This activity is a continuation of FY07 direct funding to the Ministry of Health and Social Services (MoHSS)

and relates to other activities in PMTCT, including Namibia Institute of Pathology's (NIP) provision of a

technician for PCR (7927), Potentia's provision of trainers through I-TECH (7344), training costs covered by

I-TECH (7354), CDC's activity to provide nurse supervisors and supervisory visits (7357), faith-based

Intrahealth (7403), and the System Strengthening activity by CDC (7360).

In support of PMTCT services, the Ministry of Health and Social Services (MoHSS) is responsible for

national coordination, resource mobilization, monitoring and evaluation, training, and policy development.

The USG will continue to support MoHSS in FY08 and build on FY07 activities through: (1) Support to print

ANC and maternity registers, purchase rapid test kits, clinic equipment (scales, hemoglobinometers,

lockable cabinets for ARV drugs), a 15 seater bus requested to transport PMTCT personnel to support

visits and trainings), and ARV medicines for PMTCT. (2) The national Technical Advisory Committee has

made recommendations to strengthen the PMTCT regimen to include a short-course of AZT beginning at 28

weeks gestation, plus a 7-day regimen of AZT/3TC to the mother and baby postpartum, in addition to single

-dose nevirapine. Support will be given to the country to assist in printing and dissemination of the new

national PMTCT guidelines that reflect the new WHO 2006 guidelines. It is anticipated that, once approved,

the new PMTCT regimen will be rolled out in phases to the 34 public hospitals initially before reaching the

health center and clinic level. The USG will support the costs of these ARV medicines to reach (80%) of the

eligible pregnant women.The cost of ART for treatment eligible women, their partners and other infected

children (PMTCT plus) will be supported through ARV medicines program. (3) Support for up to 658

Community Counselors (CC) who work in health facilities.

MOHSS established the CC cadre in 2004 to assist doctors and nurses with provision of HIV prevention,

care, and treatment services, including HIV counseling and testing, PMTCT, ART, TB, and STI; and to link

and refer patients from health care delivery sites to community HIV/AIDS services. Community Counselors,

who perform rapid HIV testing, play a major role in PMTCT services as the primary provider of counseling

and testing (CT) in ANC in support of the nurse. Recruitment of HIV positive individuals as CC is a strategy

employed to reduce stigma and discrimination. To date, 387 CC have been placed at (253) health facilities.

With FY08 support, this number will increase to 508 by September 2008, and to a final target of 650 by

September 2009.

PEPFAR funding for the "Community Counselor Package" includes: recruitment and salaries for the CC, 13

regional coordinators, and an assistant national coordinator (implemented through the Namibian Red

Cross); initial and refresher training for CC (implemented by a local training partner); supervisory visits by

MoHSS staff who directly supervise CC; training for MoHSS accountants who provide financial

management assistance to the program; support for planning meetings and an annual retreat for CC; and

support for CC participation at international conferences. Within COP08, funding for CC who dedicate part

of their time to this activity, is distributed among six MoHSS program areas: Preventing Mother to Child

Transmission (7334), Abstinence and Be Faithful (7329), Other Prevention (7333), HIV/TB (7972),

Counseling and Testing (7336), and ARV Services (7330). This activity also links with CDC's system

strengthening activity (7360).

(4) Covering the costs of diagnostic PCR testing. In FY08 the MoHSS will receive direct funding to pay the

NIP for tests performed on infants of HIV+ mothers, inclusive of mission health facilities. This relates to

projects within MoHSS ARV services (7330). With USG support, the standard for the diagnosis of HIV

infection in children <18 months of age was improved in FY06 to include a diagnostic PCR test on a dried

blood spot specimen. For COP08, it is proposed to roll out training in DBS collection technique to enable

sample collection from all HIV exposed babies beginning at 6 week of age. The introduction of rapid testing

performed by community counselors in FY06 along with an opt-out HIV testing strategy and linkages to ART

has contributed to a large proportion of women who now know their HIV status. A USG-hired laboratory

scientist (NIP_ Lab Support_7337) is supporting the NIP to respond to the clinical demand for diagnostic

PCR and improve the standard operating procedures of the lab to ensure quality services. The NIP is a

parastatal organization and charges a fee to the MoHSS for all laboratory tests. In FY08, the USG will

continue to provide funds to the MoHSS to pay the NIP charges for performing at least 20,000 diagnostic

PCR tests on infants of HIV+ mothers now that capacity is further developed. This nationwide target will be

reached by working through PMTCT sites and ART clinics to train health care workers on PMTCT, pediatric

diagnosis and care, the collection of DBS specimens. This activity leverages resources with those of the

private sector and Global Fund.

(5) Training for an additional 80 Traditional Birth Attendants (TBA) on their role in PMTCT services,

including promotion of HIV prevention, reproductive health services for HIV-positive women, and referral of

pregnant HIV-positive in the northern regions will be continued as approximately 25% of deliveries occur

outside of a health facility. (6) A nationwide educational campaign by the Directorate of Primary Health Care

to promote PMTCT services in collaboration with the Ministry of Information and Broadcasting (MIB).

Funding will be provided to develop, produce, and disseminate new PMTCT educational materials for

strategic communications in the clinical setting, including the promotion of male involvement. This activity

will continue from FY07. Couples counseling and testing at PMTCT sites to promote testing of men and to

build their support for their female counterparts will be supported to increase men's involvement in PMTCT

and to reduce stigma and violence against women. NB; this may increase the no. of HIV test kits to be

procured. This activity will support procurement of HIV Test Kits and Supplies. With PEPFAR support,

MoHSS will continue to purchase an increasing volume of Determine and Unigold test kits (using a parallel

testing algorithm) to be used at MoHSS and mission-managed sites for HIV testing of a projected pregnant

women, using Clerview Complete as a tie-breaker in rare instances of discordance; HIV rapid test starter

packs to launch new testing sites; and rapid HIV test training supplies for training community counselors.

Test kits and supplies are procured and distributed to health facilities by the Central Medical Stores through

existing mechanisms. The volume of test kits needed continues to increase as more sites and community

counselors are certified to perform rapid testing. (7) Linkages to care, treatment and support for the HIV-

exposed baby, mother and partner will become routine in PMTCT. This will be done through follow up of the

mother-baby pair using the case managers recruited through Potentia.

(6) In response to a demonstrated need and as a new part of the PMTCT program in COP08, eligible

pregnant and lactating women will be provided with nutritional supplementation in the form of EPAP.

