support for the following positions:

(1) PMTCT Technical Advisor within the Directorate of Special Programs, Ministry of Health and Social Services (MoHSS). This advisor, whose counterpart is the National PMTCT Coordinator in MoHSS, plays a pivotal role with national policy and workplan development, monitoring and evaluation of PMTCT services, and facilitating the rapid roll out process, including integration of PMTCT into routine antenatal and maternity services and collaboration with ART, palliative care, and laboratory services. Approximately 30% of the advisor's time is allocated to PMTCT training and curriculum content expertise. To date the advisor has facilitated rollout to 165 sites which will increase to at least 287 sites during FY07. In addition to further rollout and training, the emphasis in FY07 will include consolidation of existing sites to increase coverage with services, integrating rapid testing into PMTCT, expanded roll out of DNA PCR testing, reinforcement of exclusive breastfeeding, strengthening the PMTCT ARV regimen to include short-course AZT plus single-dose nevirapine (SD-NVP), and increased support to existing sites by combining supervisory visits with in-service tutor support visits.

(2) Five in-service tutors placed throughout the National Health Training Center network. These tutors will implement decentralized trainings in PMTCT and in dried blood spot (DBS) for DNA-PCR testing for infants, and conduct at least 50 post-training PMTCT site visits to reinforce training content.

(3) One driver to transport PMTCT Technical Advisor and tutors to training and clinical sites.

Supplemental support for the work carried out by these staff is funded through I-TECH (I-TECH/University of Washington_ PMTCT_7354).

This activity relates to another in this area, provision of condoms and support for community counselors by the Ministry of Health and Social Services (MoHSS), #7333, and to CDC activity #8001 in the Abstinence and Be Faithful area.

This activity addresses the critical human resources gap at facility levels to delivery HIV/AIDS services in Namibia. The lack of pre-service training institutions for doctors, pharmacists, and laboratory technologists in Namibia contributes to a chronic shortage of health professionals who can provide comprehensive HIV/AIDS care and treatment services on the scale and at the level of quality that is required for ARV roll out and palliative care expansion. This in turn creates issues of bonding and incentives for these cadre of health care workers to return to Namibia and retention incentives for staff currently serving in the country. The vacancy rate in the Ministry is approximately 40% for doctors, 25% for registered nurses and 30% for enrolled nurses, and 60% for pharmacists.

The lack of training institutions for doctors, pharmacists, and laboratory technologists in Namibia contributes to a chronic shortage of health professionals who can provide comprehensive care and treatment services on the scale and at the level of quality that is required. Since FY04, the USG has assisted the MoHSS to address this gap by providing supplemental personnel to the MoHSS through Potentia, which administers salary and benefits packages equivalent to those of the MoHSS. Both HHS/CDC and the MoHSS participate in the selection of health personnel who are then trained and provided with field support by ITECH, HHS/CDC, and the MoHSS with USG funding. Beginning in FY06, Potentia also began supporting technical and administrative staff that were previously funded through I-TECH in order to streamline administration and reduce costs. This human resources strategy has been central to Namibia's success to date with meeting its prevention, care and treatment targets. As of August, 2006, Potentia supported a total of 117 staff and this number is projected to increase to 363 in FY07.

This is a new activity to contract condom supply logistics officers for distribution of the new "Smile" condom. The new public "Smile" condom is comparable in quality to local commercial and socially-marketed condoms and was launched by the Ministry in 2005 following complaints from the public that the free condoms distributed from health facilities were substandard. The public response to the "Smile" condom has since been overwhelming and demand has exceeded the Ministry's ability to purchase the amount needed. These condoms are manufactured in Malaysia and undergo quality assurance in a local laboratory when delivered in Namibia prior to distribution. The Commodity Exchange is a local company which has been contracted by the Ministry to establish a condom production factory and quality assurance laboratory with funding from the Global Fund. A 2005 USG-funded evaluation of condom supply and logistics concluded that the quality assurance laboratory and plans for local production were reliable.

These condoms will be distributed free of charge to health facilities for distribution to and use by high-risk clients (HIV-positive patients, STI patients, TB patients, and patients having sex with a person of unknown HIV status) and for further distribution to NGO and FBO partners for use by to high-risk individuals (mobile workers, commercial sex workers, shabeen customers, discordant partners, PLWHA and their partners, and persons having sex with a partner of unknown HIV status).

