This activity continues from COP07 and supports a technical advisor to the Ministry of Health and Social

Services (MOHSS) for roll-out of HIV-related palliative care services, including support for the national

Integrated Management of Adult Illnesses (IMAI) palliative care program. As of August 2007, this position is

not filled so is not costed at 1.0 FTE. This activity relates to other Basic Care services: MOHSS,

Intrahealth, Potentia, I-TECH, IVQUAL , PACT/APCA and PACT, DAPP, RPM/SCMS, MOHSS ARV

services Potentia ARV services, and CDC systems strengthening.

Technical assistance from the African Palliative Care Association (APCA) and the Regional Technical

Advisor for HIV/AIDS Palliative Care has resulted in the growth of palliative care technical expertise in

Namibia; however, significant gaps remain in national leadership. These gaps are limiting the development

and expansion of HIV-related palliative care. While significant program accomplishments are underway with

this technical support, a critical need remains for an in-country, experienced, full-time palliative care

technical advisor who is dedicated to development, decentralization, and monitoring and evaluation of HIV-

related palliative care in Namibia. This advisor will directly support the MOHSS development of palliative

care at the facility level, including support for implementation and monitoring of the WHO Integrated

Management of Adult Illness (IMAI) program approved by the MOHSS. The advisor will also support

MOHSS' goals to advance pediatric care through its training program and the MOHSS Integrated

Management of Childhood Illness (IMCI) program. This advisor will further support the current MOHSS

Coordinator for Palliative Care and OI Services in the MOHSS Directorate of Special Programmes to

develop the Coordinator's palliative care expertise and leadership in palliative care. The technical advisor

will also serve as a liaison between the MOHSS case management unit's implementation efforts, the

extensive I-TECH trainings and mentorship programs, as well as the IMAI site nurses and their referring

district ART doctors. The advisor will receive technical support in 2008 from the APCA and the USAID

Regional Technical Advisor for HIV/AIDS Palliative Care.

The technical advisor will also closely collaborate with the MOHSS Family Health Division, which is

responsible for community-based palliative care, clinical nutrition and family planning integration, USG

partners to address other critical program gaps in the Government that are essential to palliative care and

HIV prevention. This includes:

- partnering with the MOHSS Nutrition subdivision and I-TECH nutrition advisor to ensure that

developments in clinical nutrition are well integrated into HIV/AIDS palliative care programs;

- partnering with the MOHSS Family Health Division in the Directorate of Primary Health Care Services and

the Global Fund to strengthen the delivery of community-home based care and the integration of palliative

care at home and community levels.

- partnering with the family planning unit, I-TECH, and the Global Fund to ensure that MOHSS investments

in family planning begin to integrate with HIV/AIDS service delivery areas.

Lastly, although the emphasis of this advisor will be palliative care, the technical advisor will also support

the goals of ARV services. The advisor will coordinate closely with the MOHSS' Central Medical Stores and

SCMS/RPM+ to address gaps in procurement and supply chain management for home-based care kits and

essential palliative care medications. The technical advisor will emphasize key palliative care priorities

across program areas that will include the provision of elements of the preventive care package and

appropriate OI care and pain and symptom control for adults and children. 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. Malaria prevention activities include leveraged support

from the Global Fund for bed nets. The advisor will also work with the Ministry of Agriculture and Rural

Development and other partners to explore the feasibility and cost of appropriate safe water strategies for

persons living with HIV/AIDS (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 other symptom

-relieving medications. Technical support from the African Palliative Care Association (8043) will support

this activity. The technical advisor will ensure gender-sensitive approaches, including equitable training and

support of male and female health care workers and strategies that promote male involvement. These

approaches will support the goal of equitable access to HIV/AIDS services for PLWHA and their families

throughout USG-supported programs.

The CDC/Namibia office has seconded a laboratory technical advisor to the Namibia Institute of Pathology

since 2003. This technical advisor was brought on board with an original scope of work to serve as a liaison

between CDC, the Namibia Institute of Pathology, and the Ministry of Health and Social Services to build

capacity and to ensure quality for HIV bioclinical monitoring. In the ensuing years, this technical advisor has

gradually become more involved in this same role for TB bioclinical monitoring and has worked closely with

the International Laboratory Branch Consortium (Activity ID 3858.08) to bring in short- and long-term

technical advisors to work alongside NIP staff to build their expertise and to upgrade the TB laboratory with

an ultimate goal of accreditation from the American Society of Clinical Pathologists. This funding is not

new, but has been reassigned to this program area to more accurately reflect the amount of time (0.30 FTE)

that this techical advisor is dedicating to TB issues in Namibia. The remaining 0.7 FTE of this position is

reflected in the HLAB Program Area (Activity 3862.08). These activities leverage ongoing TB expertise and

resources from the MoHSS, the Global Fund, the TB Control Assistance Program (TBCAP), and other

organizations.

