PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
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 Ministry of Health and Social
Services (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 develop scopes of work and participate
in the selection of health personnel who are then trained and provided with field support by I-TECH (7354),
HHS/CDC (7357), and the MOHSS (7334) with USG funding. USG support for PMTCT training is leveraged
and harmonized with similar support being provided through the Global Fund. 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.
FY08 funding for PMTCT will cover salaries and support for the following positions:
(1) PMTCT Technical Advisor within the MOHSS Directorate of Special Programmes. 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, training of health care workers in
PMTCT, 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 188 of 258 (73%) sites which will increase to at least 218 of 258 (84%) sites during
FY08. In addition to furthering rollout and training in FY08, the PMTCT advisor will emphasize:
- consolidation of existing sites to increase coverage with services
- complete integration of rapid testing into PMTCT
- expansion of DNA PCR testing and the early infant diagnosis program
- reinforcement of exclusive breastfeeding
- strengthening of the PMTCT ARV regimen to short course AZT beginning at 28 weeks of pregnancy plus a
seven-day course of AZT/3TC to the mother at the onset of labor and to the baby for seven days
postpartum, in addition to single dose nevirapine.
Increased support will be provided to existing sites by combining supervisory visits with in-service tutor
support visits. In a new activity in 2008, the PMTCT Technical Advisor will assist with developing and
implementing a case management program (Potentia and I-TECH; new) that has as a priority component
the follow-up of mothers and babies who "slip through the cracks" of the PMTCT program.
(2) Five in-service tutors placed throughout the National Health Training Center (NHTC) 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) Continuing support for one driver to transport the 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 (7354).
In a new activity for FY08, Potentia will recruit and hire 34 clinical case managers. There is a critical gap in
human resources in Namibia, and creating and filling positions with the Government of the Republic of
Namibia (GRN) is a slow process. Potentia Human Resources Consultancy, a Namibian company, was
identified as a bridging mechanism for hiring personnel to work within the Ministry of Health and Social
Services (MOHSS). Potentia is able to recruit and hire qualified candidates in a timely manner, including
third country nationals when qualified Namibians cannot be identified. The MOHSS and the USG provide
Potentia with scopes of work, identify where the positions will be placed, and participate in the selection of
new hires. These staff persons are trained, managed, and evaluated as would any MOHSS employee in a
similar position. The compensation package for Potentia hires are in line with those of the MOHSS and the
Global Fund to prevent MOHSS employees from "jumping ship" and to facilitate the gradual absorption of
Potentia employees into the MOHSS workforce as positions become available.
Case managers will fall in the chain of command of the MOHSS Directorate of Special Programmes'
Director of Case Management. The case managers will provide adherence counseling, prevention with
positive services, coaching of patients regarding notifying partners, following-up of patients who "slip
through the cracks", facilitation of support groups, and referrals to other health and social services, including
counseling for drug/alcohol treatment and domestic violence. Particular emphasis will be placed on
encouraging men to seek services and to support their partners and children in doing the same. These
case managers will have backgrounds in psychology and will be trained by I-TECH (new). All will be trained
in Prevention with Positives (PwP) counseling and effective behavior change communication through
Namibia's Male Norms Initiative. Both of these trainings emphasize the delivery of "be faithful" and
abstinence/sexual postponement messaging as appropriate.
This activity is a continuation of FY07 activities and has been updated. This activity relates to many
activities including the provision of condoms and support for community counselors by the Ministry of Health
and Social Services (MOHSS), #7333, and to the position of a prevention technical advisor (HVAB #8001).
This activity addresses the critical human resources gap at facility levels to deliver 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 providing suitable incentives for health care
workers to return to practice in public settings in Namibia and retention incentives for staff currently serving
in the country. The vacancy rate in the MOHSS is approximately 40% for doctors, 25% for registered
nurses, 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 Human Resources Consultancy, a Namibian firm
which administers salary and benefits packages equivalent to the packages offered by the MOHSS. Both
HHS/CDC and the MOHSS participate in the development of position descriptions and 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 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 2007, Potentia supported a total of 301 staff and this number is projected to increase in FY08 in
order to support the rapid scale-up of prevention, care and treatment services. Potentia positions partially
related to delivery of HVOP services include doctors, nurses, enrolled nurses, and VCT supervisory staff.
