In FY08, the USG will to continue to work closely with the Ministry of Health and Social Services (MoHSS)

at the national, regional and service levels in the 34 health districts to provide technical expertise during the

roll-out and strengthening of PMTCT services, to monitor the implementation at existing service delivery

sites, to conduct the first formal evaluation of the program, and to support expansion of services from 188

clinical sites in March 2007 to 218 sites by the end of 2008. This is a continuation of FY07 and is closely

linked with MoHSS_7334, Potentia_7344, I-TECH_7354, NIP_7927, and IntraHealth_7430 PMTCT

services. Namibia began PMTCT services in early 2002 at two public hospitals. In late 2002, the Global

AIDS Program of HHS/CDC began its collaboration with Namibia;s MoHSS by providing technical

assistance in PMTCT, VCT, TB/HIV, surveillance, and ART services. The overall responsibilities for,

coordinating, and rolling out of PMTCT services lie with the Deputy Director of family Health Division in the

Primary Health Care Directorate. A PMTCT Coordinator employed through GFTATM and a full-time USG-

supported PMTCT technical advisor assist the Deputy Director in carrying out these activities. The USG

also supports training, information systems, logistics and technical assistance to the national PMTCT

program. Specific activities include: (1) Funding for two HHS/CDC PMTCT field support nurses as Foreign

Service Nationals (FSNs). Working with Ministry staff at the national, regional, and district-level, these

nurses conduct crucial supervisory support visits to current and upcoming PMTCT sites to provide on-site

monitoring, training, and assessment of the quality of services, patient flow, record keeping as well as

challenges and needs. The roll-out of rapid testing in PMTCT sites will also require hands-on support to

health facilities. This staff also support sites to integrate the wide range of HIV prevention, treatment, and

care services into the clinical setting and improve linkages with local non-governmental organizations

(NGOs). Approximately 25% of women do not deliver in a health facility and these nurse supervisors will

assist with the identification and training of traditional birth attendants (TBAs) in PMTCT. They are stationed

in Oshakati Hospital, the largest hospital in the north, where the Ministry has allocated office space to

HHS/CDC in order to facilitate logistical, material, and technical support to this area where the majority of

the population resides. CDC PMTCT field nurses will partner with other programs to identify needs, facilitate

and implement supportive programs. They offer TA to sites in a coordinated way, so as not to duplicate

services provided by others. This activity leverages resources with the Global Fund, which is funding a

PMTCT Coordinator, training, diagnostic PCR testing, and three PMTCT trainers at the national level. (2)

Support for travel of: - selected Namibian staff in the PMTCT program to attend relevant informational

meetings and conferences on PMTCT in Namibia and in the southern Africa region to learn from best

practices in neighboring countries. And MoHSS and USG counterparts to the 13 regions to conduct

supportive supervisory visits to improve and expand PMTCT services.

3. The provision of family planning (FP) for persons living with HIV/AIDS and others at-risk is also a primary

prevention strategy for mother to child transmission. However, FP needs, particularly for HIV+ women and

their partners, have been largely overlooked in Namibia. Contraceptive use among Namibian women is high

(38%), but anecdotal evidence suggests that women on ART are becoming pregnant unintentionally. This

not only has implications for the mother's well-being but also for pediatric AIDS. Many women are also

thinking of having another pregnancy and would like to discuss their options with their service providers.

Namibian health workers are willing to address FP, but they are often constrained by a lack of information,

training and clarity on messaging. HIV clinics lack clinical guidelines/protocols and IEC materials, as well as

a formal referral system for FP. Knowledge gaps exist among clinic staff; many HIV staff do not understand

the concept of dual protection, while FP staff often believe their clients are at low risk for HIV. This funding

will support the development, translation, printing and distribution of IEC materials related to FP topics.