The Global Fund supports a Condoms Logistics Manager in the Ministry plus two additional Condom Logistics Officers in the regions. A more responsive supply management chain to meet the demand has been created in the Ministry to make condoms more accessible to the public. However, three staff is totally inadequate for a country the size of California and an additional 15 officers are needed at the district hospitals to facilitate local supply and distribution from hospital pharmacies to health facilities and PEPFAR-funded NGOs and FBOs who distribute condoms to high-risk people. Condom logistics officers (costing ~$10,000 per annum per officer), who would receive technical support from the Ministry and RPM-plus, would be placed at the following 15 district hospitals: Oshakati, Onandjokwe, Rundu, Katima Mulilo, Outapi, Oshikuku, Opuwo, Engela, Eenhana, Grootfontein, Otjiwarongo, Swakopmund, Marienthal, Gobabis, and Keetmanshoop. Apart from the 331 public health facilities, implementing partners who will benefit from this activity include TCE, Walvis Bay Multi-Purpose Center, and a wide range of partner NGOs/FBOs.

This activity relates to other Activities in Basic Health Care & Support & ARV Services: MoHSS (#7331), Intrahealth (#7404), I-TECH (#7349), Comforce, (#8024), MoHSS ARV services (#7330), Potentia ARV services (#7339), & CDC systems strengthening (#7360).

There is a critical human resources gap at facility levels to deliver HIV/AIDS services in Namibia. The lack of pre-service training institutions for doctors, pharmacists, & laboratory technologists in Namibia contributes to a chronic shortage of health professionals who can provide comprehensive HIV/AIDS care & treatment services on the scale & of the quality that is required for ARV roll out & palliative care expansion. This in turn, creates issues of bonding & incentives for these cadre of health care workers to return to Namibia & retention incentives for staff currently serving in the country. The vacancy rate in the Ministry is approximately 40% for doctors, 25% for registered nurses, 30% for enrolled nurses, & 60% for pharmacists.

Since FY04, the USG has assisted the MOHSS to address this gap by providing supplemental personnel to the MOHSS through Potentia, a private sector company, which administers salary & benefits packages equivalent to those of the MoHSS (however the hiring process is more rapid than that of the MoHSS). Both HHS/CDC & the MOHSS collaborate in the selection of health personnel who are then trained in-service & supported on-the-job by ITECH, HHS/CDC, & the MoHSS with USG funding. Beginning in FY06, Potentia also began supporting technical & administrative staff previously funded through I-TECH in order to streamline administration & reduce costs.

This human resources strategy has been central to Namibia's success to date with meeting its prevention, care & treatment targets. The Public Health Service Commission, a unique HR management structure in Namibia has made great strides by recognizing the recruitment & deployment delays within the MOHSS & bringing in additional staff through a private contractor. Potentia has a rapid personnel recruitment, deployment & management strategy, which currently contracts 33 doctors, 23 nurses, 12 pharmacists, 3 pharmacy assistants & 15 data clerks to 29 MoHSS Communicable Disease Clinics (CDCs) which manage 80% of the approximately 22,000 patients on ART & clinical care in the public sector.

The IMAI framework for decentralized HIV/AIDS training, service delivery standards, & task-shifting to district & community levels of care will support the MoHSS decentralization plans & with the goal of providing comprehensive HIV/AIDS care for Namibian communities. Adaptation of all 5 IMAI modules is underway & pending final approval by the MoHSS. Shifting tasks from physicians, nurses will begin providing palliative care & managing clients who are not yet eligible for ART & clients who have received their first 6 months of ART at hospital CDCs. Anticipated in 2007, the 13 regions will be responsible for the rollout of IMAI to selected health centers & clinics in their catchment area. Technical advancement for pediatric care is provided by the MoHSS pediatric care & treatment training program & the MoHSS Integrated Management of Childhood Illness (IMCI) program. Key priorities in facility-based palliative care service delivery by Potentia-supported health care workers will include the provision of the preventive care package for adults & children (cotrimoxizole prophylaxis, TB screening & INH prophylaxis, CT, HIV child survival interventions, HIV prevention messaging with access to condoms & referral for family planning, clinical nutrition counseling, measurement & monitoring, etc), other OI management, ART adherence, routine clinical monitoring & systematic pain & symptom management. Closer partnerships with districts & communities will allow increased opportunities to expand safe water & hygiene strategies & access to malaria prevention for PLWHA & their families, including leveraged support from Global Fund-supported for bed-nets. The USG will also work with the Ministry of Agriculture & Rural Development to explore the feasibility & cost of appropriate safe water strategies for PLWHA.