This activity is an expansion from FY07 and includes continued training and deployment of Community

Counselors and support for education on the association between alcohol and HIV. The Ministry of Health

and Social Services (MOHSS) established the Community Counselor cadre in 2004 to assist doctors and

nurses with provision of HIV prevention, care, and treatment services, including HIV counseling and testing,

PMTCT, ART, TB, and STI, and to link and refer patients from health care delivery sites to community

HIV/AIDS services. Emphasis is placed on the recruitment of HIV positive individuals as Community

Counselors as a strategy to reduce stigma and discrimination. As of end of June 2007, 382 Community

Counselors (approximately 25% of whom are HIV positive) have been placed at 253 health facilities. By end

of September 2007, 448 Community Counselors will be deployed in health facilities throughout the country.

With FY08 funding, an additional 150 Community Counselors will be trained and deployed, giving a

cumulative total of 650. The additional counselors will accommodate loss through attrition, enhance

provision of outreach-based VCT, expand prevention with positives (PwP) efforts, and initiate counseling

and testing services in correctional facilities. The Community Counselor "package" includes: recruitment

and salaries for the Community Counselors, 13 regional coordinators, a national coordinator, and an

assistant national coordinator (implemented through the MOHSS' partnership with the Namibian Red Cross

Society); initial and refresher training for Community Counselors (implemented by a local training partner);

supervisory visits by MOHSS staff who directly supervise the Community Counselors; training for MOHSS

staff who are responsible for management of the program at national level; support for planning meetings

and an annual retreat for Community Counselors; and support for MOHSS staff and Community Counselor

to attend conferences and other workshops.

Within COP08, funding for Community Counselors, who dedicate part of their time to this activity, is

distributed among six MOHSS activities: Preventing Mother to Child Transmission (7334), Abstinence and

Be Faithful (7329), Other Prevention (7333), HIV/TB (7972), Counseling and Testing (7336), and ARV

Services (7330). This activity also links with CDC's System Strengthening activity (7360). Community

Counselor prevention activities include delivery of AB and C messages appropriately targeted to various risk

groups defined by age, sex, HIV status, and STI/TB diagnosis, as well as distribution of condoms to high-

risk groups in health facilities. Community Counselors are the primary personnel at health sites responsible

for providing HIV testing and counseling, and in this capacity, are well-positioned to deliver AB prevention

messages to those who test either positive or negative. They conduct both group and individual sessions

primarily in outpatient settings (antenatal clinic, TB clinic, ART clinic, outpatient services for VCT, etc).

Community Counselors are trained to encourage clients to bring in their partners for counseling and testing,

providing opportunities to deliver prevention messages to discordant couples (approximately 12% of

couples in VCT are discordant). As part of development of an individual risk reduction plan during the post-

test counseling stage, Community Counselors educate clients about sexual abstinence, partner reduction,

being faithful to a partner of known HIV status, and correct and consistent condom use as ways in which to

prevent HIV.

A high proportion of Community Counselors' clients will be sexually active HIV-positive patients in health

facilities, providing an opportunity for the prevention with positives (PwP) approach. Since October 2006,

Community Counselors have been receiving training in PwP counseling (using CDC's curriculum) and are

providing these counseling services at the ART sites to which they are assigned. With FY08 funding,

additional Community Counselors will implement nationwide rollout of PwP in other settings. Community

Counselors will promote couples counseling and encourage all their clients, but particularly PLWHA, to

reduce their high risk behaviors through abstinence, being faithful to one partner or promoting "secondary

abstinence." Couples counseling and testing will also be reinforced to identify prevention opportunities with

discordant couples. In addition, funding for this activity includes travel for technical support for PwP from

CDC Headquarters and study tours to other countries successfully implementing PwP by national staff

managing the program.

In a continuation of FY07, this activity will also support the MOHSS' Coalition on Responsible Drinking

(CORD). CORD incorporates media messaging and work with shebeens and breweries to reduce alcohol

abuse, a major driver of the HIV epidemic in Namibia. The CORD program will be rolled out to all regions of

the country; USG funds will be used to educate business owners and the general public about the

association between alcohol consumption, high-risk sexual behavior, and HIV transmission and acquisition.

Messaging around the "B" component will emphasize the relationship between alcohol and impaired

judgment, including the increased likelihood of having risky sex with a non-steady partner.

All activities will incorporate gender messaging in compliance with Namibia's male norms initiative which

seeks to address cultural norms that factor into HIV transmission, including lack of health care seeking

behavior by men, multiple sex partners, transactional and transgenerational sex, power inequities between

men and women, and heavy alcohol use.

This activity includes 5 primary components: (1) continued training & deployment of Community Counselors

(CC), (2) procuring condoms for high-risk individuals, (3) targeting STI Patients for HIV counseling & testing

& correct & consistent condom use, (4) providing herpes suppressive therapy to ART patients, & (5)

supporting the Ministry of Health & Social Services' (MOHSS) Coalition on Responsible Drinking (CORD).

(1) The MOHSS established the CC cadre in 2004 to assist doctors & nurses in health care facilities with

provision of HIV prevention, care, & treatment services, including HIV counseling & testing, PMTCT, ART,

TB, & STI; & to link & refer patients from health care delivery sites to community HIV/AIDS services.

Emphasis is placed on the recruitment of HIV positive individuals as CC as a strategy to reduce stigma &

discrimination. As of July 2007, 382 community counselors (25% of whom are HIV positive) have been

placed at 253 health facilities. By end of December 2007, 508 community counselors will be trained &

deployed in health facilities. With FY08 support, an additional 150 community counselors will be hired &

trained, giving a cumulative total of 650 by September 2009. The additional community counselors will

accommodate loss through attrition, enhance provision of outreach-based counseling & testing, initiate

counseling & testing services in correctional facilities, & expand prevention with positives (PwP) efforts.

With COP 08 funding, 300 deployed community counselors will receive refresher training in rapid testing,

couples counseling, prevention with positives (PwP), & preventive care counseling for children & counseling

in clinical settings. PEPFAR funding for the "Community Counselor package" includes: recruitment &

salaries for the CC, 13 regional coordinators, national coordinator & an assistant national coordinator

(implemented through the Namibian Red Cross); CC initial & refresher training (implemented by a local

training partner); Recruitment & salary for a MOHSS Counseling & Testing Outreach Coordinator;

supervisory visits by MOHSS staff who directly supervise the CC; training for MOHSS who coordinate the

program at national level; support for CC planning meetings & an annual CC retreat; & support for CC

participation at international conferences.