Before development of new materials occurs, a group of stakeholders will meet to review existing IEC

materials from other countries to determine whether existing materials can meet the needs. This activity will

also support a similar effort to review, update, print, and widely distribute FP guidelines for Namibia. IEC

materials and FP guidelines will be made available to government and FBO health care facilities, health

care workers at military bases, and organizations carrying out health promotion activities. Further there is

need to integrate FP messages and methods in the ART sites so that unwanted pregnancies are reduced in

HIV positive women, that women receive counseling on how to fall pregnant with as little risk of HIV

transmission to their babies as possible and on how to avoid reinfection in pregnancy. For this it is proposed

that each ART site be assigned a nurse to oversee this activity. 4. Currently for COP07, a study will be

conducted on infant feeding practices in Namibia with support from CDC and the Global Fund. This activity

will roll into 2008 and will require financial support from PEPFAR for biostatistician to come in quarterly and

monitor the data. Infant feeding is a critical component of PMTCT and needs to be monitored and followed

up rigorously at site level. There is need to have more trainings on infant feeding in the context of HIV.

5. Increasing PMTCT uptake and the quality of counseling particularly for infant feeding could be facilitated

by having a mother to mother support programme. Social mobilization and a communication package for

PMTCT would help to raise community awareness of PMTCT and reduce stigma and discrimination.

PMTCT follow up of mother-baby pair needs to be intensified so as to improve monitoring of the PMTCT

programme and to this end a system of follow up needs to be put in place. This is in recognition of the fact

that even if there is data on HIV DNA PCR results in infants, this is not for all babies who will have come

through PMTCT. Using case managers employed through Potentia to conduct follow up of mother-baby

pairs, the outcome of babies that did not come for PMTCT follow up will be determined.

At national level, a data analyst will support all PMTCT activities including various aspects of programme

management and synthesis of PMTCT data to better inform the programme

This is a continuing activity from FY07 that relates to DAPP (7325), the Ministry of Health and Social

Services or MOHSS (7329), and Potentia (new). This activity includes two components, namely (1) support

for a behavioral scientist to serve as the USG's technical advisor to the MOHSS Directorate of Special

Programmes on HIV prevention and behavior change communication, Ministry of Health and Social

Services (MOHSS), and (2) travel in support of technical assistance visits from CDC Headquarters

concerning the following prevention interventions: prevention with positives (PwP), male involvement, male

circumcision, STI and TB programming, and the role of alcohol in HIV prevention. This position has been

approved and posted, but is unlikely be filled by the end of 2007.

In late 2002, the Global AIDS Program of HHS/CDC began its collaboration with Namibia by opening an

office in the MOHSS National AIDS Coordination Program (now known as the Directorate of Special

Programmes) to provide technical assistance in PMTCT, VCT, TB/HIV, surveillance, and ART services. In

response to requests from the MOHSS, CDC has gradually formed a team of technical advisors at the

national level, including two direct hires, in the areas of adult and pediatric care/treatment, PMTCT, VCT, SI,

palliative care, and laboratory services. While the MOHSS has made substantial progress in terms of rolling

out treatment, PMTCT, and VCT in the emergency phase of PEPFAR, less attention has been given to

establishing a comprehensive systematic national prevention strategy based on best practices and

evidence-based interventions. Primarily through the leadership of the Ministry of Information and

Broadcasting (MIB), which receives substantial USG support, an active but generalized prevention

campaign known as "Take Control" has been in place for a number of years. In FY08, the "Take Control"

campaign will expand to include nuanced, age-appropriate messages on alcohol, male circumcision, and

prevention with positives (PwP).

The MOHSS, which is the technical lead and coordinator of all sectors in HIV prevention, has not had a HIV

prevention focal person to provide technical leadership and vision on prevention issues. The Director of

Special Programmes recognized the shortcomings and lack of leadership in prevention and requested the

support of a behavioral scientist to build local capacity in the use of evidence-based approaches to design

national prevention programs. This assistance is critical as it will come as the MOHSS is staffing the

"Expanded National Response" subdivision and implementing WHO's Communication for Behavior Change

Interventions (COMBI) program within the Directorate. Both of these efforts focus on behavior change and

strategic communications. Therefore, the local environment is well suited for continued assistance from a

USG Technical Advisor (TA) on prevention.