The Ministry has recently re-set national ART targets to have started 34,745 on ART by March 2007, 50,349 by March 2008 & to significant expand palliative care achievements to reach the 230,000 PLWHA in Namibia. The Ministry does not have this capacity & FY06 staffing levels supported by PEPFAR are only 41% of this projected need for FY07. The FY07 request is therefore to contract a total of 60 doctors, 75 registered or enrolled nurses, & 40 pharmacists or pharmacy assistants for a total of 175 professionals, or 72% of the projected need with the remainder to be made up by the Ministry itself, the Global

Fund, & other partners such as DED & VSO who focus on specified regions in the north. Some of these staff may be eventually deployed to health centers & clinics under decentralized ART & palliative care services. At least 13 nurses are planned to support the Supervisory Public Health Nurse in high-burden districts, with ART, TB & Palliative care activities, added in response to needs identified in 2006 during the MoHSS supervisory support program.

In addition to providing contracted clinical personnel to Communicable Disease Clinics, this activity will also support the provision of training personnel to the Ministry's National Health Training Center, ITECH & the Regional Health Training Centers. The training centers do not have sufficient human capacity at present to provide this training due to competing priorities with CT, PMTCT, TB/HIV, STIs & other activities. This activity will cover 0.5 FTE of an ITECH curriculum development expert to develop the capacity of a Namibian in curriculum development, transportation of tutors to clinical sites for follow-up after IMAI training, an STI trainer, an additional nurse trainer, & a trainer manager to ensure that sufficient numbers of the best-suited health workers for IMAI complete quality training.

Mechanisms to assess & improve Human Resource Management, including training performance, job competencies, skill transfer & performance & retention of health workers will continue to be integrated within the Potentia program. This will include linkages with the HIVQUAL (HIVQUAL ARV Services#7450) program to assist in collecting annual evaluations from MoHSS supervisory staff to assess HIV provider performance improvement. USG support will explore a performance-based monitoring system for all MOHSS staff with underperforming staff will be offered opportunity to address deficits through additional training & support. Gender considerations are integrated within the program by ensuring equitable employment & support of male & female health care workers, as well as, equitable access to HIV/AIDS services for PLWHA & their families throughout Potentia-supported programs.

USG experience to date & data from the MoHSS ART/care HMIS has shown that for approximately every three HIV-infected patients who are evaluated for ART, two are started on ART & one is not yet eligible & is enrolled in comprehensive HIV care. This may change as those with earlier stages of HIV are identified & enrolled into comprehensive HIV/AIDS care. Therefore, in FY07 1/3 of the budget for contracted HIV/AIDS health professionals will be assigned here to Palliative Care: Basic Health Care (#7340) & 2/3 will be assigned to Treatment: ARV Services (#7339).

This activity relates to other training activities in this area including the I-TECH activity (7353) and the CDC technical assistance activity (7974).

There is critical human resources gap at facility levels to delivery HIV/AIDS services in Namibia. The lack of pre-service training institutions for doctors, pharmacists, and laboratory technologists in Namibia contributes to a chronic shortage of health professionals who can provide comprehensive HIV/AIDS care and treatment services on the scale and at the level of quality that is required for ARV roll out and palliative care expansion. This in turn creates issues of bonding and incentives for these cadre of health care workers to return to Namibia and retention incentives for staff currently serving in the country. The vacancy rate in the Ministry is approximately 40% for doctors, 25% for registered nurses and 30% for enrolled nurses, and 60% for pharmacists.

The lack of training institutions for doctors, pharmacists, and laboratory technologists in Namibia contributes to a chronic shortage of health professionals who can provide comprehensive care and treatment services on the scale and at the level of quality that is required. Since FY04, the USG has assisted the MOHSS to address this gap by providing supplemental personnel to the MOHSS through Potentia, which administers salary and benefits packages equivalent to those of the MoHSS. Both HHS/CDC and the MOHSS participate in the selection of health personnel who are then trained and provided with field support by ITECH, HHS/CDC, and the MoHSS with USG funding. Beginning in FY06, Potentia also began supporting technical and administrative staff that were previously funded through I-TECH - in order to streamline administration and reduce costs. This human resources strategy has been central to Namibia's success to date with meeting its prevention, care and treatment targets.

As of August, 2006, Potentia supported a total of 117 staff and this number is projected to increase to 363 in FY07.

In this activity, Potentia will contract professionals to serve as TB/HIV trainers with I-TECH, which is the major USG partner for health worker training in Namibia. In FY06, funding for local I-TECH positions was transferred to Potentia in order to save on administrative costs. This includes half of the cost of a Physician Training Manager (shared with ART Services and a Curriculum Developer (shared with ART Services) and a full-time IMAI/TB in-service trainer to be based at the National Health Training Center.

Training content corresponds to Namibia national guidelines and emphasizes routine counseling and testing for consenting TB patients, isoniazid preventive therapy for eligible TB/HIV patients, cotrimoxazole prophylaxis, linkages of TB with HIV/AIDS services, and provision of ART in eligible TB/HIV patients, including children.