This activity will continue to contract condom supply logistics officers for distribution of the MOHSS' "Smile"
condom. The public "Smile" condom is comparable in quality to local commercial and socially-marketed
condoms and was launched by the MOHSS 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 quite positive and demand has exceeded the MOHSS' ability to purchase the amount
needed. These condoms are manufactured in Namibia by Commodity Exchange and undergo quality
assurance in a local laboratory prior to distribution. The Commodity Exchange is a local company
contracted by the MOHSS leveraging support 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 are 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 by NGO and FBO partners for use by to high-risk
individuals (mobile workers, commercial sex workers, shebeen customers, discordant partners, PLWHA and
their partners, and persons having sex with a partner of unknown HIV status). The Global Fund currently
supports a Condoms Logistics Manager in the MOHSS plus two additional Condom Logistics Officers in the
regions. The MOHSS created a more responsive supply management chain to make condoms more
accessible to the public. PEPFAR will continue to support an additional 15 officers 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 MOHSS and RPM-plus, are 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
DAPP, the Walvis Bay Multi-Purpose Center, Nawa Life Trust, PACT, Capacity and many other
NGOs/FBOs/CBOs who rely on the ability to access condoms at a district level as part of their program
interventions.
In a new activity for FY 2008, Potentia will recruit and hire 45 clinical case managers and HIV Regional
Supervisors. Case managers will fall in the chain of command of the MOHSS Directorate of Special
Programmes' Director of Case Management. The case managers will provide adherence counseling,
prevention with positive services, coaching of patients regarding notifying partners, following-up of patients
who "slip through the cracks", facilitation of support groups, and referrals to other health and social services,
including counseling for drug/alcohol treatment and domestic violence. Particular emphasis will be placed
on encouraging men to seek services and to support their partners and children in doing the same. These
case managers will have backgrounds in psychology and will be trained by I-TECH. All case managers will
be trained in effective behavior change communication through Namibia's Male Norms Initiative as well as
be a part of the alcohol programming and training and the prevention with positives initiative.
Also in 2008, eight Regional HIV Supervisors will be recruited, hired, and assigned to regions to provide
supportive supervision of HIV activities being delivered in health facilities. These supervisors will report to
the HIV Chief Health Programme Administrator and focus on the programmatic, not the clinical side of HIV
service delivery. The supervisors will assist with the implementation of the case management program and
the delivery of VCT, PwP, and adherence counseling. A chief benefit of these new positions will be more
hands-on and frequent personnel management and quality assurance in the outlying areas. Currently,
supportive supervision visits are infrequent because of the logistics and expense of traveling from Windhoek
to distant facilities throughout the country.
Both the clinical case managers and regional supervisors will be assigned 10% to HVAB, 10% to HVOP,
40% HTXS, 30% HBHC, and 10% to HVCT.
The hiring of these positions will support all regions and thus this activity is national in scope.
Keenly aware the sustainability of these positions relies heavily on the ability of the MOHSS to absorb them
in to their human resource organizational structure; these posts will be closely monitored in order to ensure
their effectiveness is optimized and ascertain their value added. As in past years, the USG will continue to
work with the MOHSS to enhance the capacity of the human resources department as well as support a
Human Resources strategic plan in order to better absorb the Potentia supported positions over time.
This human resources activity continues from COP 2007 and relates to other activities in Basic Health Care
and ARV services, including the Ministry of Health and Social Services (MOHSS), Intrahealth, I-TECH
(7349), CTSGlobal/Comforce, MOHSS ARV services, Potentia ARV services, HIVQUAL, and CDC systems
strengthening.
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, 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 quality that is required for continued rollout of ARV and palliative
care services. The lack of a community of such professionals itself creates issues of providing attractive
incentives for newly trained Namibians to return to Namibia and practice in the public sector, as well as to
provide suitable incentives for Namibian and third-country nationals currently serving in the country. The
vacancy rate in the MOHSS is approximately 40% for doctors, 25% for registered nurses, 30% for enrolled
nurses, and 60% for pharmacists.