The TA will serve as the focal person for USG-supported prevention initiatives involving the MOHSS. The

TA will work with the MOHSS to develop capacity to provide national leadership on the most evidence-

based prevention strategies available, including behavioral change interventions and medical interventions

(eg, circumcision, microbicides, etc) as they become available. The TA will support a process to adapt best

practices from other countries and to promote dissemination of best practices from within Namibia at the

national and international level. This will include ongoing support to the head of the Counseling and Testing

unit in the Directorate to roll out, monitor, and evaluate the PwP intervention through community counselors

and health workers. The PwP initiative incorporates "be faithful" messaging to discordant couples and thus

contributes to AB efforts. This TA will further support the Male Norms Initiative, with particular emphasis on

defining and promoting strategies that result in abstinence/sexual postponement for adolescent boys, male

partner reduction, and greater willingness to access services.

Other key activities for the prevention technical advisor in FY08 will include working with USG partners

DAPP (7325), Potentia (new), and I-TECH (new). Specifically, the TA will support efforts to streamline

DAPP's training curricula for field officers and to harmonize messaging with other in-country prevention

efforts. The TA will work with DAPP to adopt curricula incorporating AB messaging proven to be effective.

In a new initiative, Potentia will hire and I-TECH will train 34 case managers with psychology/social work

backgrounds for deployment to ART and ANC sites throughout the country. The TA will play a key role in

developing scopes of work, hiring criteria, and selecting suitable candidates, as well as for assisting I-TECH

with developing a training curriculum for this cadre. These case managers will contribute to AB efforts by

facilitating support groups, providing couples and PwP counseling, and referring clients for health and social

services that can support prevention efforts.

As appropriate, the TA will ensure that efforts 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, 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 is a continuation of COP07 for CDC technical assistance to the Ministry of Health and Social

Services (MOHSS) to strengthen guidelines and facility interventions to prevent nosocomial transmission of

TB, including within ART sites, and to complete the transition and rollout of the Electronic TB Register

(Windows-based ETR.Net). This activity relates to TBCAP (16210). The CDC team will further support the

continued rollout of HIV rapid testing within TB sites, as well as TB testing within ART sites. While not

directly funded under these activities, these efforts are supported through ongoing assistance to the

community counselor initiative within MOHSS (16154), the hiring of trainers and clinical staff through

Potentia (16193), and support for in-person and digital video conferencing training on TB topics through I-

TECH (16219).

In late 2002, the Global AIDS Program of HHS/CDC began its collaboration with Namibia by opening an

office in the MOHSS National AIDS Coordination Program (now the Directorate of Special Programmes for

TB, HIV, and Malaria) to provide technical assistance in PMTCT, VCT, TB/HIV, surveillance, and ART

services. At that time, the MOHSS National TB Control Program (NTCP) had a single staff member; since

then, additions to the staff have included a USG-funded TB Technical Advisor, two additional program

managers, a coordinator for community-based TB initiatives (Global Fund), and two data clerks to support

the ETR (Global Fund). The NTCP has developed its first Medium Term Plan and updated its TB guidelines

to include provider-initiated HIV counseling and testing (PICT), cotrimoxazole (CTX) prophylaxis for TB/HIV

co-infected patients, and management of TB treatment and antiretroviral therapy (ART).

Two of the many challenges facing the NTCP include implementing, monitoring and sustaining practical

measures to prevent nosocomial transmission of TB, particularly to HIV-infected patients, and strengthening

of the surveillance system for TB/HIV. In FY08, CDC will work with USG experts to ensure that all relevant

measures in the hierarchy of TB infection control (administrative/work practice, environmental, and

respiratory protection) are integrated into sites providing TB and/or HIV care. The USG will take advantage

of ongoing renovations of MOHSS ART sites to ensure that structural interventions (e.g. design and patient

flow patterns) minimize the risk of transmission of TB. Particular attention will be placed on maximizing

natural ventilation.