Within COP07, funding for Community Counselors is distributed among six program areas, all of them Ministry of Health and Social Services activities: Preventing Mother to Child Transmission (7334), Abstinence and Be Faithful (7329), Other Prevention (7333), HIV/TB (7972), Counseling and Testing (7336), and ARV Services (7330). This activity also links with CDC's system strengthening activity (7360). In addition, the activity leverages resources from the Global Fund to the Ministry that support an Assistant Counseling and Testing Coordinator to help with the rollout of community counselors and rapid HIV testing, and to non-governmental organizations for VCT services.

This activity also addresses the critical human resources gap at facility levels to delivery HIV/AIDS services in Namibia. The lack of pre-service training institutions for doctors, pharmacists, and laboratory technologists in Namibia contributes to a chronic shortage of health professionals who can provide comprehensive HIV/AIDS care and treatment services on the scale and at the level of quality that is required for ARV roll out and palliative care expansion. This in turn creates issues of bonding and incentives for these cadre of health care workers to return to Namibia and retention incentives for staff currently serving in the country. The vacancy rate in the Ministry is approximately 40% for doctors, 25% for registered nurses and 30% for enrolled nurses, and 60% for pharmacists.

The lack of training institutions for doctors, pharmacists, and laboratory technologists in Namibia contributes to a chronic shortage of health professionals who can provide comprehensive care and treatment services on the scale and at the level of quality that is required. Since FY04, the USG has assisted the MOHSS to address this gap by providing supplemental personnel to the MoHSS through Potentia, which administers salary and benefits packages equivalent to those of the MoHSS. Both HHS/CDC and the MoHSS participate in the selection of health personnel who are then trained and provided with field support by ITECH, HHS/CDC, and the MoHSS with USG funding. Beginning in FY06, Potentia also began supporting technical and administrative staff that were previously funded through I-TECH - in order to streamline administration and reduce costs. This human resources strategy has been central to Namibia's success to date with meeting its prevention, care and treatment targets. As of August, 2006, Potentia supported a total of 117 staff and this number is projected to increase to 363 in FY07.

(1) In response to a request from the Namibian government, a Technical Advisor to the national coordinator for counseling and testing in the Ministry of Health and Social Services (MoHSS) was provided in early 2005 and will be continued. This has succeeded in the deployment of 175 Community Counselors to 74 public health facilities beginning in June 2005 and rapid HIV testing in more than 50 public health facilities. MoHSS established the Community Counselor cadre in 2004 to assist doctors and nurses with provision of HIV prevention, care, and treatment services, including HIV counseling and testing for PMTCT, TB, and STI patients as well as ART adherence and supportive counseling; and to link and refer patients from health care delivery sites to community HIV/AIDS services. Emphasis is placed on the recruitment of HIV positive individuals as community counselors as a strategy to reduce stigma and discrimination. To date, 175 community counselors (25% of whom are HIV positive) have been placed at 74 health facilities. With FY07 support, this number will increase to 430 by September 2007, and to a final target of 480 by December 2007.

Policy development, quality assurance, and support to field services are important aspects of this position. The Counseling and Testing Technical Advisor will continue to provide technical assistance to the head of the Counseling and Testing unit, Directorate of Special Programs, MoHSS to increase access to VCT and routine counseling and testing in the clinical setting. The Counseling and Testing advisor will also guide the national program in the implementation of the VCT guidelines and will support the regions and districts in implementation and monitoring of program effectiveness. He will continue to support the unit with the roll out and supervision of counseling and testing sites in health facilities, as well as the recruitment, training, and allocation of Community Counselors for counseling and testing and to support other programmatic areas, including PMTCT, AB, Condoms and Other Prevention, TB/HIV, and ART Services (adherence counseling). The Advisor will be intimately involved with CDC advisors in the Ministry's implementation of the prevention with positives initiative at the national level through the community counselor initiative.

(2) To increase capacity for decentralized training, 5 trainers will be deployed to the Ministry's Regional Health Training Centers to train 560 health workers in counseling and testing, rapid testing, and couples counseling. This activity includes the creation of a new position to oversee the training of Community Counselors. The Community Counselor Training Coordinator will be placed at the Ministry VCT program to develop curricula, train trainers, provide mentoring and evaluation support, and plan and implement supervision strategies for this cadre of health wordkers. A counseling trainer will take the lead on Prevention with Positives and Family Planning Trining. This activity also includes the cost of an additional rapid test trainer because the availability of only one expert trainer has impeded rollout of rapid testing. One RT training coordinator will be supported as the lead person at national level to identify trainees from health facilities and organize trainings. Funding will also support 0.5 FTE curriculum developer and a driver to transport trainers to health facilities following training.

