The USG has supported two key faith-based partners Catholic Health Services (CHS), Lutheran Medical Services (LMS) and one FBO/NGO, Lifeline/Childline (LL/CL) to implement the PMTCT, AB, ART, counseling and testing (CT), and palliative care activities under the Emergency Plan. In 2006, implementation was assumed from FHI by IntraHealth/The Capacity Project (Capacity). Capacity will provide clinical technical assistance, organizational and financial capacity building, and other human resource development support. The clinical technical assistance will be in the form of group discussions on clinical issues/cases, patient management software development, analysis of clinical data, updating of clinical information and consultation with in-country consultants (MoHSS and regional) and international consultants as appropriate.

CHS manages four faith-based hospitals and 45 health centers and clinics in 3 different health regions. LMS manages one of the highest volume hospitals in the country and 15 health centers and clinics. The five FBO hospitals are serving a population of 400,000 (20% of the total population). LMS and CHS provide PMTCT, ART, CT, palliative care, prevention and training to their staff and communities they serve.

By the end of COP06 implementation period, decentralization of PMTCT services in 10 CHS and LMS clinics will be completed. In 07, services will be expanded to another six health facilities with an emphasis on quality of service delivery and encouraging male participation in PMTCT. In collaboration of the MoHSS, LL/CL and I-Tech, 40 new health workers from CHS and LMS will be trained in PMTCT plus refresher training for staff in existing sites. Training will include PMTCT, dried blood spot (DBS) for DNA_PCR testing and outreach to faith-based affiliates, Catholic AIDS Action (CAA), Evangelical Lutheran Church AIDS Program (ELCAP), and Evangelical Lutheran Church in Namibia (ELCIN). Capacity will cooperate with strategic partners Development Aid from People to People (DAPP) and Lironga Eparu (the national PLWHA NGO) to develop a support network for a mother-to-mother initiative utilizing the Mothers-to-Mothers-to-Be best practice model from South Africa (see Basic Health Care section). These support groups will assist the mothers enrolled in PMTCT and help in the tracing of infants missing follow up.

Virological testing of infants commenced in March 2006, and according to MoHSS guidelines will continue through 07. Support will also be provided to explore time-constrained complementary feeding options for infants following early weaning after exclusive breastfeeding by HIV positive mothers. All children enrolled in the PMTCT program will be closely followed with cotrimoxazole prophylaxis (CTX), continuous feeding options counseling and early diagnosis of HIV by PCR/DNA. They will also be provided a basic preventive care package by linking them to immunization centers, TB screening and INH prophylaxis for children at risk, mosquito nets, and TBD safe water measures (e.g., hyper-chloride tablets, safe water containers).

Capacity will implement a new male-involvement program in the five faith-based hospitals. The program will encourage male partners to participate in the full range of PMTCT services, including CT, family planning counseling, infant feeding, and ART. Focus groups of mothers, their partners, and policy makers will be held to develop and test potential methods of encouraging male participation such as sending notification of available services, allocating specific days such as Saturdays for counseling of males by male counselors. Tools to strengthen and encourage male participation will be explored and assessed based on local needs. Assessment will be through comparing male partners' anticipation percentage before and after implementing the program.

In 07, CHS will roll out PMTCT services to three additional district health centers/clinics in support of the network decentralization model. Based on the current levels of service provision, CHS will provide routine CT for approximately 4,250 pregnant women per year attending ANC services at CHS health facilities. 3,750 (88%) will receive post-test counseling. LMS is providing PMTCT services to all women attending ANC services at the integrated prevention, care and support center ‘Shanamutango' at Onandjokwe Lutheran hospital. In 07, PMTCT services will be offered in three health centers. LMS will provide routine counseling and testing for about 3,750 pregnant women per year attending ANC services, delivering at the hospital or attending ANC services at other district health centers/clinics in support of the network de-centralization model.

Clinical staging and CD4 testing will be offered to all HIV positive pregnant women who

are post-test counseled and positive. This number is currently 450 each per year for CHS and LMS. HAART will be offered for those eligible according to national guidelines (60 per year for CHS and 70 for LMS). A single dose of Nevirapine or an alternative highly effective short-course regimen will be provided to pregnant women who are not eligible for HAART. These women will be enrolled in a program that includes a preventive care package of regular follow-up counseling, opportunistic infections prophylaxis and management, prevention counseling, TB screening, prophylaxis or TB referral, counseling for family planning (FP) and prevention, clinical nutritional counseling, linkage to community support groups (mother-to-mother groups) and medical monitoring. In 07, all mothers enrolled in the PMTCT program will have FP counseling in post-natal visits with more emphasis on ABC prevention and health education. Based on current figures, ~98% of all mothers who will be enrolled in the PMTCT program in the five faith-based hospitals will opt for one family planning method.

All facilities play a key role in community mobilization, through training community volunteers in PMTCT and conducting meetings with community members, including teachers and traditional leaders. Viral detection by PCR-DNA testing for infants of HIV positive mothers started in 1 CHS hospital in 06. The management of these infants follows the recommended algorithm from MoHSS. In 07, infant testing will be expanded to all CHS hospitals and 550 infants (CHS) and 650 infants (LMS) will be tested for PCR-DNA (represent 75% of infants born to HIV positive mothers and sick young babies from the hospital inpatient and outpatient departments).