The USG will support the preparation of an action plan for bringing Namibia in line with revised WHO/CDC

recommendations; current identified priority needs include structural interventions, training of health care

workers, earlier detection and treatment of cases, expansion of directly observed therapy (DOTS),

enhanced TB/HIV service integration, and improved TB surveillance, including for MDR and XDR-TB. This

action plan follows on the heels of a FY07-supported health facility assessment. Emphasis will be placed

on targeting sites with higher rates of MDR-TB and in locations where patients with undiagnosed and

untreated cough are managed to minimize exposure to HIV-infected patients and health workers. The CDC

team in the MOHSS will support the NTCP with development and implementation of the plan to ensure that

action steps are followed. COP 08 funds will further support development of a TB component within

national infection control guidelines

Namibia is one of several southern Africa countries that adopted the ETR developed by the BOTUSA

Project (Botswana-CDC collaboration) in Botswana. The ETR collects information on HIV status and use of

ART in TB/HIV patients and is a tool to measure key indicators and to better monitor expansion of HIV care

and treatment among TB patients. ETR is expected to further contribute to enhancements in TB

surveillance, and inform improvements in TB prevention, early detection, and treatment. Efforts will

continue in 2008 to roll out this system nationwide. Additional USG technical assistance will be provided in

COP08 to follow through with the rollout, including training of end users in the district TB program offices

and at the regional and national levels for data management. This activity leverages resources with the

USAID-funded TBCAP and with the Global Fund (Round 2 and Round 5) support to the MOHSS.

This new activity supports the HIVQUAL program and relates to the Ministry of Health and Social Services

(MOHSS) ARV Services (7330), Potentia ARV Services (7339), I-TECH (7350), HRSA (7450), CTS

Global's Strategic Information activity (7323), and Intrahealth (7406). Funding for this activity will be

directed for HIVQUAL Namibia in-country activities through the CDC/Namibia office. This activity will

expand on the HIVQUAL work which began in Namibia in FY 2007 to reach 16 ART sites. In FY 2008 the

program will add 18 new sites throughout all 13 regions to reach all the 34 public and faith-based district

hospitals. In addition, at least five health centers will be targeted during 2008. Initially these will be identified

because of their proximity to participating hospitals. These funds will be used to support general office

management for the HIVQUAL Coordinator for Namibia, as well as travel and training costs related to rolling

out the HIVQUAL program as outlined above.

HIVQUAL aims to provide a framework for health services staff and individual health care providers to

engage in a participatory process of quality improvement (QI) based on evidence and data collected locally.

Using the HIVQUAL model, Health Units, Districts, Regions and the Ministry of Health and Social Services

(MOHSS) will be able to gauge the quality of services provided to the HIV+ population at increasingly higher

levels using indicators based on national guidelines. Data can for the foundation of proposed feasible and

sustainable strategies to improve quality.

In FY 2008, the activity will be conducted under the leadership of the MOHSS Directorate of Special

Programs (DSP) in close collaboration with CDC/Namibia and the US-based HIVQUAL team for technical

support. Activities will include: 1) QI training; 2) assessment of quality management programs at the

participating clinics; 3) performance measurement (at six-month intervals) of selected core indicators; 4)

ongoing QI coaching at participating sites; 5) promotion of consumer engagement in HIV care 6) regular

conference calls with the US-based team. Data analysis and planning for expansion will also occur.

Activities will result in strengthening systems of care and documenting strategic information in health care

facilities. An important emphasis of this approach is to develop providers' skills for collecting and using use

of performance data within their own organizations to improve their systems of care. Use of facility-level

data derived from the national health information system for the purpose of improving quality is an important

goal of HIVQUAL. Training will also be provided to key MOHSS staff at the national, regional, and site level

as indicated.

Established indicators measured through HIVQUAL determine the level of continuity of care, access to

antiretroviral therapy and CD4 monitoring, TB screening and prevention, prevention education, adherence

assessment, PCP prophylaxis, weight monitoring, food security and alcohol screening. In FY08, HIVQUAL

indicators will also be devised and extended to include PMTCT and Pediatric ART programs. .