The $250,000 plus up funds will support: (1) hiring of six laboratory technicians to carry out HIV rapid testing quality assurance. These technicians will relieve major bottlenecks in the ongoing rollout of HIV rapid testing in Namibia, specifically with regard to certifying rapid testing sites and the staff persons who carry out rapid testing. The technicians will certify sites and staff persons based on guidelines established by the Namibia Institute of Pathology and the Ministry to ensure the confidentiality, accuracy, and safety of rapid testing carried out in Ministry facilities. These technicians will conduct site visits to ensure the integrity of testing sites and the performance levels of the staff. These findings will be relayed to appropriate persons within the VCT program to inform programmatic decision-making. This activity will eventually be scaled back as test sites are certified and coverage is maximized. (2) hiring a short-term IT professional to develop a rapid testing database to be used by the technicians and others within the national VCT program. Currently, no central database exists that can capture the rapid testing activities being carried out in the field. The six technicians will be able to use the database to monitor rapid testing activities and to support adjustments in programmatic activities as appropriate in collaboration with key VCT stakeholders.

This activity is an expansion of FY06 (relates to Potentia Basic Health#7340, Potentia PMTCT#7344, MoHSS ARV Services #7330, MoHSS ARV Drugs #7335, ITECH ARV Services 7350 and Potentia SI #7338) to provide urgently needed supplemental health personnel to the Ministry of Health and Social Services (MoHSS) through Potentia.

This activity addresses the critical human resources gap at facility levels to delivery HIV/AIDS services in Namibia. The lack of pre-service training institutions for doctors, pharmacists, and laboratory technologists in Namibia contributes to a chronic shortage of health professionals who can provide comprehensive HIV/AIDS care and treatment services on the scale and at the level of quality that is required for ARV roll out and palliative care expansion. This in turn creates issues of bonding and incentives for these cadre of health care workers to return to Namibia and retention incentives for staff currently serving in the country. The vacancy rate in the Ministry is approximately 40% for doctors, 25% for registered nurses and 30% for enrolled nurses, and 60% for pharmacists.

The lack of training institutions for doctors, pharmacists, and laboratory technologists in Namibia contributes to a chronic shortage of health professionals who can provide comprehensive HIV/AIDS care and treatment services on the scale and at the level of quality that is required for ARV roll out. Since FY04, the USG has assisted the MoHSS to address this gap by providing supplemental personnel to the MoHSS through Potentia, which administers salary and benefits packages equivalent to those of the MoHSS (however the hiring process is more rapid than that of the MoHSS). Both HHS/CDC and the MoHSS participate in the selection of health personnel who are then trained (in ART, OI and Pain management, PMTCT, TB, Nutrition, and 2007, STI diagnosis and management, and Prevention with Positives) and provided with field support by ITECH, HHS/CDC, and the MoHSS with USG funding. Beginning in FY06, Potentia also began supporting technical and administrative staff that were previously funded through I-TECH - in order to streamline administration and reduce costs. This human resources strategy has been central to Namibia's success to date with meeting its prevention, care and treatment targets.

Potentia currently contracts 33 doctors, 23 nurses, 12 pharmacists, 3 pharmacy assistants, and 15 data clerks (total of 86 staff) to 29 MoHSS Communicable Disease Clinics (CDCs) which manage approximately 80% of the approximately 22,000 patients on ART in the public sector. The Ministry has recently re-set national ART targets to have started 34,745 on ART by March 2007 and 50,349 by March 2008. To reach the 2008 target will require an estimated 79 doctors, 106 nurses, and 58 pharmacists (total of 243 staff) working full-time in Communicable Disease Clinics. The Ministry does not have this capacity and FY06 staffing levels supported by PEPFAR are only 41% of this projected need for FY07. The FY07 request is therefore to contract a total of 60 doctors, 75 registered or enrolled nurses, and 40 pharmacists or pharmacy assistants for a total of 175 professionals, or 72% of the projected need with the remainder to be made up by the Ministry itself, the Global Fund, and other partners such as DED and VSO who focus on specified regions in the north. Some of these staff may be eventually deployed to health centers and clinics as ART/care is decentralized through the IMAI approach (see Palliative Care Overview.) At least 13 nurses are destined to support the Supervisory Public Health Nurse in high-burden districts, with TB/HIV activities; this is a new support position in 2007 added in response to needs expressed during MoHSS supervisory support visits. In addition, a new position of medical technologist was added to the MoHSS Tertiary Care Services Division to assist in monitoring the appropriateness of invoices submitted by the NIP for bioclinical lab monitoring testing. The USG works closely on the management of the national ART program from within Ministry headquarters and is able to quickly leverage resources, including personnel assignments, with these other important partners. The MoHSS will begin encouraging the hospital CDC's to rotate their staff in through the CDC to expand the number of staff who are aware of basic palliative care needs of HIV+ patients.