LL/CL's trainers will continue to provide counseling training for community counselors for faith-based and MoHSS hospitals and clinics, ensuring that a qualified pool of trained community counselors are available to counsel pregnant women on the benefits of testing for PMTCT enrollment. LL/CL will provide supervision and support of previously trained counselors placed at hospitals and will train 120 new community counselors in PMTCT and maternal and infant feeding practices.

Capacity will work with HIV Clinician Society to train 80 private and public clinicians country wide in the provision of PMTCT services according to national and international standards.

The USG has supported two key faith-based partners, Catholic Health Services (CHS), Lutheran Medical Services (LMS), and one FBO/NGO, Lifeline/Childline (LL/CL) to implement the PMTCT, AB, ART, counseling and testing, and palliative care activities under the Emergency Plan. In 2006, implementation was assumed from FHI by IntraHealth/The Capacity Project (Capacity).

LL/CL is a registered Namibian NGO with a faith focus, operating since 1981. It operates two main programs, counseling training and school-based and community prevention programs aimed at youth. LL/CL trains volunteer counselors, community counselors, lay counselors and nurses in PMTCT counseling, counseling and testing, ARV counseling and provides supervision and psychological support. In addition, it provides refresher training to counselors and nurses in the field. The trained graduates, community counselors, are deployed in the MoHSS health system which includes FBO health facilities. The school-based and community programs of LL/CL provides A & B prevention activities to student and teachers as well as the general public through its community radio services and face to face counseling sessions.

In Namibia, NGOs and faith-based organizations play a critical and active role in HIV/AIDS prevention and care. The USG supports a comprehensive youth prevention program through the use of multi-media, participatory drama, life-skills training and previously developed youth-focused Christian family life education (CFLE) curricula, focusing on AB messages. In 07, the USG will continue to support faith-based youth programs using NGOs and faith-based affiliates to implement the AB programs. LL/CL plays a key role in this program area.

On a national level the LL/CL Schools program conducts AB activities in schools for students including OVC. In addition, two of the three teams of the LL/CL conduct regular community outreach/mobilization activities in northern villages around the catchment area of the schools.

The LL/CL School Program uses drama as a communication and learning tool for children to safely address issues of "YES and NO Feelings." The program will reach 45,000 children and teachers in Grades 1 through 7 in 150+ schools across 12 regions (one additional region in 07). The program teaches children about HIV/AIDS and sexuality before they become sexually active, sexual assault, abuse, and provides children with skills to resist unwanted sexual approaches and to deal with strangers.

"Being a Teenager" is a life skills theater forum program for students at secondary schools including OVC. Vulnerable or abused children will receive additional counseling and specialized support services through 200 trained teachers and counselors. The counselors will refer the clients to the appropriate services including youth-friendly counseling and testing sites monitored by LL/CL.

LL/CL will expand its Windhoek-based community radio call-in program on AB prevention to all regions. According to the Namibian Broadcasting Corporation (NBC), this program is expected to reach 100,000 - 120,000 (~6% of the total national population) members of the general public by the end of 07. This figure represents an increase of about 300-400% of the number of listeners reported in 2005. The program takes the opportunity to discuss issues related to abstinence, fidelity, reduction of partners, gender-based violence, sexual coercion and male norms in the community. Plans for expanding the program content include a partnership with "Leading DADS" a newly founded NGO. The partnership will also include "DAD" talking to children on relationship issues such as love, respect, boundaries, feeling of safety, respect, male and female roles etc. This partnership will use the radio services of LL/CL to broadcast a dialogue between children and adults to discuss these issues including a direct dialogue with the audience. An evaluation to determine community acceptance of the "Leading DADS" concept will also be conducted.

The USG has supported 2 key faith-based partners Catholic Health Services (CHS), Lutheran Medical Services (LMS) and one FBO/NGO, Lifeline/Childline (LL/CL) to implement the PMTCT, AB, ART, counseling and testing (CT), and palliative care activities under the Emergency Plan. In 2006, implementation was assumed from FHI by IntraHealth/The Capacity Project (Capacity).

CHS manages four faith-based hospitals and 45 health centers and clinics in 3 different health regions. LMS manages one of the highest volume hospitals in the country and 15 health centers and clinics in its district area. The five faith-based hospitals are serving a population of about 400,000 (20% of the total population). LL/CL is a Namibian registered NGO with a faith focus since 1981. It operates 2 main programs, counseling and training (CT) and school-based and community prevention programs aimed at youth. LL/CL trains volunteer counselors, community counselors, lay counselors and nurses in PMTCT counseling, CT, ARV counseling and provides supervision and psychological support. In addition, it provides refresher training to counselors and nurses in the field. The trained graduates, community counselors, are deployed in the MoHSS health system which includes FBO health facilities. The school-based and community programs of LL/CL provides A B prevention activities to student and teachers as well as the general public through its radio services and face to face counseling sessions.

In 07, the USG through Capacity will continue to support prevention programs for sexually active youth using NGOs and faith-based affiliates (LMS, CHS & LL/CL) to expand Be Faithful interventions and implement Condoms and Other prevention programs.

The LMS hospital will continue to support the distribution of condoms through its ART site and other hospital departments (outpatients, inpatients, dispensary area and others) as well as in the health centers and clinics. The condoms are provided through the MoHSS.