Since FY 2004, the USG has assisted the MOHSS to address this gap by providing supplemental personnel
to the MOHSS through Potentia, a Namibian private sector company that administers salary and benefits
equivalent to the MOHSS, but is able to recruit and hire more rapidly than the MOHSS. Both HHS/CDC and
the MOHSS collaborate in developing scopes of work and selecting health personnel who are then trained
and supported on-the-job by I-TECH, HHS/CDC, and the MOHSS with USG funding. Beginning in FY 2006,
Potentia also began supporting technical and administrative staff involved in this activity previously funded
through I-TECH to streamline administration and reduce indirect costs. These personnel will continue to be
gradually absorbed into the MOHSS workforce. Since the inception of the Potentia project in 2003, 18
Potentia staff members have transitioned into permanent MOHSS positions, both at the clinical and
administrative level.
This human resource strategy has been central to Namibia's success with meeting its prevention, care and
treatment targets. Potentia has a rapid personnel recruitment, deployment and management strategy, which
in COP 2007 will contract with 60 physicians, 45 nurses, 30 enrolled (licensed practical) nurses, 22
pharmacists, 18 pharmacy assistants, and 59 data clerks to support efforts in the 43 MOHSS communicable
disease clinics (CDCs) that manage 80% of the 33,000+ on ART and the 27,000 receiving care services in
the public sector.
The MOHSS is gradually beginning to shift tasks from physicians to nurses, with nurses beginning to
provide palliative care, managing clients not yet eligible for ART, and clients who have received their first six
months of ART at hospital CDCs. This is consistent with WHO's Integrated Management of Adult Illness
(IMAI) framework for decentralized HIV/AIDS training, service delivery standards, and task shifting to district
and community levels of care will support the MOHSS decentralization plans to support comprehensive
HIV/AIDS care for Namibian communities. MOHSS has approved and adapted all five IMAI modules,
including the IMAI palliative care module. Namibia's 13 regions are anticipated to complete the rollout of
IMAI in 2008 to selected health centers and clinics in their catchment areas.
Technical advancement for pediatric care is provided by the MOHSS pediatric care and treatment training
program and the MOHSS Integrated Management of Childhood Illness (IMCI) program. Key priorities in
palliative care service delivery by Potentia-supported health care workers will include the provision of the
preventive care package for adults and children; management of opportunistic infections; adherence
counseling for HIV/TB; routine clinical monitoring; symptom and pain management. Closer partnerships with
districts and communities will allow increased opportunities to expand safe water, hygiene strategies and
access to malaria prevention for persons living with HIV/AIDS (PLWHA) and their families. Malaria
prevention efforts will leverage support from Global Fund-supported bed nets.
In 2007, the MOHSS engaged in a costing exercise supported by the USG and the European Commission
that projected a need for 76 physicians, 191 nurses, 44 pharmacists, and 40 pharmacy assistants to ensure
full rollout of IMAI by 2009. The MOHSS does not have this capacity and FY 2007 staffing levels supported
by PEPFAR represent approximately 58% of the current human resource needs. The COP 2008 request is
therefore to scale up hiring of critical staff, with a total request for 65 doctors, 79 registered nurses, 46
enrolled nurses, 28 pharmacists, and 25 pharmacy assistants. There will also be 34 new case managers
who will commit 30% of their time to palliative care activities. These staff members will comprise 69% of the
projected need with the remainder to be supported by the MOHSS, Global Fund, and other development
partners. New staff members will be recruited, trained, and deployed to health centers and clinics as
appropriate under the MOHSS' plan for decentralized ART and palliative care services. As noted above,
these personnel are managed and compensated commensurate with MOHSS staff, and are to be gradually
be absorbed into the MOHSS workforce as funding allows to support sustainability. In an ongoing activity, at
least 34 additional nurses will support the supervisory public health nurse in high-burden districts with
coordination and supportive supervision of ART, TB and palliative care activities. These positions were
added in response to needs identified in 2006 during the MOHSS supervisory support program.
In a new activity for COP08, Potentia will recruit and hire 34 clinical case managers for deployment to ART
and ANC sites. Case managers will fall in the chain of command of the MOHSS Directorate of Special
in effective behavior change communication through Namibia's Male Norms Initiative.
In addition to providing contracted clinical personnel to CDCs, this activity will continue to support the
provision of training personnel to the MOHSS' National Health Training Center, the Regional Health
Training Centers, and I-TECH. The training centers do not have sufficient human capacity to provide IMAI
training due to competing priorities. This activity will cover 0.5 FTE of an I-TECH curriculum development
expert to develop the capacity of a Namibian in curriculum development, an STI trainer, a nurse trainer, a
training manager, and transportation of tutors to clinical sites for follow-up after IMAI training.