HIVQUAL is uniquely facility and region-specific. At the clinic level, QI methods can be adapted to each

organization's particular systems and capacities. An assessment tool to measure the capacity of the quality

management program at each facility is used and it both measures the growth of quality management

activities as well as guides the coaching interventions. Facility-specific data that are aggregated can provide

population-level performance data that indicate priorities for national quality improvement activities and

campaigns. Publication and dissemination of these data will be done under the auspices of the MOHSS.

Regionally, networks of providers who are engaging in quality improvement activities can work together to

address problems that are unique to each area, including, for example, human resource shortages and

coordination of care among multiple agencies as well as adherence to care services. Quality improvement

training will be conducted for groups of providers. The project will work in partnership with all treatment

partners who will help disseminate quality improvement strategies and activities throughout their networks.

The concept of quality improvement using the HIVQUAL model is still relatively new in Namibia.

Consequently, a lot of advocacy and training will need to be done in order to increase awareness and buy-in

of the initiative by health care providers. Advocacy material for quality improvement will be printed and

disseminated to health care facilities. The bulk of these activities will be undertaken within COP 07 and

continued in COP 08.

The USG HIVQUAL team will expand its focus to build quality improvement coaching skills among MOHSS

staff and providers in Namibia and provide advanced level trainings for sites as well as basic training for

new participants. The training activities will be done in collaboration with I-TECH. Mentoring of Namibia-

based staff will continue throughout the activity.

Effective leadership in quality and safety in health care means having access to the most recent information

and practical experience. The sharing of best practices is necessary to learn from each other's experiences

and promote quality improvement. The national coordinators of HIVQUAL under the Case Management Unit

of the MOHSS will thus participate in quality improvement conferences to learn from others and share

experiences.

Additional staff for the activity will be required under the Case Management Unit of the DSP, MOHSS as the

program expands both in the number of participating sites and focus areas to include pediatric and PMTCT

indicators. A position for a HIVQUAL Nurse Co-coordinator will be defined and filled to support the

HIVQUAL Medical Officer already working on the project. A part time data manager position will be defined

and filled to provide dedicated support to HIVQUAL so that other data managers will not be pulled away

from their work to support this activity.

Activity Narrative:

This activity is part of the overall SI strategy in Namibia to build capacity to assemble, analyze, and better

utilize multiple sources of existing data to answer key program questions. It is related to CTS Global (7322)

as well as technical triangulation advising by UCSF (7928) and will use an integrated team of SI experts

including persons from the Ministry of Health and Social Services (MOHSS), CDC, USAID, and UNAIDS.

Triangulation is a short-hand term for synthesis and integrated analysis of data from multiple sources for

program decision making. It is a powerful tool used to: demonstrate program impact; identify areas for

improvement; direct new programs and enhance existing programs; and help direct policy changes. It

strengthens understanding of complex health issues and provides support for making evidence-based

public health decisions. The goal of this activity is twofold: to conduct the country-driven data triangulation

process to answer key questions prioritized by the country team; and to build the long-term in-country

capacity of country stakeholders to use data from multiple sources to provide an evidence base for program

and policy decision-making.

The process will be guided by the in-country team, led by the MOHSS, in close collaboration with USG staff.

At the first stage an in-country task force will be formed to identify priority questions, taking into account the

country context and existing strategic information activities. Identification of priority questions will be

followed by identification of data that would help to answer the questions. Once various data sources are

identified (for example, surveillance, surveys, special studies), the University of California at San Francisco

will work with in-country data analyst(s) to review, synthesize and analyze the data. Findings will be

reviewed by the task force for presentation, dissemination, program and policy modifications, and further

recommendations. The objective of the triangulation activity is that Namibian personnel will be able to

continue this type of analysis without help of UCSF.

Funds will be used by the MoHSS (the local implementing partner for triangulation) for planning, facilitating

and conducting the triangulation process. Specifically, funds will cover a local in-country coordinator/analyst

to keep the process moving forward, preparation of materials including workshop materials, reports, and

presentations, and any costs associated with conducting the in-country workshops.