Within COP08, funding for Community Counselors, who dedicate part of their time to this activity, is

distributed among six program areas, all of them MOHSS activities: Preventing Mother to Child

Transmission (7334), Abstinence & Be Faithful (7329), Other Prevention (7333), HIV/TB (7972), Counseling

& Testing (7336), & ARV Services (7330). This activity also links with CDC's system strengthening activity

(7360). Community Counselor prevention activities include delivery of ABC messages appropriately

targeted to various risk groups defined by age, sex, HIV status, & presentation of other STIs, & distribution

of condoms to high risk groups. CC are the primary personnel at health sites responsible for providing HIV

testing & counseling, & in this capacity, are well-positioned to deliver prevention messages to those who

test both positive & negative. CC are trained to encourage clients to bring in their partners for counseling &

testing (CT), providing opportunities to deliver prevention messages to discordant couples (approximately

12% of couples who are tested at VCT sites are discordant). Effective October 2006, CC will be trained in

"Prevention with Positives" (PwP) counseling using CDC's curriculum for integration into counseling

services within ART & PMTCT sites.

(2) Procurement of Condoms. This is a continuation of an activity added in 2007 to leverage support with

the Global Fund, which provided support for the MOHSS' new "Smile" brand of male condoms & for female

condoms in 2007. The "Smile" condom is comparable in quality to local commercial & socially-marketed

condoms & 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 overwhelming & demand has exceeded the MOHSS' ability to purchase the amount

needed. Commodity Exchange is a local company which has been contracted by the MOHSS to establish a

condom production factory & quality assurance laboratory with funding from the Global Fund. A 2005 USG-

funded evaluation of condom supply & logistics evaluation concluded that the quality assurance laboratory

& plans for local production needed supplemental support.

The MOHSS requests an additional $420,000 to meet a projected financial gap to purchase an additional

77,000 Femidoms ($103,180) & 6,092,692 "Smile" condoms ($316,820) in FY08. These condoms will be

distributed free of charge to health facilities for use by high-risk clients (HIV-positive patients & discordant

couples, STI patients, TB patients, & patients having sex with a person of unknown HIV status) & for further

distribution to NGO/FBO partners for distribution to high-risk individuals (including mobile workers,

commercial sex workers, & the clientele of shebeens).

The planned number of condoms to be procured in FY08 is 20 million. Global Fund is expected to fund ~13

million, PEPFAR ~6 million, and the Namibian government ~1 million condoms.

(3) STIs have clearly been shown to increase acquisition & transmission of HIV by two- to five-fold

(Wasserheit, 1999). In 2006, 67,414 STI cases were reported in Namibia primarily from public health

facilities, representing 2.9% of the outpatient consultations. Despite the implementation of syndromic

management of STIs by the MOHSS in 1994, there are still gaps in quality & coverage of STI services,

especially with regard to delivering effective services to most at risk populations. In FY08, additional

community counselors will be assigned to additional outpatient departments throughout the country to

ensure that persons diagnosed with STIs are provided with risk reduction counseling & HIV rapid testing.

(4) In a FY08 pilot, the MOHSS intends to use funds to procure acyclovir for ART patients coinfected with

HSV. New STI Treatment Guidelines will be released in 2007 that will for the first time recommend acyclovir

therapy for persons with HSV. Before the release of the guidelines, acyclovir was not available to persons

presenting to MOHSS health care facilities with genital herpes. Assuming a 50% of coinfection rate among

adults, the pilot will provide acyclovir therapy for an estimated 2,500 patients at the three busiest ART sites.

Prior to initiating this program, protocols will be submitted for approval through the appropriate channels

within MOHSS & CDC.

(5) In a continuation of FY07 activities, USG funds will support expansion of the MOHSS' Coalition on

Responsible Drinking (CORD). CORD incorporates media messaging & works with shebeens & breweries

to reduce alcohol abuse, a major driver of the HIV epidemic in Namibia. CORD will be rolled out to all

regions of the country & will use these funds to educate business owners & the general public about the

association between alcohol consumption, high-risk sexual behavior, & HIV transmission & acquisition.

All programming funded through this activity will incorporate gender messaging in compliance with

Namibia's male norms initiative which seeks to address cultural norms that factor into HIV transmission,

Activity Narrative: including lack of health care seeking behavior by men, multiple sex partners, transactional &

transgenerational sex, power inequities between men & women, & heavy alcohol use.

This continuing activity includes support to the MOHSS for gaps in equipment, supplies and transport for

established Communicable Disease Clinics (CDCs) and the peripheral health centers and clinics that will be

added to the network of ART and palliative care service delivery sites in COP08. The MOHSS is

responsible for national coordination, resource mobilization, monitoring and evaluation, training, and policy

development in support of all HIV/AIDS related services. The MOHSS manages a network of more than 300

health facilities spread out over a vast geographic area in 13 health regions and 34 health districts. MOHSS

leadership and implementation for facility-based palliative care for adult PLHWA is within the framework of

WHO's Integrated Management of Adolescent and Adult Illness (IMAI) program. The IMAI Guidelines for

Namibia have been approved, and training and rollout of IMAI is underway. The five IMAI modules include:

(1) acute care; (2) chronic HIV care with ART; (3) general principles of good chronic care; (4) palliative care;

and (5) the caregiver booklet.

Taking on tasks previously provided by physicians, nurses will provide palliative care, managing clients who

are not yet eligible for ART as well as clients who have received their first six months of ART at hospital

CDCs. An IMAI technical advisor for palliative care will be recruited and placed in the MOHSS in COP2007.

The advisor will provide continued technical support in COP2008, along with the hiring of additional nurses

to support all 13 regions to rollout IMAI to selected health centers and clinics in 2008. The IMAI framework

for decentralized HIV/AIDS training, service delivery standards, and task-shifting to district and community

levels of care inform the MOHSS decentralization plans and enable the health system to more adequately

provide comprehensive HIV/AIDS care for Namibian communities. 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 facility-based palliative care service

delivery include the provision of the preventive care package for adults and children which includes

cotrimoxizole prophylaxis; TB screening and isoniazid preventive therapy; integrated CT; child survival

interventions for HIV-positive children; clinical nutrition counseling and selective supplementation for

PLWHA who are on ART; prevention strategies which include balanced ABC prevention messaging and

condoms; support for disclosure of status; referral for family planning and PMTCT services; and counseling

for alcohol abuse and gender-based violence.