Activity Narrative: Mechanisms to assess and improve human resource management, including training performance, job
competencies, skill transfer, and performance and retention of health workers will continue to be integrated
within the Potentia program. This will include linkages with the HIVQUAL program to assist in collecting
annual evaluations from MOHSS supervisory staff to assess HIV provider performance. USG support will
assist with implementation of performance-based monitoring system for all clinical staff. Underperforming
staff will be provided with additional training and support.
Gender considerations are integrated in this activity by ensuring equitable employment, support of male and
female health care workers, equitable access to HIV/AIDS services for PLWHA, and training for HCWs
under the ongoing Male Norms Initiative in Namibia.
USG experience and data from the MOHSS show that for every three HIV-infected persons evaluated for
ART, two are started on ART and one is not yet eligible and is enrolled in comprehensive care. This may
change as those with earlier stages of HIV are identified and enrolled in care with greater frequency.
Therefore, in FY 2008 1/3 of the budget for contracted health professionals will be assigned here to
Palliative Care: Basic Health Care and 2/3 will be assigned to Treatment: ARV Services.
This activity continues and expands from COP07 and relates to other training activities in this area including
the I-TECH activity (16219) and the CDC technical assistance activity (16240). There is critical human
resources gap at facility levels to delivery of HIV/TB 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/TB care and treatment services on
the scale and at the level of quality that is required for ART roll out and palliative care expansion, including
early detection and treatment of TB. The lack of a professional community creates issues of providing
attractive incentives for native Namibians who leave for training to return to Namibia and for strategies to
retain staff currently serving in the country. The vacancy rate in the MOHSS is approximately 40% for
doctors, 25% for registered nurses and 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 developing scopes of work and the selection of
health personnel who are then trained and deployed with field support from ITECH clinical mentors,
HHS/CDC, and the MOHSS with USG funding. While not funded under this activity, FY08 funding will
support five additional physicians for placement within MOHSS ART sites, but will also support two
physicians with TB expertise. These physicians will not only care for clients, but who also will be
responsible for improving TB/HIV integration in MOHSS facilities and bidirectional linkages with community-
based TB/HIV services. In FY08, Potentia funding will also support the hiring of 40 additional nurses to
support ongoing rollout of the Integrated Management of Adult Illness (IMAI) program, which is expected to
have a significant impact on improving early detection and treatment of TB, as well as the provision of TB
preventive therapy for PLWHA.
Continuing from COP07, Potentia will also continue to support technical and administrative staff previously
funded through I-TECH 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. In this
activity, Potentia will contract professionals to serve as TB/HIV trainers with I-TECH, the major USG partner
for training health workers in Namibia. Requested funds include half of the cost of a Physician Training
Manager and 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's 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 for eligible TB/HIV patients, including children.
In a new activity in COP08, Potentia will recruit and hire 34 clinical case managers to be assigned to ART
clinics. These case managers will have multiple responsibilities, including providing TB/HIV adherence
counseling, coaching patients regarding referring appropriate partner and family members for facility- and
community-based TB/HIV services, following up on patients who fail to return for appointments, and
faciliting support groups. These case managers will have backgrounds in psychology and will be trained by I
-TECH (new).
This activity is a continuation from COP07. Within COP08, funding for Community Counselors (CCs) is
distributed among six program areas, all of them Ministry of Health and Social Services (MOHSS) activities:
Preventing Mother to Child Transmission, Abstinence and Be Faithful, Other Prevention, HIV/TB,
Counseling and Testing, and ARV Services. This activity also links with CDC's system strengthening
activity. In addition, the activity leverages resources from the Global Fund to the MOHSS that support an
Assistant Counseling and Testing Coordinator to help with the rollout of CCs 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 prevention, care and treatment services on the scale and at the level of quality
that is required for nationwide rollout. The vacancy rate in the MOHSS is approximately 40% for doctors,
25% for registered nurses and 30% for enrolled nurses, and 60% for pharmacists. The lack of training
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 Human Resources Consultancy,
a Namibian firm which administers salary and benefits packages equivalent to those of the MOHSS. Both
MOHSS and HHS/CDC participate in developing scopes of work and the selection of health personnel who
are then trained and provided with field support by MOHSS, ITECH, and HHS/CDC with USG funding.
been central to Namibia's success to date with meeting its prevention, care and treatment targets. The
HVCT positions hired through this activity include:
A technical advisor to assist the MOHSS National Counseling and Testing Coordinator was provided in
early 2005 and will be continued. This advisor has played a key role in the deployment of 407 CCs to 188
public health facilities beginning in June 2005 and rapid HIV testing in 91 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, most importantly by providing HIV counseling and testing services
to PMTCT, TB, and STI patients as well as to partners of persons on ART whose HIV status is unknown.