This activity links to UCSF triangulation as the MOHSS personnel will be trained and mentored by UCSF

representatives. It will also relate to the CTS Global technical advisors who will assist in the mentoring

process and Potentia-supported data personnel as these individuals will help ensure clean data sets are

available for triangulation. This activity will target the general population nation wide and will emphasize

strategic information, local organization capacity building, and public health evaluation.

These funds were initially designated as TBD but have been reprogrammed to be designate CDC as the

prime partner. CDC will leverage these funds against those of the Global Fund to assess the impact of

donor resources on the HIV/AIDS epidemic in Namibia. CDC funds will support travel, material costs,

printing, and other costs associated with the impact evaluation.

This is a new activity in FY 2008 with a strategic information emphasis area. It will provide resources to

evaluate the outcome and impact of the Namibian response to HIV/AIDS in the period of time since

PEPFAR, the Global Fund for AIDS, TB, and Malaria (GFATM) started to provide resources to support the

Namibian response. It is related to CTS Global TA for a strategic information liaison (7322), a health

information systems TA (7322), a monitoring & evaluation TA (7322), the Ministry of Health and Social

Services (MOHSS) hardware and software procurement (7332), and Potentia support for technical

personnel (7338) and will use an integrated team of SI experts including persons from the MOHSS, USG,

Global Fund, and UNAIDS.

There has been a tremendous growth in support for HIV/AIDS initiatives over the past 5-7 years since the

GFATM and PEPFAR activities began. The GFATM has developed a methodology to evaluate the impact of

these resources to assess the impact these resources have made on lives and to determine ways to

optimize the impact of future resource distribution. This methodology will be administered uniformly to four

countries that have received GFATM funding and, though Namibia is not one of these, Namibia could gain

greatly by conducting the same evaluation. This activity will provide resources to conduct the GFATM

evaluation methodology to Namibia. This will provide Namibia with a robust and well designed evaluation of

their HIV/AIDS response while allowing comparison with other countries. The evaluation will permit

improvement of the Namibian HIV/AIDS response with national and international comparisons to generate

valuable lessons learned and best practices.

This is a new activity in FY 2008 that is closely associated with OHPS new activity #17361. These funds

were initially designated as TBD but have been reprogrammed to be designate CDC as the prime partner.

CDC will sole source contract these funds to the University of Namibia (UNAM) through the US Embassy in

Windhoek. The sole source determination is possible as UNAM is the sole institution providing graduate-

level public health education in Namibia.

Within Namibia, a chronic problem in the response to HIV/AIDS recognized by the Government of the

Republic of Namibia (GRN) and partners alike is the lack of highly skilled professionals. Building human

capacity to Namibianize programming, skill sets, leadership, etc. a difficult task. In order to create a skilled,

well-trained cadre of Namibian professionals in the areas of public health, and in particular Management,

Nutrition and Monitoring and Evaluation (M&E), there is a need to support the curriculum development and

implementation of an intensive diploma course and longer-term training through a MPH course at UNAM.

FY 2008 funds will be used to release a funding opportunity announcement (FOA) to solicit applications

from Schools of Public Health (SPH) to partner with UNAM to develop a master's level program in public

health leadership, along with certificate programs in M&E/strategic information and nutrition. There is a clear

lack of personnel who have received formal education in public health concepts and practices to serve as

current and future leaders of Namibia's public health system. Often, persons in high level positions

supporting HIV prevention, care and treatment programming in-county are non-Namibians. With PEPFAR

support, the public health leadership program will subsidize tuition for up to 50 qualified Namibians each

year. The leadership program will focus on developing core knowledge, skills and abilities with the goal of

producing graduates who can move into mid- and high-level positions within the national and regional

governments, bilateral and multilateral organizations, and non-governmental organizations including

grassroots organizations. Coursework will include an overview of current issues in public health, with an

emphasis on the diseases and conditions most affecting Namibia and sub-Saharan Africa; fiscal, personnel

and resource management; monitoring and evaluation; basic epidemiology; health policy; technical writing;

negotiation skills; advocacy, public relations and community mobilization; nutrition; and social marketing.