In a continuation from FY07, this activity will provide funding for 0.7 FTE for a laboratory scientist assigned

to the Namibia Institute of Pathology (NIP). To reflect the TB responsibilities of this position, the remaining

0.3 FTE is reflected in the HVTB program area. The laboratory scientist provides support to NIP for the

purposes of strengthening HIV diagnosis in young infants, introducing HIV incidence testing into routine

antenatal surveillance, continuing surveillance for HIV drug-resistance, improving TB diagnosis and quality

assurance. It relates to the Ministry of Health and Social Services (MOHSS) PMTCT (7334), CDC (7357),

and NIP (7927). In FY05, CTS Global hired and placed a laboratory scientist at NIP as a technical advisor

(TA) to help develop and implement standard operating procedures to ensure quality services related to

diagnostic DNA PCR, CD4, HIV incidence testing, and resistance testing. During FY05, the diagnostic

algorithm for pediatric diagnosis using PCR was developed and the use of dried blood spots (DBS) was

field-tested. During FY06, in collaboration with the Ministry of Health and Social Services (MOHSS) PMTCT

program, the diagnostic DNA PCR was introduced for symptomatic infants and HIV-exposed infants at six

weeks of age. The TA played a focal role in ensuring that technicians at the central and peripheral NIP labs

were trained in PCR, new equipment was purchased, and health workers were trained in the collection of

dried blood spots. Also, following training in incidence assays, NIP plans to introduce HIV incidence testing

with banked specimens of the 2006 sentinel survey once an updated assay is available. The first threshold

survey of HIV drug-sensitivity was conducted in 2007 on samples from the 2006 sentinel survey.

The TA will continue to work with the International Laboratory Branch Consortium to coordinate ongoing

information sharing between NIP and other laboratories. These continuous quality improvement activities

will focus on laboratory management, logistics, strategic planning, and technical training, with a particular

emphasis on TB diagnostics. During FY07, the Association of Public Health Laboratories collaborated with

NIP to follow up the management training with strategic planning efforts. Also in FY07, an expert from the

Clinical and Laboratory Standards Institute was assigned to NIP for three months to build NIP's capacity in

TB diagnostics, with particular emphasis on proper use of newly procured state of the art equipment

(MGIT960). In FY08, the TA will continue to work with the NIP and the MOHSS to improve turnaround

times between specimen collection and receipt of test results by expanding placement of NIP's Meditech lab

information system in all ART sites and decentralizing testing to peripheral areas through expanded use of

point of care equipment.

This activity is a continuation of funding to CTS Global first initiated in FY 2005. It relates to these other SI

activities: the Ministry of Health and Human Services (MOHSS) (7332), Potentia (7338), Namibia Institute of

Pathology (NIP) (7995), the International Training and Education Center on HIV/AIDS (I-TECH 7355), the

Namibia Blood Transfusion Services (NamBTS, 7321) and CDC (7359). The emphasis is to continue and

expand the support from two technical advisors (TAs) to Namibia's National AIDS Program, one to carry out

monitoring and evaluation (M+E) activities and one to the National Health Information Systems (HIS) Unit.

Namibia recently released a National M+E Plan to measure progress toward the goals in its national

strategic plan for HIV/AIDS. This M+E plan stipulates indicators required from all government and non-

government sectors; however, human capacity to finalize this plan and to obtain and process the indicators

is limited. To address this gap, the USG seconded TAs to the MOHSS, first a health information systems

(HIS) advisor in FY 2005 and then an M+E specialist in FY 2006. To develop and sustain local capacity,

these technical advisors work closely with their counterparts in the MOHSS.

Since FY 2005, the USG TA for HIS has supported establishment of the current national management

information system (MIS) for ART and PMTCT while strengthening the MIS for VCT and TB. These systems

have been providing crucial information for reports for MOHSS and partners (including PEPFAR) as well as

assisting the government in projecting future program needs. However they are ‘stand-alone' systems,

necessitating data re-entry of information in more than one place, such as clinic, lab and pharmacy.