Additional palliative care priorities also include management for opportunistic infections, ART adherence,

routine clinical monitoring, and systematic pain and symptom management. Closer partnerships with

districts and communities will allow increased opportunities to expand safe water and hygiene strategies

and access to malaria prevention for PLWHA and their families, including leveraged support from Global

Fund-funding for bed nets. The USG will also work with the Ministry of Agriculture and Rural Development

to explore the feasibility and cost of appropriate safe water strategies for PLWHA. It is also anticipated that

roll-out of IMAI will likely result in MOHSS development of a national palliative care policy that allows nurses

to prescribe narcotics and symptom-relieving medications. Technical support from APCA will support this

activity. Planning for palliative care rollout has identified a number of program gaps that the MOHSS is

currently unable to support. Many of the targeted sites are ill-equipped in terms of equipment, supplies, and

transport. Specifically, this activity includes three primary components: (1) Procurement of equipment

necessary to provide essential HIV-related clinical care, including tools to improve clinical monitoring. In an

effort to address barriers to proper care of HIV-infected women, equipment will also be procured to improve

gynecological screening and care of HIV-positive women to more adequately address HIV-related

conditions such as cervical dysplasia and reproductive tract infections; (2) Procurement of equipment and

supplies for decentralized sites which will enable improved monitoring and supervision to facilities within the

catchment area of the district hospital who will be implementing IMAI rollout. This includes office supplies

and tools essential for IMAI palliative care rollout, including printing of IMAI patient cards and files; (3)

Procurement of additional vehicles to address significant transportation barriers in rural Namibia. With the

addition PEPFAR support for 11 vehicles throughout Namibia and leveraged support with the Global Fund,

it is anticipated that the MOHSS and PEPFAR partners will be able to provide improved support and

supervision to facilities within the catchment area of district hospitals that will be implementing IMAI rollout.

This includes support from case managers to trace ART defaulters and strengthen outreach services which

support the continuum of decentralized care between facilities and communities. In partnership with PACT

(new) and APCA, support will be provided to the MOHSS Primary Health Care Directorate to develop a

standardized training program for community and home-based palliative care services which will be linked

to facility-based care and IMAI rollout. The program will coordinate closely with SCMS/RPM+ to address

gaps in procurement and supply chain management for home based care kits and essential palliative care

medications. Funding for this activity has been split between two activities: MOHSS Basic Health Care (1/3

of the budget) and MOHSS ARV Services (2/3 of budget). Activities will ensure gender-sensitive

approaches, including equitable training and support of male and female health care workers with the goal

of equitable access to HIV/AIDS services for PLWHA and their families throughout MOHSS programs.

This activity is a continuation from COP07, and supports a portion of the funding for community counselors,

who dedicate part of their time to this activity. Funding for community counselors is distributed among

several program areas, all of them Ministry of Health and Social Services (MOHSS) activities: Preventing

Mother to Child Transmission (16149), Abstinence and Be Faithful(16150), Other Prevention (16151),

HIV/TB(16154), Counseling and Testing(16156), and ARV Services(16158). This activity also links with

CDC's system strengthening activity(16160). This activity is an extension of the MOHSS' Community

Counselor Initiative to support counseling and HIV testing of TB patients and relates to all provider-initiated

counseling and testing services and VCT in health facilities. According to 2006 data, 30% of TB patients

were tested for HIV. This has increased significantly from the 16% tested in 2005 and is likely the result of

new guidance that included Stage III disease (pulmonary TB) for ART eligibility. However, capacity for CT,

especially using rapid test technology, of TB patients continues to have room for improvement.

MOHSS established the community counselor cadre in 2004 to assist doctors and nurses in healthcare

facilities with provision of HIV prevention, care, and treatment services, including HIV counseling and

testing, PMTCT, ART, TB, and STI; and to link and refer patients from health care delivery sites to

community HIV/AIDS services. Emphasis is placed on the recruitment of HIV positive individuals as

community counselors as a strategy to reduce stigma and discrimination. As of the end of June 2007, 382

community counselors (approximately 25% of whom are HIV positive) have been placed at 253 health

facilities. By end of September 2007, 448 community counselors will be deployed in health facilities

throughout the country. With COP08 funding, an additional 150 community counselors will be trained and

deployed, giving a cumulative total of 650. The additional counselors will accommodate loss through

attrition, enhance provision of outreach-based VCT, expand prevention with positives (PwP) efforts, and

initiate counseling and testing services in correctional facilities. The community counselor "package"

includes: recruitment and salaries for the community counselors, 13 regional coordinators, a national

coordinator, and an assistant national coordinator (implemented through the MOHSS' subcontract with the

Namibian Red Cross Society); initial and refresher training (implemented by a local training partner) that

includes a module on TB; supervisory visits by MOHSS staff who directly supervise the community

counselors; training for MOHSS staff who are responsible for management of the program at national level;

support for planning meetings and an annual retreat for community counselors; and support for MOHSS

staff and community counselor participation at international conferences.

Supervised by a nurse, community counselors are the primary personnel at health sites responsible for

providing HIV testing and counseling, providing pre-and post-test counseling and testing (using rapid tests

when possible) to TB patients. Of the 30% of TB patients tested for HIV in 2006, 67% were HIV positive.

The majority of persons with TB are HIV-positive, justifying the need for continued integration of TB/HIV

activities. The additional community counselors in 2008 will allow for continued rollout of CT to TB sites

throughout the country and providing CT to a minimum of 70% of patients.

All activities will incorporate gender messaging in compliance with Namibia's male norms initiative which

seeks to address cultural norms that factor into HIV transmission, including lack of health care seeking

behavior by men, multiple sex partners, transactional and transgenerational sex, power inequities between

men and women, and heavy alcohol use.

Within COP08, funding for Community Counselors (CCs), who dedicate part of their time to this activity, 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 Counseling and Testing activities of

interfaith Intrahealth, Potentia and I-TECH, and CDC's system strengthening activity. This activity is a

continuation of COP07 activities and includes four primary components: (1) The Community Counselor

Initiative, (2) procurement and distribution of HIV test kits and supplies, (3) promotion of counseling and

testing through Namibia's National HIV Testing Day, and (4) professional development of MOHSS national

counseling and testing program staff.

(1) Training and deployment of community counselors through the MOHSS Community Counselor Initiative.