In Namibia, there are some studies that estimate the incidence of rape to be ~once every ½ hour. The reported cases are much less than the actual occurrences. CHS and LMS hospitals offer post-exposure prophylaxis (PEP) services for their workers and victims of rape 24 hours a day. They and LL/CL have links to the Maternity Welfare Office to assist victims of rape and sexual abuse. Health workers and counselors who will be trained in Children Counseling Program in AB program area will get a special training session on how to manage counseling of rape victims and their care-givers and to refer them to the correct channels. LMS will train 10 health workers and CHS will train a further 20 health workers on PEP and rape counseling with the assistance from other USG funded implementing partners.

LL/CL will train 200 counselors, HIV Clinician Society will train 150 private clinicians and LMS & CHS will train 150 health workers and counselors to promote HIV/AIDS prevention through other behavior change (Beyond A & B) during the training sessions for other program areas.

LL/CL outreach community mobilization activities in villages and schools primarily focus on AB prevention especially when offered in the context of the family unit and the peer setting of schools. Other prevention and condoms are included in the educational and awareness related messages in appropriate settings. The community teams of staff and volunteers regularly liaise with other USG partners for messages, referrals and condoms such as TCE educators of DAPP, Lironga Eparu (PLWHA), home-based caregivers of CAA & ELCIN Aids Action, a variety of staff at Onandjokwe Hospital , IBIS, Sam Nujoma MPYC etc. to allow for better coordination and less duplication. Regional AIDS Coordinating committee (RACOC) meetings through the Regional Councils also allow for excellent opportunities for Other Prevention coordination and condom access on a regional level. The MoHSS provides condoms to FBO/NGOs, RACOCs and health facilities at no cost.

No direct funding is allocated to this program area as the costs of this program area are reflected in other program areas such as palliative care, AB and ART services.

A significant number of those in the public sector workforce are exposed to risky situations leading to HIV transmission due to their work situation as they are separated from their communities and families through posting requirements of their employment (e.g., health, education, police and military) resulting in the disruption of primary family relationships and the need to establish secondary relationships where they work.

The public sector is the largest employer in Namibia with 80,000 members employed through 20 line ministries and 13 Regional Councils. In accordance with the National Strategic Plan on HIV/AIDS (MTP III 2004-09) and to address reduction of partners, cross-gen sex and changing male norms, in FY07 the USG will support the Office of the Prime Minister (OPM) in its role as facilitator and capacity builder for the development of HIV/AIDS policies and workplace programs by all line ministries and regional councils. The USG has partnered since 2002 with the Ministry of Defense (Activity # 7894) and its Namibia Defense Force on its prevention program, and since 2005 with the Ministry of Safety and Security (Activity # 7420). In 07, the USG will add the Ministry of Education (Activity # 7460) with its 30,000 employees as a workplace partner in addition to ongoing support to the MOD and MoSS.

Recently, in partnership with GTZ, the EU and UNDP and using reallocated FY 06 funding, the USG participated in the development of a mission statement and strategic plan for the nascent OPM program. In FY 06, support was provided for an OPM requested assessment of the impact on the public sector of HIV/AIDS which was primarily funded by UNDP. In FY 07 the USG in partnership with the above referenced development partners will provide support to build the capacity of the OPM's HIV/AIDS management unit through technical assistance and training. In addition, using the data from the assessment, OPM will be supported in identifying key line ministries for technical assistance in the development of HIV/AIDS policies and capacity building for planning and implementation of work place programs.

The USG has supported 2 key faith-based partners Catholic Health Services (CHS), Lutheran Medical Services (LMS) to implement the PMTCT, AB, ART, counseling and testing, and palliative care under the Emergency Plan. In 2006, implementation was assumed from FHI by IntraHealth/The Capacity Project (Capacity). CHS manages four faith-based hospitals and 45 health centers and clinics in 3 different health regions. LMS manages one of the highest volume hospitals in the country and 15 health centers and clinics in its district area. The five faith-based hospitals are serving a population of about 400,000 (20% of the total population) and are currently (HIS June 30) providing 22% of treatment.

Collectively in FY 07, LMS and CHS will provide 10,000 patients with preventive care. Clients for facility-based care and community-based care will be offered access to Cotrimoxazole prophylaxis, TB screening, Isoniazid prophylactic therapy (available and recommended by MoHSS but slow implementation) TB strategy, counseling and testing, safe water and hygiene promotion, prevention of diarrhea, clinincal nutrition counseling, anthropometric measurements, micronutrients supplementation, minimal targeted nutrition supplementation for severely malnourished PLWHA who are on ART, condoms and referral for family planning and STI clinics.

Capacity will also continue supporting LMS and CHS to provide training and enhance the ability of hospital staff to provide a comprehensive preventive care package for PLWHA. In-service and refresher trainings will also be provided, referrals strengthened to and from community-based organizations, and promotion of PLWHA support groups in the community.

In collaboration with other USG partners (I-Tech Activity 7349), 50 district health professionals will be trained using the palliative care curriculum developed by the MOHSS. Topics will include the diagnosis, prevention and treatment of opportunistic infections, and supportive treatment for persons with advanced HIV disease that either are not eligible for or do not respond to ART.