Moreover, facilities cannot share computerized data unless cumbersome data manipulation is performed. In

FY 2008 the HIS TA will focus on development of a new system (web-hosted or networked) that will allow

rapid exchange of information among facilities and all service levels (district, region, national) to improve

patient tracing to reduce defaulters, facilitate reporting, and promote data use for policy and program

decisions. This phase will involve evaluating the appropriateness of solutions implemented in the Southern

Africa region and may leverage information technology resources from the private-public partnerships

developed locally and in the US, including partnerships between the MOHSS and local information

technology expertise (both public and private). Also in FY 2008, this TA will continue to facilitate training of

data managers to expedite reporting and data synthesis, improve data quality, and strengthen local use of

information and dissemination. The TA will also continue to support the design and analysis of national

surveys, including those for HIV and TB drug resistance, HIV incidence, and longitudinal surveillance. To

facilitate maximum data use, this TA will also continue to support spreadsheet modeling and specialized

software applications developed with USG/UNAIDS support to inform policy makers of the current and

future extent of the epidemic so that sufficient Government and partner support can be secured. Finally, this

TA will continue as the instructor for the epidemiology/ biostatistics module of the University of Namibia's

MPH program to build local capacity in epidemiological study design, data collection and analysis.

The USG M+E TA has assisted in formulating and executing the M+E plan as well as designing and

executing national surveys outlined in the plan. These national surveys include the HIV sentinel survey in

pregnant women, a national health facility survey (HFS), and the demographic and health survey (DHS).

During FY 2008, this TA will continue support of national surveys, including the 2008 sentinel survey, an

AIDS indictor survey (AIS) and a health facility survey (HFS) coordinating secondary analysis of the DHS.

To promote appropriate execution and interpretation of these surveys, this TA will coordinate training

workshops emphasizing surveillance concepts and general M+E concepts to all national and sub-national

M+E personnel. The TA will also provide support for implementing the MOHSS' computer-based

management information system designed to track the indicators in the M+E plan (MTP3). This TA will also

support M+E dissemination activities including routine reports required by MOHSS, OGAC, Global Fund,

the UN, and other stakeholders as appropriate. During FY 2008 this TA will also continue to support the

MoHSS with M&E related strategic planning.

Leveraging the foundation of information systems and data capture personnel established between FY2004

-2007, SI objectives in FY 2008 will concentrate heavily on data quality and data use for program and policy

improvement. The HIS TA, while continuing support to routine data collection and indicator calculation, will

focus efforts on using existing databases to report more detailed indicators (including TB/HIV and ARV drug

adherence), both to support evaluations as prioritized by the MOHSS, and to improve data quality through

the HIVQUAL initiative. In FY 2008 the USG will continue to support MOHSS personnel studying for their

MPH degrees at the University of Namibia with emphasis on data management with mentoring from the HIS

technical advisor/epidemiologist. With existing data, the M+E TA will move on from coordinating the

National M+E Plan and implementing surveys to creating reports that synthesize information into practical

recommendations for improving prevention, care, and treatment efforts to mitigate the epidemic. This

activity leverages resources with: the Global Fund support for the Health Facility Survey and DHS; the

European Commission support for the national M&E MIS; and WHO support for Namibia's participation in

the Health Metrics Network.

A new position for FY 2008 is a strategic information staffer to liaise with CDC's partners, as well as to

assist the Department of Defense, the Department of State, and the Peace Corps with SI activities as

possible. The technical advisors for HIS and M+E are assigned to counterparts within the MOHSS: given

the breadth and scope of strategic information activities with the MOHSS, they thus have limited availability

to assist other CDC partners in the field with strategic information. In FY 2008, the SI liaison will primarily

work with other CDC partners including Development AID People to People (DAPP), the Namibia Institute

of Pathology (NIP), and the Blood Transfusion Services of Namibia (NAMBTS) to assist with developing or

improving data management systems, ensuring the quality of data, supporting ongoing evaluation activities,

and assisting the partners with using data for decision-making. While CDC and USAID have SI personnel,

the other three USG agencies that are partners in PEPFAR do not. To be sure, the SI needs of these

partners are less than that of USAID and CDC and these two agencies combined receive over 90% of the

PEPFAR funds for Namibia. However, the SI liaison will be of assistance to the DoD as they collaborate

with the Namibian Ministry of Defense to build SI capacity in the Namibian military, including support for the

first HIV prevalence study in this institution. Other identified needs include working with the Peace Corps to

harmonize data collection related to HIV efforts being carried out by volunteers and to establish a data

collection system for the PEPFAR-funded activities through the Department of State's Self-Help Program.