To date, our experience and data from the MoHSS ART/care HMIS has shown that for approximately every three HIV-infected patients who are evaluated for ART, two are started on ART and one is not yet eligible and is enrolled in comprehensive HIV care. This may change as those with earlier stages of HIV are identified and enrolled into comprehensive HIV/AIDS care. Therefore, in FY07 1/3 of the budget for contracted HIV/AIDS health professionals will be assigned to Palliative Care: Basic Health Care 7340

whereas 2/3 will be assigned here to Treatment: ARV Services. Quality of ARV Services (e.g. indicators based on proportion of eligible patients who are: on ARV, had a CD4 count tested within the past 6 months, on appropriate regimens, were seen by provider within the previous 3 months, etc) will be assess at 12 CDCs in 2007 through the HIVQUAL initiative (see ARV services #7450). The HIVQUAL medical officer will also assist in collecting annual evaluations from MoHSS supervisory staff to assess HIV provider performance. Underperforming staff will be offered opportunity to address deficits through additional training.

In addition to providing contracted clinical personnel to Communicable Disease Clinics, this activity will also support the provision of training personnel to ITECH and the Ministry's National Health Training Center and Regional Health Training Centers. The training centers do not have sufficient human capacity at present to provide this training due to competing priorities with CT, PMTCT, TB/HIV, STIs, and other activities. Though adaptation of the WHO IMAI curriculum is underway, this will be an ongoing activity in FY07 as the training is evaluated to ensure that it equips nurses to provide quality HIV/AIDS treatment. This activity will cover 0.5 FTE of a US-based ITECH curriculum development expert to develop the capacity of a Namibian in curriculum development, a driver to transport tutors to IMAI clinical sites for follow-up after IMAI training, an STI trainer, an additional nurse trainer, and a trainer manager to ensure that sufficient numbers of the best-suited nurses for IMAI complete quality training.

The plus up funding will support cost of living increases of 5% for all Potentia hires working in ART clinic sites - including doctors, nurses, pharmacists, pharmacist assistants and data clerks. The figure here includes current hires and projected hires for 2007, who will need to be hired at this increased rate. This was not otherwise budgeted for in COP07. The increase brings the Potentia hires in line with Ministry positions, but does not exceed those positions.

This activity is a continuation and expansion of FY04/FY05/FY06 and also relates to CTS Global (7322), CDC Base (7359), MoHSS (7332), Namibia Institute of Pathology (NIP) (7995), and ITECH (7355).

Potentia, a sub-partner in FY04 and a direct partner starting in FY05, is a private-sector Namibian personnel agency.

Yearly Namibian public health services provide PMTCT to more than 40,000 women, VCT to >50,000 additional people, ARV treatment to >20,000, and TB treatment to approximately 17,000 (many of whom have HIV co-infection). Monitoring and evaluation (M+E) of these programs is critical to optimize their delivery and secure their continued support. Personnel with data collection, analysis, and dissemination skills are thus essential to these services.

For this activity, Potentia will administer an expanded cadre of SI personnel. Since FY04, data clerks and analysts have successfully analyzed and summarized ART and care data to service providers and policy makers at the local level to help track and improve services, and to the National level which reports to the Namibian Government and partners including PEPFAR, the UN, WHO, and the Global Fund. In FY06/FY07 responsibilities of this cadre are being expanded beyond routine data collection and reporting to assist with national survey and to enable, with analytic guidance from USG technical advisors, in-depth program evaluation including L-STEP and HIVQUAL.

SI personnel included here are those to support collection, analysis, and reporting of ART, PMTCT, VCT, and TB activities: data clerks, data analysts, graduate student analysts, M+E program administrators, and a project coordinator for longitudinal surveillance of ART patients (L-STEP). Both USG and the Ministry participate in the selection of personnel who are then trained and advised in the field by the MoHSS and the USG.

Training for SI personnel will also be expanded in FY07 (see #7355, #7322). This, combined with a more efficient computer-based management information system (see #7322, #7332, #7355), will permit more and higher quality evaluation of program design (including targeted evaluation) to occur so that successful intervention strategies can by identified and disseminated.