In Namibia, faith-based organizations (FBOs) provide almost all HIV-related community-outreach and community care services outside the government and the extended family. Community-based care relies mostly on volunteers to reach people in their own homes to assess their needs, provide needed referrals, encourage proper use of medications, and offer physical comfort and emotional support, as well as training family members in basic hygiene, provision of safe water and/or bed nets in malarial regions. However, continuum of care between facilities/communities is somewhat fragmented. There are limitations based on MoHSS policy as to what elements of the preventive care package can be offered at the facility level (e.g. pain management: morphine mist) and what elements are best supported at the community level. Community-based care givers need more training and information. Capacity will assist the CHS and LMS to work with Lironga Eparu (national PLWHA organization) and its regional support groups and USG partners to create a network for preventive care services (as described in the beginning of this section) for positive patients in the communities and utilizing community-based volunteers as partners in HIV case management referral program (see details below). Capacity will specifically work with PACT (USG partner managing community care partners) to bridge gaps especially in geographic distribution of community volunteers and will work together to cover these areas and to strengthen the links between the communities, health centers/clinics and the district hospitals.

In 07, Capacity will develop a bi-directional (HIV Case Management Referral Program) referral network between the district hospitals, health centers, and the communities. A bi-directional referral system provides links between the referring organization and the receiving organization through coordinating referrals. The patients are assigned to a case manager, a professional who helps patients and families define and meet their needs. Such health professional staff will be the link between the district hospital, the clinic and the communities and will provide support and training to the patients, community volunteers and support groups. Support will be provided to community caregivers to orient them to referrals, for training, visiting facilities to see what they are referring to/why, etc. The referral mechanism depends on documentation including: creation of a client file, referral form, and client tracking form, referral register, as well as creation of and maintenance of a directory of service providers in the geographic area. The bi-directional

referral system will be achieved in collaboration with the MoHSS roll out of IMAI to the centers and the clinics. The MoHSS proposed to pilot 13 sites for IMAI in Namibia during calendar year 2007-2008, 2 of these sites will be from LMS and CHS.

Linkage of children enrolled in other areas of the program (PMTCT, palliative care, treatment) for growth monitoring, full immunization, and in addition, counseling for mothers on infant/young child feeding options is a priority.

Capacity will assist CHS and LMS under the supervision of the MoHSS PHC Directorate Nutrition Unit to implement a kitchen corner that joins the ART site in Oshikuku hospital and another one in Onandjokwe Hospital to help the training of HIV patients, and their caregivers on how to prepare a nutritious meal using local food stuff. (ITECH Activity #7349). One health worker will be recruited in each of these 2 hospitals to facilitate clinical nutrition counseling, nutrition assessment for the patients, do clinical quality control and to co-ordinate the collaboration between support groups and ART sites. Exit interviews with caregivers will be conducted to evaluate these sessions. A registered nurse will be recruited and trained to manage this program and to offer care-givers and patients clinical nutrition counseling, education as well nutrition assessment for PLWHA beside other duties.

Capacity through HIV Clinician Society will train 50 private clinicians in the elements and provision of a preventive care package in the private sector. 50 DAPP field officers under the TCE program (Activity 7326) will be trained to work with support groups mobilizing for and providing elements of the preventive care package.

The management of STI in health facilities is supported by the MoHSS budget. There is a clear linkage between STI clinics, C&T sites and ART services to ensure counseling and testing of STI patients and evaluating their eligibility ART.

The USG has supported two key faith-based partners Catholic Health Services (CHS), Lutheran Medical Services (LMS) and one FBO/NGO, Lifeline/ Childline (LL/CL) to implement the PMTCT, AB, ART, counseling and testing, and palliative care activities under the Emergency Plan. In 2006, implementation was assumed from FHI by IntraHealth/The Capacity Project (Capacity). CHS manages four faith-based hospitals and 45 health centers and clinics in three different health regions. LMS manages one of the highest volume hospitals in the country and 15 health centers and clinics. The five FBO hospitals are serving a population of 400,000 (20% of the total population).

• Namibia is one of the countries whose population most affected with both TB and HIV. The TB incidence rate in Namibia is 809 per100, 000 (MoHSS, 2005). About 61% of cases are expected to be HIV positive. These patients are eligible for HIV/AIDS treatment. Because TB remains the leading cause of death for people living with HIV/AIDS, integration of TB/HIV services into clinics remains an important priority for support. • In the five faith-based hospitals, there are TB district clinics collaborating with the MoHSS Regional Directorate of Health. The TB clinics are linked to counseling and testing (C&T) sites in their host hospitals operationally and in some of these sites physically too. In Oshikuku hospital (CHS), the TB district clinic is a registered site for counseling and rapid testing, allowing almost 100% of TB patients to receive C&T for HIV/AIDS. In 07, the other 3 CHS hospitals are planning to add C&T services to their TB clinics. In LMS, the TB clinic will be housed in the same building as C&T, allowing for close physical and operational linkages. In the ART sites and other departments in the five faith-based hospitals, Capacity will continue staff training to screen HIV patients for TB risk factors and to offer isoniazid prophylaxis to eligible ones in addition to cotrimoxazole prophylaxis, micronutrients supplementation and counseling and testing for family members. Staff from the five faith-based hospitals and their clinics will be trained on TB/HIV management. • Capacity, with the collaboration of the HIV Clinician Society and NTCP, will train 40 private practitioners together with 25 of the staff in the five faith-based hospitals and their linked clinics on TB/HIV management during 07. • The personnel and operational costs of the TB clinics and the TB drugs costs are funded by the MoHSS.