CCs are further trained to provide adherence, supportive, and STI/TB counseling, as well as to link and
refer patients from health care delivery sites to community HIV/AIDS and TB services. CCs receive
specialized training in couples counseling, in particular to address the unique needs of serodiscordant
couples. The CC training curriculum incorporates gender-sensitive approaches that support the goal of
equitable access to HIV/AIDS services for PLWHA and their families throughout MOHSS programs. To
reduce stigma and discrimination, emphasis is placed on the recruitment of HIV positive individuals as CCs.
With COP08 support, the number of CCs will increase to 650 by December 2008. New initiatives in 2008
will place CCs in outreach testing sites and correctional facilities. Policy development, quality assurance,
and support to field services are important aspects of the technical advisor position. The advisor will
continue to provide technical assistance to the head of the Counseling and Testing unit, MOHSS
Directorate of Special Programmes, to increase access to VCT and provider initiated counseling and testing
(PICT) in the clinical setting. The advisor will also guide the national program in the continued
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 CCs for
counseling and testing and to support other programmatic areas, including PMTCT, AB, Condoms and
Other Prevention, TB/HIV, outpatient departments (where the majority of STI patients are seen), and ART
Services. Within ART sites, CCs provide adherence and couples counseling, among other responsibilities.
The advisor will be intimately involved with CDC advisors in the MOHSS' continuing implementation of the
prevention with positives initiative at the national level.
To increase capacity for decentralized training, eight trainers and one driver will be deployed to the MOHSS'
Regional Health Training Centers in six different locations to train health workers in counseling and testing,
rapid testing, and couples counseling. An additional position, the Community Counselor Training
Coordinator, is placed at the MOHSS VCT program to develop curricula, train trainers, provide mentoring
and evaluation support, and plan and implement supervision strategies for this cadre of health workers. A
counseling trainer will take the lead on Prevention with Positives and family planning training. This activity
also includes the cost of two rapid test trainers. One RT training coordinator will be supported as the lead
person at national level to identify trainees from health facilities and organize trainings. Gradually, these
personnel will be absorbed into the MOHSS workforce as funding allows.
Additional funds will continue to support 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 MOHSS to ensure the confidentiality, accuracy, and safety of rapid testing
carried out in MOHSS 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.
In a new activity for COP08, Potentia will recruit and hire 34 clinical case managers. Case managers will
fall in the chain of command of the MOHSS Directorate of Special Programmes' Director of Case
Management. The case managers will provide adherence counseling, prevention with positive services,
coaching of patients regarding notifying partners, following-up on patients who "slip through the cracks",
facilitation of support groups, and referrals to other health and social services, including counseling for
drug/alcohol treatment and domestic violence. Particular emphasis will be placed on encouraging men to
seek services and to support their partners and children in doing the same. These case managers will have
backgrounds in psychology and will be trained by I-TECH (new). All will be trained in effective behavior
change communication through Namibia's Male Norms Initiative.
Activity Narrative:
This human resources activity continues from FY 2007 and relates to other activities in Basic Health Care
and ARV services, including the Ministry of Health and Social Services (MOHSS) (7331), Intrahealth (7404),
I-TECH (7349), CTSGlobal/Comforce (8024), MOHSS ARV services (7330), Potentia ARV services (7339),
and CDC systems strengthening (7360).
incentives for newly trained Namibians to return to their home country and practice in the public sector, as
well as to provide suitable incentives for Namibian and third-country nationals currently serving in the
country. The vacancy rate in the MOHSS is approximately 40% for doctors, 25% for registered nurses, 30%
for enrolled nurses, and 60% for pharmacists.
to the MOHSS through Potentia Human Resources Consultancy, a Namibian private sector company that
administers salary and benefits equivalent to the MOHSS, but is able to recruit and hire more rapidly than
the MOHSS. Both HHS/CDC and the MOHSS collaborate in developing scopes of work and selecting
health personnel who are then trained and supported on-the-job by I-TECH, HHS/CDC, and the MOHSS
with USG funding. These personnel will continue to be gradually absorbed into the MOHSS workforce.