The selected SPH will be expected to assist UNAM with curriculum development, provide faculty to teach

alongside UNAM instructors, secure equipment, and promote and evaluate the program.

Alongside the MPH degree program in public health leadership, shorter-term certificate programs will be

offered in monitoring and evaluation and nutrition. This activity will support the capacity building,

development and implementation of the M&E curriculum with the Namibian institution. These funds will also

support the involvement of the Response, Monitoring and Evaluation (R, M&E), Health Information

Systems, and Research sub-Divisions within the Ministry of Health and Social Services (MOHSS), the

Central Bureau of Statistics under the National Planning Commission. The integration of the appropriate

MoHSS sub-Divisions in this process is essential as linking the program curriculum and theory to the

practical application of M&E skills and training within the Namibian context. Workshops ensuring local buy-

in and linkages in the building of the program between the TBD University mentee, the local educational

institution, and the MOHSS will supported in this activity. Ensuring the quality of the content of the courses

as well as local and regional relevance will be facilitated through the involvement of R, M &E and their

knowledge of other similar programs and M&E curriculum.

One of the long-term objectives of this partnership and these activities is to for the local institution to

become the national M&E expert trainers. This partnership will serve to strengthen the M&E courses at the

local university, fulfill the consistent M&E training needs for the MOHSS and the line Ministries, NGO and

private sector partners, and create a skilled cadre of Namibians to fill the continual job demand for those

equipped with a high level of M&E knowledge and experience.

Although this activity will take place in Windhoek, we expect the coverage to be national in scope as

building the capacity of a local institution to offer such a degree and various courses will be beneficial to all

Namibians over the long-term.

This activity relates to CTS Global technical advisors (7322), data and M&E personnel supported through

Potentia (7338), equipment and communications supported through MoHSS (7332), and training supported

through I-TECH (7355). Support to the TB and ART information systems is a continuation from FY07 while

the TB survey is new in FY 2008.

Technical support for software applications: Namibia has adopted or developed information systems for

both ART and TB that are separate from the routine health information system. These systems are patient

based (with one record per patient per encounter) and hence are more complex than the aggregate

systems maintained for routine information. This activity will support technical assistance to help maintain

these systems.

Survey for drug resistant TB: Namibia has the second highest TB incidence in the world. Though treatment

is offered free of charge at public health facilities, TB drug resistance remains a serious threat due to

patients who fail to complete their treatment regimens. To assess the extent of this problem Namibia carries

out a TB drug resistance survey. Though the planned periodicity of this survey is once every 3-5 years, no

survey has been completed for more than 10 years. A much needed TB drug resistance survey is being

carried out in FY07 and this activity will support laboratory analysis and dissemination from the 2007 survey,

and the results are expected to be useful to pinpoint any local areas or regions in which interventions such

as directly observed therapy should be intensified.

Regional Support Visits: Most all strategic information comes from the non-central levels and it is critical that

central level SI personnel visit the field periodically to support and supervise activities with an emphasis on

capacity building. USG will support visits by the response monitoring and evaluation (RM&E) Unit to visit all

regions and districts during FY 2008.

These activities will all target the general population nation while emphasizing strategic information and

capacity building.

This activity is a continuation of activities first initiated in FY05. Since it includes partial support for the

HHS/CDC Country Director and Deputy Director of Programs, this activity relates directly to all HHS/CDC

activities and to all USG activities as part of the PEPFAR team in Namibia. The Deputy Director of

Programs position is currently vacant and unlikely to be filled before early 2008. Upon their arrival in

Namibia, the incumbent will continue to spend most of his or her time working in the Ministry of Health and

Social Services (MOHSS) Directorate of Special Programmes (DSP) to establish and roll out guidelines and

policies and to provide field support. The MOHSS DSP is responsible for TB, HIV/AIDS, STI, and Malaria

Programming in Namibia. In 2002, the Global AIDS Program of HHS/CDC began its collaboration with

Namibia by opening an office in the MOHSS DSP to provide technical assistance in PMTCT, VCT, TB/HIV,

surveillance, and ART/care services.