The MOHSS established the community counselor cadre in 2004 to assist doctors and nurses in healthcare

facilities with provision of HIV prevention, care, and treatment services, including HIV counseling and testing

for PMTCT, TB, and STI patients as well as ART adherence and supportive counseling; and to link and

refer patients from health care delivery sites to community HIV/AIDS and TB services. CCs receive

specialized training in couples counseling, in particular to address the unique needs of serodiscordant

couples. Emphasis is placed on the recruitment of HIV positive individuals as CCs as a strategy to reduce

stigma and discrimination. As of end of June 2007, 382 CCs (25% of whom are HIV positive) have been

placed at 253 health facilities. By end of September 2007, 448 CCs will be trained and deployed in health

facilities. By end of December 2007, 508 CCs will be trained and deployed in health facilities throughout

Namibia. A total of 300 deployed CCs will attend refresher trainings between January and September 2008.

Priority sites for deployment include ANC, TB clinics, ART clinics, and outpatient departments (where nearly

all STI cases are seen).

With COP08 support, an additional 150 CCs will be trained and deployed giving a cumulative total of 650 by

September 2009. The additional CCs will accommodate loss through attrition, enhance provision of

outreach-based counseling and testing, initiate counseling and testing services within correctional facilities

and expand prevention with positives (PwP) efforts.

Initial training of CCs involves six-weeks of didactic and hands-on instruction. The training curriculum is

multifaceted and includes a variety of components, including confidentiality, stigma and discrimination, pre-

and post-test counseling, couples counseling, notification and referral of exposed partners, prevention with

positives (PwP), adherence counseling, TB and STIs, risk reduction counseling (including AB and C/OP

messaging), basic alcohol and substance abuse counseling, referral for health and social services, and

rapid testing. Because CCs are frequently called upon to assist in other capacities within their assigned

sites (e.g. translating for physicians and nurses), they are also provided with orientation to the general

operations of a health center. With FY08 funding, 300 deployed CCs will also receive refresher training in

rapid HIV testing, couples counseling, prevention with positives (PwP), preventive care counseling for

children and Provider Initiated HIV Counseling and Testing (PICT) in clinical settings.

PEPFAR funding for the "Community Counselor package" includes: recruitment and salaries for the CCs, 13

regional coordinators, a national coordinator, and an assistant national coordinator (implemented through

MOHSS partnership with the Namibian Red Cross); initial and refresher training (implemented by a local

training partner); recruitment and salary for the newly established MOHSS position of Counseling and

Testing Outreach Coordinator; supervisory visits by MOHSS staff who directly supervise the CCs; training

for MOHSS staff who are responsible for management of the program at national level; support for planning

meetings an annual retreat for CCs; and support for CCs' participation at international conferences. CCs are

the primary personnel at health sites responsible for providing HIV testing and counseling, providing pre-

and post-test counseling and testing (using rapid tests) to support provider-initiated testing of PMTCT

clients and their partners, TB and STI patients, and those with HIV-related symptoms. It is noteworthy that a

large number of Namibians also access public health facilities solely for VCT services. The VCT package

entails risk assessment, development of a risk reduction strategy and encouragement to bring in partners

for testing.

(2) Procurement of HIV Test Kits and Supplies. With PEPFAR support, MOHSS will continue to purchase

the following: Determine and Unigold test kits (using a parallel testing algorithm) to be used at MOHSS and

mission-managed sites for HIV testing of a projected 125,000 clients; Clearview Complete HIV 1/2 as a tie-

breaker in rare instances of discordance; HIV rapid test starter packs to launch new testing sites; and rapid

HIV test training supplies for training CCs. Test kits and supplies are effectively procured and distributed to

health facilities by the MOHSS' Central Medical Stores through existing mechanisms. In FY08, the MOHSS

will also carry out a feasibility assessment for implementing oral fluid rapid testing in specific settings,

including outreach and correctional settings. As a part of the MOHSS ongoing review of testing options, the

USG will support the MOHSS to evaluate implementation of oral fluid rapid testing in specific facilities. The

USG will also support a launch of eighty HIV rapid test starter packs at new testing sites and continue

support for rapid HIV test training supplies as a part of the community counselors training program.

(3) Promotion of CT through an annual National HIV Testing Day. MOHSS will organize its 2nd National HIV

Testing Day in 2008 to further mobilize and advance efforts in counseling and testing in Namibia. PEPFAR

funds will be used to support promotional activities in all 13 regions, including drama presentations, radio

announcements, other entertainment/educational events, speeches by national and local leaders, and

production and distribution of print and electronic media. Billboards will be erected in at least eight regions.

Community partners such as DAPP's door-to-door "Total Control of the Epidemic" (7325 and 7327) will be

used to encourage people to test and to link them with the nearest counseling and testing site. It is

estimated that 50% or approximately 500,000 Namibians will be reached by mass media messages through

this campaign.

(4) Professional Development of MOHSS National Counseling and Testing Program Staff. PEPFAR funds

will be used to support attendance of three national-level program managers to attend and to present best

practices from Namibia at relevant regional and international HIV/AIDS conferences or meetings. This is key

to the professional development of MOHSS National Counseling and Testing program staff and essential to

sharing successes and lessons learned between countries.

All programming funded through this activity will incorporate gender messaging in compliance with

Namibia's male norms initiative which seeks to address cultural norms that factor into HIV transmission,

Activity Narrative: including lack of health care seeking behavior by men, multiple sex partners, transactional and

transgenerational sex, power inequities between men and women, and heavy alcohol use.

This is a continuation of activities initiated in FY06 and relates to other activities in this area, including

MSH/RPM+ (7135), SCMS/Partnership for Supply Chain Management (7449), and to ARV service activities,

including those of Potentia (7339), the Ministry of Health and Social Services (7330), and Intrahealth (7406).

The Central Medical Stores (CMS) of the MOHSS procures and distributes all ARVs in Namibia in the public

sector, including mission-managed health facilities. Through a single procurement structure, the CMS uses

funds from the MOHSS, the USG, the Global Fund, and other partners, including the Clinton Foundation, to

simplify procurement and maximize purchasing power. As of March 2006, ART services had rolled out to all

34 district hospitals in Namibia, and by March 2007, Namibia had the 43 MOHSS communicable disease

clinics (CDCs) managing 80% of the 33,000+ persons on ART and the 27,000 receiving care services in the

public sector. Children account for 13% of patients started on ART. ART services remain congested in

these hospitals, and thus the current focus of the national ART program is to: 1) decentralize care and

treatment, 2) focus on quality of care and treatment, 3) incorporate prevention and family planning

messages into treatment, 4) improve "user friendliness" of ARV services, 5) improve linkages to TB and

PMTCT services as well as with community-based organizations, and 6) increase the involvement of people

living with HIV/AIDS (PLWHAs) in palliative care and/or adherence support programs to strengthen the

adherence strategy.