Since the inception of the Potentia project in 2003, 18 Potentia staff members have transitioned into
permanent MOHSS positions, both at the clinical and administrative level.
in FY07 will contract with 58 physicians, 45 nurses, 30 enrolled (licensed practical) nurses, 22 pharmacists,
18 pharmacy assistants, and 59 data clerks to support efforts in the 43 MOHSS communicable disease
clinics (CDCs) that manage 80% of the 33,000+ on ART and the 27,000 receiving care services in the
public sector.
(IMAI) framework for decentralized HIV/AIDS and TB training, service delivery standards, and task shifting
to district and community levels of care will support the MOHSS decentralization plans to support
comprehensive HIV/AIDS care for Namibian communities. MOHSS has approved and adapted all five IMAI
modules, including the IMAI palliative care module. Namibia's 13 regions are anticipated to complete the
rollout of IMAI in 2008 to selected health centers and clinics in their catchment areas.
care for persons requiring ART and full rollout of IMAI by 2009. The MOHSS does not have this capacity
and FY07 staffing levels supported by PEPFAR represent approximately 58% of the current human
resource needs. The FY08 request is therefore to scale up hiring of critical staff, with a total request for 65
doctors, 79 registered nurses, 46 enrolled nurses, 28 pharmacists, and 25 pharmacy assistants. These staff
members will comprise 69% of the projected need with the remainder to be supported by the MOHSS,
Global Fund, and other development partners. New staff members will be recruited, trained, and deployed
to health centers and clinics as appropriate under the MOHSS' plan for decentralized ART and palliative
care services. Training will not only encompass HIV/AIDS prevention, care and treatment, but also TB, STI,
family planning, gender issues, and alcohol abuse. This comprehensive training ensures bi-directional
referrals and linkages with community services.
As noted above, these personnel are managed and compensated commensurate with MOHSS staff, and as
funding become available, are to be gradually be absorbed into the MOHSS workforce to support
sustainability. In an ongoing activity, at least 34 additional nurses will support the supervisory public health
nurse in high-burden districts with coordination and supportive supervision of ART, TB and palliative care
activities. These positions were added in response to needs identified in 2006 during the MOHSS
supervisory support program.
In a new activity for FY08, Potentia will recruit and hire 34 clinical case managers and 15 HIV Regional
prevention with positive services, coaching of patients regarding notifying and referring partners for HIV
counseling and testing, following-up of patients who "slip through the cracks", facilitation of support groups,
and referrals to other health and social services, including counseling for drug/alcohol treatment and
domestic violence. Particular emphasis will be placed on encouraging men to seek services and to support
their partners and children in doing the same. These case managers will have backgrounds in psychology
and will be trained by I-TECH (new). All will be trained in effective behavior change communication through
Namibia's Male Norms Initiative.
Also in 2008, fifteen Regional HIV Supervisors will be recruited, hired, and assigned to regions to provide
the HIV Chief Health Programme Administrator and focus on the programmatic, not clinical side of HIV
Related to these efforts, but reflected in the HVTB Program Area (Activity 3896.08), Potentia will recruit, hire
Activity Narrative: and place two physicians with TB/HIV expertise at the national TB reference hospital in Windhoek. In
addition to carrying out routine TB clinical duties, these clinicians will ensure that TB/HIV coinfected persons
are properly managed and that TB-infected persons of unknown status are provided with HIV counseling
and testing and linked to HIV care and treatment if positive.
This activity is a continuation and expansion of FY 2004- 2007 and relates to CTS Global (7355), Ministry of
Health and Human Services (MOHSS) (7365), and I-TECH (7384).
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 a cadre of SI personnel. Since FY2004, 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 FY 2006/FY 2007 the
responsibilities of this cadre were expanded beyond routine data collection and reporting to assist with a
national survey and to enable, with analytic guidance from USG technical advisors, in-depth program
evaluation.
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 FY 2007 (7355, 7322). This, combined with a more
efficient computer-based management information system (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.
Personnel
1. Facility-based Data Clerks: The number of facility-based data clerks will remain at 23 in FY 2008, with an
additional 4 at a senior level. In FY 2007 the data clerk role was expanded from a focus on anti-retroviral
therapy exclusively 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
some of the experienced data clerks have been promoted to a senior data clerk level.