The USG has supported 2 key faith-based partners Catholic Health Services (CHS), Lutheran Medical Services (LMS) and one FBO/NGO, Lifeline/ Childline - (LL/CL) to implement the PMTCT, AB, ART, counseling and testing, and palliative care activities under the Emergency Plan. In 2006, implementation was assumed from FHI by IntraHealth/The Capacity Project (Capacity). CHS manages four faith-based hospitals and 45 health centers and clinics in 3 different health regions. LMS manages one of the highest volume hospitals in the country and 15 health centers and clinics. The 5 FBO hospitals are serving a population of 400,000 (20% of the total population). Both LMS and CHS health facilities provide PMTCT, ARV services, counseling and testing, palliative care, prevention and training to their staff and communities they serve. LL/CL is a Namibian registered NGO with a faith focus since 1981. It operates 2 main programs, counseling training and school-based and community prevention programs aimed at youth. LL/CL trains volunteer counselors, community counselors, lay counselors and nurses in PMTCT counseling, counseling and testing, ARV counseling and provides supervision and psychological support. In addition, it provides refresher training to counselors and nurses in the field. The trained graduates, community counselors, are deployed in the MoHSS health system which includes FBO health facilities. The school-based and community programs of LL/CL provides A & B prevention activities to student and teachers as well as the general public through its radio services and face to face counseling sessions

Capacity through the LMS provides counseling by professional nurses and community counselors. The counselors are trained for both pre-test and post-test counseling. An average of 70 clients is counseled daily at the LMS Hospital, which includes VCT and hospital referrals. Community counselors are expected to carry out most of the counseling and rapid testing under supervision of trained health professionals. To cope with this demand, LMS recruited 4 community counselors in 06. Each community counselor provides at least 2 sessions for every client as well as follow-up counseling sessions when needed. Professional nurses will also carry out rapid testing, for specific situations where test results are urgently needed, such as for women in labor. All counselors will receive follow-up training and psychological support with the assistance of the LL/CL staff. The total number of persons that will receive counseling and testing per year is estimated at 12,500 (excluding pregnant women included under PMTCT), including hospitalized and ambulatory (OPD) patients as well as self-referrals. Self referral represents about 58%, while provider referral represents 42% of C & T. Counseling and testing for self-referral or provider-initiated referrals for clients from outpatient or inpatient departments in the hospital occurs under the same roof as the care and treatment center. This facilitates the linkage between C&T and care and treatment services in LMS center. In an effort to involve more men in a female dominated area, LMS recruited a male counselor to work with the male clients.

Catholic Health Services' integrated C&T centers with the SMA/New Start VCT program are operating in 3 CHS hospitals. The fourth CHS hospital (Rehoboth) also offers in-facility HIV testing for patients and works closely with the local health center (for PMTCT) and the New Start VCT center. These four hospitals will provide counseling and testing to approximately 8,000 patients from hospital wards, outpatient departments and self-referred clients. Each facility will be expanding C&T community outreach to promote uptake of services according to the MoHSS planning. The linkage between the counseling and testing sites and the ART sites will be enhanced and expanded.

In 07, Capacity will continue the management and administration of these programs. This responsibility will include providing technical assistance to improve the quality of existing counseling and testing services and expanding service to include decentralized health facilities as well as the private sector. Targeted assistance will be provided through supportive clinical supervision, mentoring, standard dissemination, training, monitoring and systematic data collection. Capacity will update clinical operational standards with partner organizations as required and improve workforce planning, monitoring and reporting systems to ensure rapid scale-up of essential treatment services. Counselors will be trained to assess the needs of their post-tested HIV positive clients of the preventive care packages and to perform the appropriate actions, linkage and referrals to address such needs.

LL/CL supports C&T by implementing an integrated counseling program to ensure effective C&T through follow-up support and supervision of 100 community counselors that were previously trained in basic counseling skills. Lifeline/Childline will continue to build the capacity of NGO/FBOs by training staff and community counselors to meet the increasing demand of the expanding C&T counseling services. LL/CL will train an additional 200 community counselors in C&T.

In 07, USG will support the Anglican Church Medical Services, Odibo Health Center, in setting up counseling and testing services . (See ARV services section)

In Namibia, the private sector provides about 20% of medical services in the country. The private clinicians also offer pre-test and post test counseling but a gap has been identified as many of these clinicians do not have enough time, the skills or human resources to perform quality counseling and testing. To bridge these gaps, Capacity will support LL/CL during 07 to provide training and services for the private sector. LL/CL-trained counselors will work under the supervision of a LL/CL senior counselor/supervisor in 3 private hospitals/departments and under the supervision of the HIV Clinician Society health worker to provide quality pre-test and post-test counseling for the private sector clients. This collaboration will represent a public/private initiative. The cost will cover the recruiting of 2 counselors for these hospitals and their supervision. The private hospitals are providing in-kind contribution for a designated counseling area, utilities and support staff.

New special training sessions on children's counseling will take place in 07 with the collaboration between Capacity Project, MoHSS, and other USG partners such as I-Tech, LL/CL, and CDC with the assistance of local, regional and international expertise. The target staff members for these training sessions are doctors, nurses and counselors. 30 of the staff of the five faith-based hospitals will attend these training sessions. These sessions will include training on children's counseling, and how to prepare children for available adolescent programs.