By the end of 2007, ART should be decentralized to at least 13 additional sites and more than 46,000 will

be on ART by March 2008. Namibia has standardized first and second-line regimens. Approximately 70% of

adults are currently on stavudine/lamivudine/nevirapine (d4T/3TC/NVP) or zidovudine/lamivudine/nevirapine

(AZT/3TC/NVP), 25% are on stavudine/lamivudine/efavirenz (d4T/3TC/EFV) or AZT/3TC/EFV, 3% are on a

tenofovir (TDF) containing regimen, and 2% are on a protease inhibitor-containing regimen. Moreover, 13%

of adult ART patients are hepatitis B surface antigen positive, yet only 3% of patients are on an efavirenz

(EFV) containing regimen. Efforts are continuing to educate clinicians to use EFV in such patients. New

national treatment guidelines are currently being printed, and the new guidelines will move ART away from

d4T due to toxicity. The financial implications of implementation of the new revised treatment guidelines are

still under assessment.

In FY07, the Clinton Foundation/UNITAID negotiated substantial price reductions for CMS for pediatric and

second-line drugs, and recently signed a multi-year memorandum of understanding with the MOHSS to

continue to assist CMS with bringing down drug costs in 2008. These negotiations have resulted in the

addition of low-cost pediatric fixed dose combination (FDCs) to CMS' formulary, which is likely to

substantially improve adherence and efficacy and reduce wastage from previous regimens which involved

messy and difficult-to-measure syrups. In addition to bringing down list prices, CF/UNITAID has also

donated pediatric and second line ARVs to CMS, resulting in a savings of over $300,000 in the past six

months.

At the same time, the Global Fund has significantly increased its commitment to drug procurement, allowing

PEPFAR to hold ART expenditures relatively steady from FY07 while expanding assistance to the MOHSS

with procurement of drugs for opportunistic infections. In 2005, the MOHSS received $1.1 million from the

USG for ARV drug procurement and successfully expended those funds on FDA-approved branded

products using their Cooperative Agreement with HHS/CDC. A procurement plan for 2007 has been

developed and implemented by the MOHSS, the USG and the Global Fund to consolidate drug

procurement through the CMS. There were no FDA-approved generic products in the MOHSS tender for

ARVs in 2005. In FY08, 93% of the drugs procured with PEPFAR funds will be FDA-approved generics and

7% will be FDA-approved branded products. Funds from MOHSS and other donors will be used to procure

non-FDA-approved products. The Supply Chain Management System is accessible for ARV procurement,

but thus far has not been utilized by the CMS. The supply chain for ARVs and related drugs works well and

cost-effectively in Namibia, with no stock-outs, so the comparative advantage with SCMS could be in terms

of price and access to infrequently used ARVs which are currently not covered under MOHSS tenders and

would be very costly to buy locally off-tender. The Global Fund began support for ARV procurement in July

2005 with approximately $4 million in Year One, $9 million in Year Two, and a projected contribution of $12

million in Year Three (2008). USG funds for ARV drug procurement in FY08 will strongly leverage resources

with those of the Global Fund, the Clinton Foundation/UNITAID, and the MOHSS.

This activity is a continuation from FY07 relates to MOHSS ARV Drugs (7335); Potentia ARV Services

(7339), the NIP (7975), I-TECH (7350), HRSA (7450), RPSO (7345); and CTS Global's Strategic

Information activity (7323). The MOHSS health care network comprises 31 district hospitals, four referral

hospitals, 35 health centers, and >240 clinics within hospital catchments. ART services and facility-based

palliative care were offered by eight public hospitals in 2003, 15 in 2004, 27 in 2005, all 35 public hospitals

in 2006, and 40 thus far in 2007 (including four peripheral "outreach" sites not providing services on a daily

basis). According to the health information system (HIS), as of July 2007, a total of 51,127 patients are

enrolled in palliative care in MOHSS facilities of whom 36,734 are on treatment. Since approximately 10%

of treatment facilities are not included in the electronic HIS, the numbers are likely to be under-reported.

Recent targets set by the MOHSS project 46,675 people on treatment by the end of 2007, and 52,000 in

care; of these approximately 85% would be the charge of the public sector network.

The MOHSS is responsible for national coordination, resource mobilization, monitoring and evaluation,

training, and policy development in support of all HIV/AIDS related services. MOHSS recognizes an urgent

need to decentralize ARV services and transfer tasks from doctors to nurses. To this end, MOHSS has

adapted WHO's Integrated Management of Adult Illness (IMAI) for Namibia and in the process of rolling

IMAI out nationwide. Each district hospital communicable disease clinic (CDC) is responsible for the rollout

of IMAI to one health centers or clinic in their catchment area. Nurses in these sites will prescribe refills for

ARVs for PLWHAs after the first six months of treatment at a district CDC. Many of the existing and future

ART facilities are ill-equipped in terms of basic medical equipment and furniture. Lack of transport still

impedes the ability of regional and especially district level supervisors to follow-up on the status of services

in peripheral health facilities.

This activity supports four primary components:

(1) Routine bioclinical monitoring tests. Support to MOHSS and mission-managed facilities including

$4,453,741 for routine bioclinical monitoring tests (CD4, full blood counts, liver function tests, syphilis and

Hepatitis B screening, renal function tests, and other tests depending on regimen) performed by the

Namibia Institute of Pathology for the anticipated 59,482 patients on ART in the 2009 calendar year and for

CD4 monitoring of non-ART patients enrolled in palliative care at communicable disease clinics (CDCs) and

current and future IMAI sites. The Guidelines for ART Therapy in Namibia stipulate which tests are to be

performed. The Global Fund does not provide financial support for bioclinical monitoring.

2) Support for the Community Counselors Initiative. MOHSS established the community counselor cadre in

2004 to assist doctors and nurses in healthcare facilities with provision of HIV prevention, care, and

treatment services, including HIV counseling and testing, PMTCT, ART, TB, and STI; and to link and refer

patients from health care delivery sites to community HIV/AIDS services. Emphasis is placed on the

recruitment of HIV positive individuals as community counselors as a strategy to reduce stigma and

discrimination. As of the end of June 2007, 382 community counselors (approximately 25% of whom are

HIV positive) have been placed at 253 health facilities. By end of September 2007, 448 community

counselors will be deployed in health facilities throughout the country. With FY08 funding, an additional 150

community counselors will be trained and deployed, giving a cumulative total of 650. The additional

counselors will accommodate loss through attrition, enhance provision of outreach-based VCT, expand

prevention with positives (PwP) efforts, and initiate counseling and testing services in correctional facilities.