1. Facility-based Data Clerks: FY07 will expand the number of data clerks from the 30 in FY06 to 40 in FY07. In FY07 the data clerk role will also be expanded from a focus on to include facilitating data collection, entry and report dissemination for PMTCT, VCT, and TB programs. Some clerks have been employed since June of 2004; others are still being hired. Thus in FY07, clerks will be classified as normal-level data clerk, tenured data clerk, and senior data clerks with the following numbers: 32 facility-base, 3 tenure, and 5 senior. Senior and tenured data clerks will supervise and mentor the others. 2. Regional Data Clerks: These are new positions for FY07. One data clerk will be appointed for each of the 13 regions. Activities of the regional data clerks will be similar to the facility-based clerks with an emphasis on data summarization for the region. These individuals will partner with the regional HIV/TB program administrators to ensure coordinated collation and dissemination of ART/PMTCT/VCT/TB data at the regional level. 3. CT/PCR Data Clerk: This one new position for FY07 will be recruited and placed at the national level to coordinate data collection for the growing volume of PCR testing of HIV-exposed infants and voluntary counseling and testing services. This clerk will receive PCR testing results linked to post-natal PMTCT information. In addition, the clerk will receive VCT results collated by regionally-based Red Cross supervisors of facility based community counselors who complete the VCT process including provision of rapid test results. 4. Data Analysts: Since FY05, data analysts have been funded through this mechanism to provide training and technical support to the data clerks and to coordinate national-level data processing and dissemination. This activity began with 1 senior and 1 junior data analyst. Due to rapidly expanding needs, 1 more senior and 1 more data analyst will be added in FY07. One senior data analyst will focus on administration and training of clerks leveraging the computer training laboratory resource supported by the FY06 COP as well as on data collation and reporting at the national level. The second will oversee design and migration of the current ART/PMTCT/VCT/TB MIS to a more capable system. One junior data analyst will assist the first senior data analyst with administration, training and data

processing; the second on MIS. The data analysts are assigned to the head office of the MoHSS National Health Information System in Windhoek. 5. L-STEP Project Coordinator: Continued from FY06 and related to Longitudinal Surveillance for Treatment under the Emergency Plan (L-STEP), this activity provides a project coordinator for L-STEP in Namibia. Collecting and analyzing information on the same individuals over time is essential. L-STEP is designed to establish a system of longitudinal surveillance of a sample of adults and children on ARV therapy at treatment sites receiving Emergency Plan support to provide the country with standardized cohort information on treatment retention, drop-out, and death, regimen adherence and change, change in health status, co-infection with active TB, receipt of a basic package of HIV care services, and development of HIV drug resistance. The project coordinator oversees the program's goals and objectives, and direct project activities with data management and analytic support from data analysts. This will supplement CDC's ongoing work through an HIS advisor, M&E advisor and facility-based clerks and will leverage the ARV database and training efforts currently ongoing. 6. Program Administrators for M+E Unit: These 3 new positions relate to the M+E Technical Advisor (Activity #7322). They will be recruited to assist with surveillance, research, and compiling/disseminating M+E data from around the country. One will coordinate surveillance efforts called for by the National M+E Plan; another will coordinate program evaluation related to ART, TB, PMTCT, CT; another will assist with collecting and disseminating HIV-related M+E data from government sectors outside of health and from non-government partners. 7. UNAM Information for Action Fellowship Programme: To support the National AIDS Program with analysis and dissemination of routine ART, PMTCT, TB, and VCT data collected in facilities so that it can be used to improve care and prevention services, the USG will leverage resources with the University of Namibia to provide 2, 1-year MPH scholarships. Students should complete mentored analysis of routine data and write a thesis and present findings to an appropriate audience. Students will be mentored by MoHSS and USG personnel including the USG HIS Technical Advisor. 8. Systems development interns: New for FY07, 2 stipends for computer science graduate students from the Namibian National Polytechnic Institute (masters level in information technology- M-TECH) to support the development of the MIS for HIV, PMTCT, VCT, and TB activities while completing their masters thesis. Namibian M-TECH students selected for this role will receive oversight from the USG HIS technical advisor and an experienced systems developer from the US private sector as well as their thesis professor.

This activity addresses the critical human resources gap at facility levels to delivery HIV/AIDS services in Namibia. The lack of pre-service training institutions for doctors, pharmacists, and laboratory technologists in Namibia contributes to a chronic shortage of health professionals who can provide comprehensive HIV/AIDS care and treatment services on the scale and at the level of quality that is required for ARV roll out and palliative care expansion. This in turn creates issues of bonding and incentives for these cadre of health care workers to return to Namibia and retention incentives for staff currently serving in the country. The vacancy rate in the Ministry is approximately 40% for doctors, 25% for registered nurses and 30% for enrolled nurses, and 60% for pharmacists.