Through the CR process it was discovered that PSI/SMA had a significant FY 06 pipeline for VCT (HVCT). In the past there have been concerns expressed by the COP technical review committee regarding the high cost of individual client testing at the community VCT Testing Centers (New Start) supported by SMA/PSI with funding, technical assistance and supervision. In addition, and as a result of increased monitoring by the USG, some performance and uptake issues have been identified. As a result of the above, a decision was made to move funding for FY 07 service delivery of community VCT to IntraHealth/The Capacity Project which already manages 5 of the 15 currently operating community VCT centers and 1 integrated hospital community testing center. IntraHealth has an excellent track record in quality service delivery and 2 of the VCT centers it manages are located in a high volume treatment hospitals so it is well versed in integration of services and community outreach.

The USG has supported 2 key faith-based partners Catholic Health Services (CHS), Lutheran Medical Services (LMS) and one FBO/NGO, Lifeline/ Childline - (LL/CL) to implement the PMTCT, AB, ART, counseling and testing, and palliative care activities under the Emergency Plan. In 2006, implementation was assumed from FHI by IntraHealth/The Capacity Project (Capacity). CHS manages 4 faith-based hospitals and 45 health centers and clinics in 3 different health regions. LMS manages one of the highest volume hospitals in the country and 15 health centers and clinics. The 5 FBO hospitals are serving a population of 400,000 (20% of the total population). The Anglican Church Medical Services', Odibo Health Center (OHC), is located in the Engela District, Ohangwena Region, one of the most under-served health regions in the country. OHC serves 15,338 people. The center has 50 beds, 17 nurses, one counselor beside other non-health workers, but no doctor, pharmacist or pharmacist assistant. The center receives 200 outpatients' clients daily, and provides ANC, TB DOT, immunization, deliveries, and other services. It has outreach and home-based care teams but lacks sufficient funds. The center is proposed as an IMAI health site by the MoHSS to serve HIV/AIDS patients.

In 07, USG will support the OHC as a new partner. In addition to technical assistance and capacity building for staff, support will be used to recruit 1 pharmacist assistant, 1 ARV nurse, and 1 counselor. Other support will include assisting the center in its outreach program, purchasing a vehicle, furniture and equipment for the counseling and testing site requirements (e.g. fridge).

In 07, the MoHSS is expected to approve the decentralization of ARV services to selected health centers and clinics primarily through IMAI implementation. Thus another 2 sites (1 LMS, 1 CHS) are expected to provide ART services in addition to the 5 faith-based hospitals.

Staff will attend training courses organized by the Ministry of Health, the HIV Clinicians Society, CDC/I-Tech and MSH, including but not limited to HIV management, updated guidelines, best practices, management of complications, palliative care, PMTCT and others. In-service training will also be provided to other staff of these hospitals and health centers.

The capacity to do pharmaceutical management will be strengthened by the introduction of computerized pharmaceutical management in the five hospitals in 07 with the collaboration of MSH.

LMS and CHS will strengthen their links with ELCIN, CAA, DAPP and ELCAP to facilitate patient referral by home-based caregivers and community-based groups. The hospitals and district clinics will use these links to assist in the training of community volunteers as treatment supporters or local contact persons for tracing defaulters.

LMS and CHS will be supported in the assessment of HIV positive patients and/or their families for cotrimoxazole prophylaxis, TB screening and isoniazid prophylaxis for eligible clients, clinical nutrition counseling, micronutrients supplementation, minmal targeted nutrition supplementation for severely malnourished PLWHA who are on ART, counseling and testing, behavior changes, condoms and referral for family planning and STI clinics. Capacity will work with its sub-grantee partners and other USG partners (RPM+, I-Tech & CDC) to promote better ARV adherence for patients on HAART. This includes but is not limited to proper counseling, tools (pill boxes), reminders, calendars and self-reporting.

CHS will enroll about 1,800 new patients on ART during 07 and the cumulative number of patients receiving ARV drugs is expected to be 5,000 patients. To cope with the increased demand for ART services, CHS will further strengthen the links between the hospital, the ART clinic, and CAA and other community-based organizations. CHS will provide with the collaboration of MoHSS & I-Tech, ART training for 30 district staff members from 3 district health centers.

1,500 new patients will be enrolled for ARV per year by LMS and the cumulative number of patients receiving ARV drugs is expected to be 4,800 patients by the end of 07. In preparation for decentralization of ART services to selected district health centers, 30 nurses from health centers and clinics will be trained by LMS & I-Tech in PMTCT, rapid testing, ARV counseling, adult and pediatric ARV management, and ARV drug dispensing

and counseling. To cope with increased demand, LMS will recruit 1 pharmacy assistant, 2 registered nurses, and 2 counselors to supervise ARV distribution in peripheral health centers/clinics.

Of the 4500 patients who are on ART in the 5 hospitals, more than 1000 (22%) of them are pediatric patients. All 5 faith-based hospitals are capable of managing pediatric care and ART. Capacity is working with other USG partners (I-Tech/CDC) to update the Namibia Pediatric Guidelines. The project plans to train 40 health workers country-wide on management of pediatric ART. The implementation of PCR-DNA testing helps in early evaluation of younger babies (< 18 months) and enrolling eligible ones on ART. In LMS, where 524 (24% of all patients on ART in LMS) pediatric patients are on ART, 95 (18%) of them are less than 2 years and 201 (38%) of them are between 3 to 5 years old. In 07, training sessions for children's counseling will ensure quality counseling and will help in supporting younger patients and their caregivers clinically, psychologically and socially.