The community counselor "package" includes: recruitment and salaries for the community counselors, 13

regional coordinators, a national coordinator, and an assistant national coordinator (implemented through

the MOHSS' subcontract with the Namibian Red Cross Society); initial and refresher training (implemented

by a local training partner) that includes a module on TB; supervisory visits by MOHSS staff who directly

supervise the community counselors; training for MOHSS staff who are responsible for management of the

program at national level; support for planning meetings and an annual retreat for community counselors;

and support for MOHSS staff and community counselor participation at international conferences.

Within COP08, funding for community counselors, who dedicate part of their time to adherence counseling,

is distributed among six program areas, all of them MOHSS activities: PMTCT (7334), AB (7329), OP

(7333), HIV/TB (7972), CT (7336), and ARV Services (7330). This activity also links with CDC's system

strengthening activity (7360) and Potentia HTXS (7339). Through serving in MOHSS CDCs, community

counselors are an important source of information and adherence counseling to ART patients. They also

assist health professionals with basic administrative tasks in the clinic and language interpretation for those

who do not speak a local Namibian language.

Community counselors' messaging to ART patients will incorporate referrals for TB services, as well as

gender messaging in compliance with Namibia's male norms initiative which seeks to address cultural

norms that factor into HIV transmission, including lack of health care seeking behavior by men, multiple sex

partners, transactional and transgenerational sex, power inequities between men and women, and heavy

alcohol use.

(3) This component continues to fund anthropometric measurements, monitoring, micronutrient

supplementation, and minimal targeted nutrition supplementation for severely malnourished PLWHA who

are on ART, including children. While MOHSS policy does not allow for provision of food to outpatients, it

welcomed a pilot with the Clinton Foundation/UNITAID to provide ready to use therapeutic feeding (RUTF)

for malnourished pediatric ART patients. The MOHSS is further partnering with the Namibian Red Cross

Society (NRCS) to refer for micronutrient supplementation and minimal targeted nutrition supplementation

for severely malnourished PLWHA who are on ART and are referred by the Communicable Disease Clinics.

The NRCS already provides USG-funded community counselors to Communicable Disease Clinics to

provide counseling and testing and they will link patients with NRCS access points in the community. Using

World Food Programme and World Health Organization entry and exit criteria for food supplementation, the

NRCS will provide a nutrition supplement for either severely malnourished persons living with HIV on or

eligible for antiretroviral therapy (ART) or any pregnant or lactating woman on or eligible for ART. From the

2008 projections for new ART patients, an estimated 10% of non-pregnant and non-lactating PLWHA, plus

all pregnant and lactating PLWHA, will be eligible for a six-month supply of a nutrition supplement. Based

on these estimates, the program seeks to target approximately 2,500 PLWHA. The NRCS will be

responsible for procurement, supply logistics, storage, monitoring, and distribution of the supplements.

NRCS and MOHSS will also collaborate to link recipients of the nutrition supplement with stainable exit

strategies such as gardening projects and income generating activities in their community.

4) Procurement of basic furniture and equipment to support new or renovated ART sites, including health

centers and clinics, as part of decentralization of services. tems to be procured will include weighing scales,

desks, chairs, and benches. The communicable disease clinics (CDCs) will also receive lactate and

hemoglobin meters, digital thermometers, ENT scopes, infant and pediatric weighing scales, and measuring

boards, leveraging similar support provided by Global Fund. Based on need, some CDC's will also receive

support for improving care of female HIV patients, such as examination tables for gynecologic

examinations, examination lamps, and specula.

Activity Narrative:

This is a continuation of activities from FY04 - FY07 leveraging support from USG technical advisors for

strategic information through CTS Global (7322), USG supported informatics personnel through Potentia

(7338), and USG supported training in SI through ITECH, (7355). The activity will (1) provide computer

equipment and connectivity for data personnel, (2) produce patient record forms, and forms for capturing

routine ART/PMTCT/CT/TB data; (3) Support a research conference to identify the most important HIV, TB,

and malaria research topics; purchase computer equipment for data capture and processing; (4) support

medium term training in M&E and HIS, (5) procure office furniture for expansion of the response monitoring

and evaluation (RM&E) subdivision; (7) Database server training (8) M&E training.

Timely data collection, processing and reporting are essential to measure progress in the National Strategic

Plan for HIV/AIDS and improve services through program evaluation and public health evaluation. The USG

is supporting the MoHSS with personnel (7388) and training (7355) to facilitate these data collection,

reporting, and program evaluation initiatives. This activity will ensure data clerks and government HIS

officers are able to collect and transmit data efficiently.

1. Computer equipment, connectivity, and patient record forms for collection and dissemination of routine

ART/PMTCT/CT/TB data:

The following items will be procured in order to continue and expand the capture, processing, and

dissemination of routine ART/PMTCT/CT/TB data. It will ensure computer equipment and patient forms are

available and in working order for both newly recruited and established data capture and processing

personnel.

(a) Computers (41) including monitors, printers, and uninterrupted power supplies will be procured for 5 new

and existing data clerks and health information systems officers. This assumes replacement of 10% of the

computers in the field and will include replacement parts for computer systems that require maintenance.

(b) Software (including antivirus) upgrades.

(c) Memory sticks (61) for ease of transferring files will be purchased for new data staff.

(d) Rapid, efficient, secure exchange of data is critical to program monitoring and improvement, but it

remains a challenge in Namibia. This activity will provide fast, secure email access to all facility and regional

informatics personnel.

(e) In FY06/07 patient care books were updated to conform to WHO standards were assembled. This

activity will support production of approximately 15,000 patient books during FY08. It will also provide 3G

devices for wireless communication by RM&E staff while in the field.

(f) Training is a central activity to improve the monitoring and evaluation capacity in country. Most of this

training is completed by staff of the RM&E and HIS offices at national level. This activity will support

procurement of 4 computer projectors to facilitate these training workshops.

(g) This is a new sub-activity in FY08 and will support the purchase of office equipment for new space to be

occupied by the Response Monitoring and Evaluation sub-Division. This space is being renovated using

USG support in FY07.