The Country Director's efforts are primarily spent assisting the DSP Director and Deputy Director with

capacity building, including the development of national technical policies and guidelines, strategic planning

for the rollout of new services, workplans for the Directorate, and field guidance and support. To date, the

DSP has been supported to develop: ART, PMTCT, and TB/HIV guidelines and a national rollout plan for

these services; guidelines for the selection of community counselors to provide CT in the clinical setting; a

rapid HIV testing policy; the HMIS for PMTCT and ART; HIV sentinel surveillance; and a system for

providing support visits to all ART sites. The emphasis during FY08 will include training providers on the

newly updated 2007 ART guidelines; expanding and evaluating prevention efforts; ongoing rollout of ART

services to clinics and health centers; strengthening the ARV regimen for PMTCT; integration of TB and HIV

services; strengthening palliative care and pediatric treatment; introducing an incidence assay into HIV

sentinel surveillance; carrying out ongoing surveillance for drug-resistant HIV and TB; accelerating the

rollout of rapid HIV testing and the community counselors program; and further leveraging of resources from

the Global Fund and other donor organizations. While primarily assisting the MOHSS with technical

assistance, both the director and deputy director provide some technical assistance relatead to policy

development and capacity building to local organizations, Development Aid People to People, the Namibia

Institute of Pathology, and the Blood Transfusion Service of Namibia (NAMBTS).

A second activity is related to improving and expanding the digital video conferencing (DVC) network in

Namibia. This activity continues from FY08 and relates to I-TECH (7352) and Potentia (7341). Targets

related to training carried out DVC are captured by the implementing partner, I-TECH. DVC has proven to

be a successful and invaluable tool in getting much needed HIV-related training to persons carrying out HIV

prevention, care and treatment services. Namibia has one of the highest rates of HIV in the world. It is also

the 2nd least populated country in the world. In Namibia, many clinicians and other caregivers provide

services in rural areas. To ensure sustainability and national capacity building, the DVC network is now

largely managed by Namibians. While the DVC network is an invaluable tool for training, the network is

aging and requires additional bandwidth to improve the quality of transmissions when multiple sites are

participating, as well as replacing hardware and software components that are impairing performance.

Currently, there are nine DVC training sites across the country, with six based at the Health Training

Centres (Windhoek, Keetmanswoop, Otjiwarongo, Oshakati, Rundu, Engela), one at the MOHSS

Directorate of Special Programmes in Windhoek, and two recently established sites at hospitals (Katima

Mulilo and Opuwo). In FY08, two new sites will be added: (1) the University of Namibia (Windhoek), and

(2) the University of Namibia - Oshakati. These sites will allow for HIV-related DVC training for nursing and

other allied health students (UNAM). Equipment to be procured includes DVC cameras, televisions, stands,

video machines, ISDN points and installation, curtains, PRI line upgrades and installation, and security. As

a result, the DVC training schedule will expand from an average of 91 to 150 events per year and increase

annual attendance from 3,681 in FY07 to 5,000 in FY08. Participation in events will diversify to include more

NGOs and community workers involved in HIV and AIDS activities.

These activities encompass efforts to maintain or enhance programming as well as to provide staff with

ongoing opportunities to expand their knowledge, skills and abilities.

These efforts include support to HHS/CDC staff through the provision of housing costs for direct hires and

general office administration. Included in general office administration are telephone services, computer

consumables, and office supplies. The activities will support the costs of in-country travel for staff to attend

meetings, to facilitate communication with regional and district officials, and to monitor CDC-supported

efforts in the field.

In FY07, 2 new ASPH fellows will embark on 2-year assignments within the HHS/CDC office. One fellow will

assist with management and administration of the cooperative agreements; the other will provide strategic

information support to the new Emergency Plan Coordinator. The HHS/CDC office has identified these

positions as essential to enhancing efficiency and communication within the PEPFAR team and with

cooperative agreement partners.

Staff development efforts will include support for HHS/CDC team members to attend training, in-services

and conferences either in person or by videoconferencing to learn about the latest developments in their

respective fields.