2. Regional Data Clerks: These positions were created in FY2007 with one per region. These clerks 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. PCR Data Clerk: This position is continuing from FY2007 and is placed at the national level to coordinate
data collection for the growing volume of PCR testing. This clerk receives PCR testing results linked to post-
natal PMTCT information. Entry and management of this data enable effective evaluation of the PCR
program.
4. Data Analysts: Since FY 2005, 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 and expanded to include an
additional junior data clerk in FY 2007. The data analysts are assigned to the head office of the MoHSS
National Health Information System in Windhoek.
5. Program Administrators for M+E Unit: These 2 positions will continue from FY 2007 and relate to the
M+E Technical Advisor (####). They 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 assist with collecting and disseminating HIV-related M+E data from government sectors outside
of health and from non-government partners.
6. UNAM Information for Action Fellowship Programme: To support the National AIDS Program with
analysis and dissemination of a survey that can be used to improve care and prevention services, the USG,
in collaboration with the MoHSS Response Monitoring and Evaluation sub-Division, will offer 5 scholarships
for Namibians who present the most useful proposals for analysis of the most recent Demographic and
Health Survey.
These human resources will support the capture and processing of quality data for all HIV services in the
country and thus plays a central role in the overall SI program area as all SI activities rely on high quality
data. Specifically, these human resources related to CTS Global technical advisors (7355), UCSF data
triangulation (7928), MoHSS data triangulation (7390), and ITECH training (7384).
Potentia personnel will target the general population with emphasis areas in strategic information, capacity
building, and public health evaluation.
This activity addresses the critical human resources gap at facility levels to delivery HIV/AIDS services in
HIV/AIDS prevention, care and treatment services. This in turn creates issues of creating suitable
incentives for newly trained health care workers to return to Namibia and to provide retention incentives for
staff currently serving in the country. The vacancy rate in the Ministry of Health and Social Services
(MOHSS) 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 Human Resources Consultancy, a Namibian firm which administers salary and benefits packages
equivalent to those of the MOHSS.
I-TECH is supported by PEPFAR as the primary capacity building and training partner for the MOHSS. I-
TECH provides a variety of trainings in-person and via digital video conferencing on a variety of clinical and
programmatic topics. Beginning in FY06, Potentia began to support 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. Potentia funding within OHPS covers support for a total of 50 personnel that either focus
on pre-service rather than in-service training, or that cut across all of the other program areas that Potentia
supports. These personnel are:
1) One (1) Technical Advisor at the University of Namibia (UNAM) during April-September 2008, to assist
the nursing program to implement the completed HIV-integrated curriculum for the four-year nursing
diploma program.
2) Three (3) Nursing Lecturers and four (4) part-time Clinical Instructors at UNAM campuses in Windhoek
and Oshakati to support students following their placement in 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) Two (2) pre-service tutors stationed at the MOHSS National Health Training Center (NHTC) and eight (8)
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 people living with HIV/AIDS (PLWHA). I-TECH staff
trains them on HIV/AIDS and related topics and provides ongoing professional development opportunities
(7352).
4) One (1) Human Resources Development Advisor and one (1) Data Clerk assigned to the MOHSS
Directorate of Policy, Planning and 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.
These efforts are critical for sustainability.
5) One (1) Digital Video Conferencing (DVC) Program Coordinator, one (1) DVC Technologist, and twelve
(12) DVC Assistants 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 opportunistic
infections and HIV co-morbidities, and video demonstrations of HIV counseling sessions. The DVC program
also provides an efficient and cost-effective 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.
6) One (1) Training Coordinator and one (1) Clerk assigned to the NTHC to coordinate training activities in
PMTCT, VCT, and Couples Counseling.
7) I-TECH field office staff: one (1) I-TECH Deputy Director; one (1) Office Manager; one (1) Financial
Officer; one (1) Receptionist; one (1) Driver; one (1) Administrative Assistant for the Oshakati RHTC office;
one (1) Curriculum Development Manager who will coordinate the revision and/or completion and approval
of all major curricula and media products; two (2) Training Assistants and one (1) Materials Production Clerk
to support training coordination; one (1) Facilities Manager; one (1) Housemother; and two (2) Cleaners to
support the operation of a Training Center in Windhoek.
Targets related to the capacity building aspect of this activity are captured in I-TECH (7352).