According to the MoHSS alcohol and drug use and abuse survey in 2002, 55.6% of the adult population was classified as current drinkers. Alcohol is known as a major contributing factor in the spread of HIV in sub-Saharan Africa. It also negatively impacts the eligibility of HIV+ patients to be able to start treatment, as well as contributes to non-adherence, defaulting, and increased risk of side effects in ART patients. Based on results from a study done at CHS Rehoboth Hospital and presented at the 2006-PEPFAR Conference in Durban, alcohol was identified as the main cause of defaulting in the Rehoboth ARV center, almost 46.6% of defaulting patients. In 07, Capacity through CHS will pilot an alcohol intervention program at the Rehoboth ART center. This program will be developed with technical assistance from the PEPFAR TWG Subcommittee on Substance Abuse to incorporate evidence-based interventions and will include health worker and counselor training to better understand and treat alcohol abuse and alcohol-induced problems in their patients through counseling, behavior change interventions, and rehabilitation where eligible clients will be referred to the National Rehabilitation Center (managed by MoHSS). The pilot program will include an evaluation component to assess program outcomes and lessons for potential program expansion to other CHS facilities. Baseline and monitoring data will be collected. Two social workers/nurses will be recruited to manage the program, which will be implemented with other health care workers at the ARV center.

A preliminary analysis of patient data from the LMS hospital showed a statistically relevant correlation between malnutrition and mortality of children on ART. 10 out of 11 dead children had moderate to severe protein-energy malnutrition before starting ARV therapy. Capacity will assist LMS in completion of a similar analysis to cover other factors affecting mortality of patients on ARV such as age, nutritional status, opportunistic infections, gender, immunization and others.

Capacity will monitor the quality of clinical services in the ART sites by monitoring certain quality indicators (as CD4 testing frequency, TB screening and others). As stated earlier under the care program area, the recruited health worker responsible for nutrition assessment, nutrition counseling & co-ordination with the support groups will also be responsible for this activity.

The USG has supported 2 key faith-based partners Catholic Health Services (CHS), Lutheran Medical Services (LMS) and one FBO/NGO, Lifeline/ Childline (LL/CL) to implement PMTCT, AB, ART, counseling and testing, and palliative care activities under the Emergency Plan. In 2006, implementation was assumed from FHI by IntraHealth/The Capacity Project (Capacity). CHS manages four faith-based hospitals and 45 health centers and clinics in 3 different health regions. LMS manages one of the highest volume hospitals in the country and 15 health centers and clinics. The 5 FBO hospitals are serving a population of 400,000 (20% of the total population). LMS and CHS provide PMTCT, ART, CT, palliative care, prevention and training to their staff and communities they serve. LL/CL is a NGO with a faith focus. It operates 2 programs, counseling training and school-based and community prevention programs aimed at youth. LL/CL trains an array of counselors, including community counselors, and nurses in PMTCT counseling, CT, ARV counseling and provides supervision and psychological support. It also provides refresher training to counselors and nurses in the field. The community counselors are deployed in the MoHSS health system which includes FBO health facilities. The school-based and community programs of LL/CL provide AB prevention activities and messages to students and teachers as well as the general public through its radio services and face to face counseling sessions.

In 07 Capacity will develop improved tools and models for the collection, analysis and dissemination of HIV/AIDS information for the purposes of behavioral and biological surveillance and also for monitoring purposes.

Capacity will support LL/CL with the development of a data collection system to analyze the trends in uptake of counseling sessions regarding age groups, gender, primary counseling issues, geographic areas and other factors, by supporting a database for LL/CL to register the counseling sessions including crisis hot-line or face to face counseling. The analysis will assist LL/CL to identify the areas of counseling needed most by different age groups, gender and communities and hence training of the counselors will be better focused.

In 07 Capacity will continue supporting CHS and LMS with a user-friendly electronic patient management system at the five mission hospitals. The system will assist CHS and LMS in collecting, analyzing and storing patient information in a database which is also to be used for quality control. The patient information will be readily available for analysis for the timely provision of data such as medication administered to a particular patient, vital statistics, a patient's progress and response to treatment. This system currently works in 3 of the faith-based hospitals in parallel to Epi info system that is used by the MoHSS for collection of epidemiological data and PEPFAR reporting. The system is meant for interim use until a national system is finalized and approved by the GRN. At that time these facilities will migrate to the new system.

Capacity Project will support a database for the alcohol program in Rehoboth hospital. This database will be used for data collection to assist in the analysis of the different program activities and to monitor and to evaluate the program impacts on the intended community including: age, gender, educational level, employment status and social status among others.

The USG has supported 2 key faith-based partners Catholic Health Services (CHS), Lutheran Medical Services (LMS) and one FBO/NGO, Lifeline/ Childline - (LL/CL) to implement the PMTCT, AB, ART, counseling and testing, and palliative care activities under the Emergency Plan. In 2006, implementation was assumed from FHI by IntraHealth/The Capacity Project (Capacity). CHS manages four faith-based hospitals and 45 health centers and clinics in 3 different health regions. LMS manages one of the highest volume hospitals in the country and 15 health centers and clinics. The 5 FBO hospitals are serving a population of 400,000 (20% of the total population). LMS and CHS provide PMTCT, ART, C&T, palliative care, prevention and training to their staff and communities they serve. LL/CL is a NGO with a faith focus. LL/CL trains an array of counselors, including community counselors, and nurses in PMTCT counseling, C&T, ARV counseling and provides supervision and psychological support.