(h) Four laptop computers will be purchased to facilitate training and travel by RM&E staff.

2. Produce patient booklets and registers for ART:

ART is a highly delicate treatment and thorough record keeping is critical to quality patient care. The

MOHSS has developed patient booklets and registers to facilitate this record keeping. Record keeping is

also essential to prevention of mother to child HIV transmission, tuberculosis treatment, and voluntary

counseling and testing. This activity will support printing of necessary forms, booklets, and registers.

3. Research conference support:

Namibia has capacity to address key research questions to improve services and guide policy. However,

there is currently a weak network of researchers and program implementers to develop and disseminate

research questions and resulting data. This activity will support a national research conference to bring

together individuals in Namibia completing research and evaluation activities to promote the exchange of

research ideas and results. Program implementers will also be invited to encourage application of research

findings for program and policy design.

4. Support Long Term Training:

One of the major challenges facing the Namibian response to HIV/AIDS is weak human capacity. Human

capacity strengthening through short courses (workshops) has limited ability to provide the more

sophisticated skills needed to generate high quality SI in Namibia. This activity will support longer term

training courses (4-8 weeks) for 3-6 staff members of the M&E steering committee. This support will cover

air fare, tuition, room and board for the participants.

5. Printing and dissemination of Response Monitoring and Evaluation Annual Report:

Dissemination of monitoring and evaluation reports is essential to inform programme managers and policy

makers of the HIV/AIDS response. This activity will support the printing and dissemination of this report.

Printing will be contracted to the lowest local bidder who is trustworthy and dissemination will occur through

regional level dissemination workshops coordinated by the RM&E sub-Division.

6. Procure server for national level data management:

Efficient monitoring and evaluation is dependent on ready access to high quality data from various sources.

To fulfill its role in monitoring and evaluating the national response to the epidemic, the response monitoring

and evaluation sub-Division of the Directorate of Special Programmes must have access to databases from

routine health activities (including STI), TB, ART, PMTCT, and others. To make these databases available,

this activity will support procurement of a database server to be housed at the Office of the Prime Minister,

which will house these various databases and make them available to those who need to use the data.

7. Provide training on database server:

Activity Narrative: MOHSS data analysts will be trained in management of data on a SQL server. This will allow efficient

management of health data at the central level.

8. Strengthen monitoring and evaluation capacity at government governing bodies and umbrella

organizations:

Quality monitoring and evaluation (M&E) will require capacity building at line ministries and umbrella

organizations for civil society. This activity will provide M&E courses for such M&E officers at these

organizations.

9. Procurement of furniture for RM&E offices:

The response to HIV/AIDS in Namibia has grown exponentially in recent years and the need for RM&E staff

needs to experience similar ensure strategic information is available to support program and policy. The

current RM&E staff complement is limited by the office space available to them. FY 2007 COP support will

renovate existing space into which RM&E can expand. This activity will provide office furniture for expansion

into that space. This space is co-located with the national health information systems offices to facilitate

collaboration between these related subdivisions.

This activity is a continuation from FY07 and provides limited scholarships (bursaries) to train Namibian

students to become health professionals. It relates to other activities in this Program Area: I-TECH (7352)

and Potentia (7341). Without question, inadequate human resource capacity is the leading obstacle to the

development and sustainability of HIV/AIDS-related health services in Namibia. The vacancy rate in

government positions in the Ministry of Health and Social Services (MOHSS) is estimated to be 40% for

doctors, 60% for pharmacists, 48% for social workers, 25% for registered nurses, and 30% for enrolled

nurses. Doctors and pharmacists cannot be trained in Namibia due to the lack of a medical school and other

training institutions. Training for medical technologists will be initiated at the Polytechnic of Namibia in

2008, but the program will have limited capacity (20 students) in its first years of operation. To fill urgently

needed nursing and pharmacy positions, this activity will support MOHSS plans to increase the output of

enrolled nurses and pharmacy assistants from the National Health Training Center, who can be trained in

two years instead of four years, and for registered nurses at the University of Namibia. These positions are

urgently needed as Namibia's Integrated Management of Adult Illness program continues to be rolled out.

A total of 336 doctors, pharmacists, pharmacy assistants, nurses, enrolled nurses, laboratory technologists,

social workers, and nutritionists will be trained in Namibia, South Africa, and Kenya. PEPFAR will support

up to 20 students in the inaugural laboratory technologist program at the Polytechnic of Namibia, anticipated

to begin enrolling students in January 2008. Two additional students will be supported for postgraduate

studies in epidemiology and clinical psychology. Students are bonded to serve the MOHSS upon

completion of studies and will work in an area related to HIV/AIDS.

Another activity in this area is a cross-border collaboration first funded in FY07. The PEPFAR teams in

Angola and Namibia will continue to support the following activities: The Ministries of Health (MOH) of

Angola and Namibia will enhance an already established relationship to form a mentoring program to

strengthen PMTCT service access and coverage, improved quality of care and better outreach and follow-

up for ART service delivery in the border regions. This mentoring program involves exchanging

experiences, technical skill transfer, and sharing of protocols achieved through cross-border visits by

regional and provincial MOH delegations. The collaboration will build on initial staff visits and exchanges

carried out with support from WHO in 2006, as well as a new PMTCT initiative initiated in 2007 by USAID

with the Cunene Provincial Health Department, CUAMM, Chemonics and other partners.

This initiative expands PMTCT, safe birthing, and reproductive health care services to expectant mothers in

pre-birth waiting stations at one or more Angolan MOH health centers and maternity hospitals. MOHSS

Namibia personnel will be supported by the Centers for Disease Control (CDC) Namibia. Angolan MOH and

NGO staff will visit selected facilities in Ohangwena, Oshakati and other Namibian locations, and will

participate in training organized with the support of the MOHSS, USAID and CDC. MOHSS Namibia

personnel will conduct organized site visits at facilities in Ondjiva, Cahama, Santa Clara and other municipal

locations, and share recommendations on better application of best practices and international protocols,

including their success at promoting for institutional births. Training activities for MOH and NGO staff in both

countries will be coordinated with and seek to leverage resources available under the current bilateral

Global Fund programs in Angola and Namibia. Ensuring the participation of individuals fundamentally

responsible for the start-up and roll-out of PMTCT services in Namibia will be a key strategy employed to

ensure lessons learned from Namibia are transferred to Angola. Other areas for expansion may include, but

are not limited to, VCT and TB.