The lack of training institutions for doctors, pharmacists, and laboratory technologists in Namibia contributes to a chronic shortage of health professionals who can provide comprehensive care and treatment services on the scale and at the level of quality that is required. Since FY04, the USG has assisted the MOHSS to address this gap by providing supplemental personnel to the MOHSS through Potentia, which administers salary and benefits packages equivalent to those of the MoHSS. Both HHS/CDC and the MOHSS participate in the selection of health personnel who are then trained and provided with field support by I-TECH, HHS/CDC, and the MoHSS with USG funding. Beginning in FY06, Potentia also began supporting technical and administrative staff that were previously funded through I-TECH - in order to streamline administration and reduce costs. This human resources strategy has been central to Namibia's success to date with meeting its prevention, care and treatment targets. As of August, 2006, Potentia supported a total of 117 staff and this number is projected to increase to 363 in FY07.

Potentia funding within OHPS covers support for a total of 48 personnel that either focus on pre-service rather than in-service training, or that cuts across all of the other program areas that Potentia supports. These personnel are:

1) One Technical Advisor at the University of Namibia (UNAM) during April-September 2007, to assist the nursing program to implement the completed HIV-integrated curriculum for the 4-year nursing diploma program.

2) 3 Nursing Lecturers and 4 part-time Clinical Instructors at UNAM campuses in Windhoek and Oshakati to follow up students at their clinical sites to continue to strengthen HIV/AIDS integration into pre-service training at UNAM. UNAM has increased its intake of nursing students in response to the severe shortage and needs continued support in the classroom and clinical training setting.

3) 3 pre-service tutors stationed at the MoHSS National Health Training Center (NHTC) and 10 at the five Regional Health Training Centers (RHTCs). These tutors follow up the nursing students in their clinical sites where they learn about how to take care of PLWHA. I-TECH staff train them on HIV/AIDS and provide ongoing professional development (see I-TECH_Other/PA/SS_7352).

4) Two pre-service pharmacy tutors at the RHTCs to supervise pharmacy assistants in their clinical works.

5) One Human Resources Development Advisor and one Data Clerk assigned to the MoHSS Directorate of Policy, Planning & Human Resources Development to assist with policy development, human resource forecasting, management of the staffing database, training strategies and strategic planning, including defining of the expanded roles of nurses and community counselors in HIV/AIDS care. This is critical for sustainability.

6) One Digital Video Conferencing (DVC) Program Coordinator, 1 DVC Technologist / IT Advisor, and 5 DVC Assistants (one for each RHTC) to ensure that the DVC program is coordinated and operational throughout the country. The DVC program provides training opportunities such as HIV case conferences, lectures on OIs and HIV co-morbidities, and video demonstrations of HIV counseling sessions. The DVC program also provides an efficient means of communicating programmatic HIV/AIDS-related information from the national to the local level, such as technical updates, and to provide technical and managerial support to the sites as they expand.

7) One Training Coordinator and one Clerk assigned to the NTHC to coordinate training activities in PMTCT, VCT, and Couples Counseling.

8) I-TECH field office staff: 1 I-TECH Deputy Director, 1 Office Manager, 1 Financial Officer, 1 Receptionist, 1 Driver, 1 Administrative Assistant for the Oshakati RHTC office, 1 Curriculum Development Manager who will coordinate the revision and/or completion and approval of all 14+ major curricula and media products; 2 Training Assistants and one Materials Production Clerk to support training coordination; 1 Facilities Manager, 1 Housemother, 2 Cleaners to support the operation of a Training Center in Windhoek.

9) NHTC facilities staff at Keetmanshoop RHTC to maintain the operation of this pre-existing but underutilized training center.

This activity will allow for the recruiting and hiring of short-term consultants to assist the Ministry of Health and Social Services with the mid-term review of HIV/AIDS prevention and care efforts outlined in Namibia's Medium Term Plan-III. MoHSS has requested the USG's assistance with identifying objective experts to serve as part of a multi-national delegation that will thoroughly assess and report on Namibia's progress toward the HIV-related objectives identified in the MTP-III. This review will carried out in collaboration with the MoHSS and a variety of donor agencies, including the Global Fund and the European Union. Specifically, the USG will support consultants to assist with evaluation of human resource development, health systems, and treatement with a focus on PMTCT services. Every effort will be made to identify African experts for these consultancies. In addition to recruitment and consultant fees, these funds will further support costs related to housing and traveling the consultants to the various site visits that will occur during the review process. Deliverables will include written reports of findings, identified successes and constraints, and recommendations for improvement.