Capacity supports the USG's philosophy of working within the context of the Namibian Government's National Strategic Plan on HIV/AIDS, (MTPIII 2004-2009), Vision 2030, and other GRN policy documents. This contextual linkage is strengthened by ensuring that all local implementing partners are aware of the policies and strategic documents that exist, and that support is available to further incorporate/adapt these requirements to their organizational settings. Technical assistance, legal consultation, capacity building, and organizational development are among the methodologies used to support these processes within partner-organizations. Capacity also believes that institutional and human capacity development requires a critical, multifaceted and comprehensive ‘systems level' analysis and strategy with which to address staffing, planning, M&E, and organizational growth and sustainability. This would include providing support for skills-training for local implementing partners to manage, implement and monitor programs, including financial systems that adhere to USG and audit requirements. The goal will be to maximize organizational efficiency and effectiveness, and promote autonomy in order to graduate as many local partners as possible to direct funding by the USG.

The Namibian HIV Clinicians Society has been a key partner in training private and public health care providers and has became one of the main actors in promoting quality HIV care in Namibia. The ability of the Society will be further strengthened to respond to the need for continuous professional development through regional branches. The HIV Clinicians' Society will organize professional development seminars, meetings and case discussions for at least 300 participants throughout the country including private and public practitioners and pharmacists. The Society will facilitate the dissemination of scientific information and lessons learned to its members' The Society will conduct organize training sessions and seminars, and facilitate networking among clinicians. Capacity will support the Society by supporting the recruiting and the training of financial and administrative staff in addition to recruiting a part-time health worker that will be responsible for the clinical supervision of the counselors serving in the private facilities beside other clinical activities in the national office.

The Pharmaceutical Society of Namibia (PSN) is a new partner for USG. Capacity, in collaboration with other USG partners (MSH and I-Tech), will work with PSN to train and update private pharmacists and pharmacist assistants on MoHSS PMTCT/ART guidelines and dispensing generic drug names as done in MoHSS facilities. It is intended that through this partnership, mutual agreements will be reached to lower the cost of dispensing ARV drugs and in doing so, will help to assure the sustainability of the HIV/AIDS program, and to involve new local partners.

A complete and mature Human Resource Information System (HRIS) is a critical component of any meaningful and sustainable Human Resources for Health intervention. In addition to capturing, managing and reporting on basic workforce data in a single location, a complete HRIS solution; tracks health care work training data, captures licensure and certification information, manages workforce deployment as well as enables long term workforce planning and modeling.

At the request of the MoHSS, Capacity will develop and deploy an integrated HRIS. This development and deployment task contains the following activities.

Identify all stakeholders and organize them into a Stakeholder Leadership Group, which will then initiate, lead and monitor all subsequent activities in HRIS strengthening. Two representatives--one an expert in workforce planning, the other an information systems specialist--will identify and interview stakeholders and organize and facilitate the initial Stakeholder Leadership Group meetings. The result of these early meetings would be a set of HR policy questions to be addressed by the HRIS. The next step involves a technical assessment of the existing information technology infrastructure to determine the specifications and costs of improving the HRIS. Based on the analysis of available hardware, software, databases, network and Internet connectivity, the Project will develop a plan for infrastructure strengthening to support the HRIS. The third major activity area involves developing and implementing the HRIS software. Once the infrastructure plan is in place, Capacity will write use cases and system specifications as a guide for a comprehensive HRIS to meet identified needs and work with existing Ministry systems. The final aspect of this activity area focuses on training. Recognizing that a HRIS is useless without knowledgeable users, Capacity will create a training plan to address key topic areas as identified by stakeholders, such as data collection, data operations, data security, ensuring data quality, reporting, and using data for decision making.

A significant number of those in the public sector workforce are exposed to risky situations leading to HIV transmission due to their work situation as they are separated from their communities and families through posting requirements of their employment (e.g., health, education, police and military) resulting in the disruption of primary family relationships and the need to establish secondary relationships where they work.

The public sector is the largest employer in Namibia with 80,000 members employed through 20 line ministries and 13 Regional Councils. In accordance with the National Strategic Plan on HIV/AIDS (MTP III 2004-09) and to address reduction of partners, cross-gen sex and changing male norms, in FY07 the USG will support the Office of the Prime Minister (OPM) in its role as facilitator and capacity builder for the development of HIV/AIDS policies and workplace programs by all line ministries and regional councils. The USG has partnered since 2002 with the Ministry of Defense (Activity # 7894) and its Namibia Defense Force on its prevention program, and since 2005 with the Ministry of Safety and Security (Activity # 7420). In 07, the USG will add the Ministry of Education (Activity # 7460) with its 30,000 employees as a workplace partner in addition to ongoing support to the MOD and MoSS.

Recently, in partnership with GTZ, the EU and UNDP and using reallocated FY 06 funding, the USG participated in the development of a mission statement and strategic plan for the nascent OPM program. In FY 06, support was provided for an OPM requested assessment of the impact on the public sector of HIV/AIDS which was primarily funded by UNDP. In FY 07 the USG in partnership with the above referenced development partners will provide support to build the capacity of the OPM's HIV/AIDS management unit through technical assistance and training. In addition, using the data from the assessment, OPM will be supported in identifying key line ministries for technical assistance in the development of HIV/AIDS policies and capacity building for planning and implementation of work place programs.