PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
IntraHealth/Namibia, the Capacity Project, is expecting as a result of its FY06/ 07 capacity building process
to transition to direct funding Catholic Health Services (CHS) and its 4 hospitals and 26 health centers and
clinics for FY 08. Pending results of the required pre-award survey (responsibility determination), including a
financial/organizational capacity evaluation and availability of FY08 funding, i.e., continuing resolution (CR),
CHS may initially have to enter into a Leader with Associates Award under IntraHealth and move to direct
funding when it meets all eligibility requirements under USAID Acquisition and Assistance regulations. This
process will ensure the continuity of program activities. The direct funding mechanism will replace the
Associates Award and be implemented as soon as CHS is deemed eligible and approved by the Pretoria
USAID Regional Contracting office.
The PEPFAR PMTCT program aims to reach 80% of pregnant women with prophylaxis and reduce new
infant infections by 40%. The Capacity Project (CP) currently supports five faith-based hospitals (FBH) with
a catchment of around 300,000 people in rural and semi-urban settings. The FBH plus 26 associated health
centers and clinics have provided PMTCT services for the past four years, gradually scaling up.
By end FY 2008, CP will have supported Catholic Health Services (CHS), Lutheran Medical Services
(LMS), and Anglican Medical Service (AMS) to roll out PMTCT services in a total of 47 service outlets (5
hospitals & 42 HC and Clinics). CP supports PMTCT+ programming providing pregnant women with a
minimum PMTCT package integrated into traditional ANC services (syphilis serology, hemoglobin, blood
group and urine test). This package includes for first visit ANC, opt-out CT (group followed by individual),
rapid testing (RT) with same-day results or HIV ELISA testing. It is estimated that in FY 2008, 5,500 women
will be offered the minimum PMTCT package as first antenatal clinic (ANC) attendees, and 1,100 will
receive ARV prophylaxis at the maternity ward. 90% uptake is expected for both post-test counseling
among women attending ANC and for ARVs at delivery for both women and their babies. Using Single Dose
Nevirapine (SDN) for the mother and infant, an estimated 150 new infant infections will be averted. More
efficacious regimens will be implemented as the PMTCT guidelines are revised.
HIV-positive women identified at first ANC visit are referred to the ART clinic for initial clinical evaluation,
CD4 testing and eligibility assessment for HAART, IPT, or CTX prophylaxis. This number is currently
estimated at around 1,100 women for FY 2008. HAART will be offered to those eligible as per the national
ART guidelines (an estimated 120 women). Those who need it will be enrolled in the care program that
includes regular follow-up counseling, opportunistic infections prophylaxis, STI screening, TB screening,
prophylaxis, and/or referral.
PMTCT and ART services are integrated under the same roof in LMS and three of the CHS Hospitals. In
Rehoboth Hospital, and Odibo HC (AMS), referred women go to ART sites located outside the PMTCT
settings that are strongly linked through a referral mechanism involving the PMTCT district coordinator and
the nurse in charge along with the use of an electronic patient management now used in the LMS ART site
that will be implemented in the other sites. Critically, attention will also be directed to strengthening links
between PMTCT and standalone VCT sites for those women who find these sites most convenient.
Three of six maternity wards have CT services for women delivering with unknown HIV status. In Odibo,
Andara, and Nyangana hospitals, the CT sites are few meters away from the maternity ward; CP will work
with these facilities to get maternity wards certified as RT sites. Roll out of RT to a number of satellite
facilities (8 in Onandjokwe, 5 in Andara, 3 in Nyangana, two in Rehoboth, and 10 in Oshikuku districts) will
be undertaken in collaboration with the Ministry of Health and Social Services (MoHSS) and the Namibian
Institute of Pathology (NIP). Provision of CT services inside the maternity wards during, and after hours has
resulted in tremendous reduction in the number of women delivering with unknown HIV status (from 25% in
2005 to 13% in 2006). In future, more women will receive postpartum CT, closing the gap on missed
opportunities.
HIV-positive mothers also receive infant feeding and family planning counseling. Additionally for HIV+
mother, support groups will be offered if possible. Mothers-to-Mothers is an example to be piloted though
use of other less expensive models will be explored. In FY08, about 10% of HIV+ women will get nutritional
supplementation.
HIV-negative mothers will be offered preventive counseling to maintain their negative status. All women will
be offered couples counseling. Presently, only 2% of ANC mothers are counseled either as a couple or as a
referred partner. The male involvement initiative started in FY 2007 will scale up in FY 2008. Increased
number of males will be invited and expected to take part in the full range of PMTCT activities. Messages
will also address gender-based violence, stigma, and discrimination especially related to disclosure and
partner testing. To enhance a family-focused care approach, the partner and other family members such as
children from previous pregnancies will be invited to access HIV testing and care and treatment services.
Through couples counseling, discordant couples will be closely followed-up with condom promotion, and
offered prevention with positives. For women testing negative at first ANC, a retest will be offered to those
tested three months earlier alternatively at/or after delivery. This new approach in the revised guideline will
be reinforced through training and ongoing clinical mentoring.
Current PMTCT guidelines recommend exclusive breast feeding for all infants for the first six months of life.
For HIV-exposed infants replacement feeding is recommended under AFASS conditions (Acceptable,
Feasible, Affordable, Sustainable, and Safe). At six months, abrupt cessation of breast feeding, and
introduction of unmodified animals milk and complementary foods are recommended. Most mothers in FBH
(>90%) opt for exclusive breast feeding as AFASS criteria are not met. To enhance feeding counseling
program and nutritional assessment, CP will provide staff with training and will continue to support the
kitchen corners initiatives started in FY 2007. Accordingly, postnatal services for HIV-exposed children will
be strengthened through direct referral to child health services (infant immunization, growth monitoring, and
nutritional assessment) which are part of the district primary health care activities. All HIV-exposed infants
are enrolled for follow up, and at six weeks, they are offered CTX prophylaxis and diagnostic PCR testing.
PCR is available in all FBH, and is done in accordance with the national algorithm. During this follow up,
micronutrient supplementation and TB screening for all infants as well as Isoniazid prophylaxis for eligible
babies and CTX will be provided. Early infant diagnosis allows timely clinical evaluation, entry to care, and
initiation of HAART for young infants. More PMTCT staff will be trained on the dried blood spot technique
(DBS) in collaboration with NIP/I-TECH, and also on post-DBS counseling. Because a significant number of
children are lost to follow up, more efforts in tracing for defaulters with help of support groups and other
mechanisms will be enhanced. During FY 2008, 825 infants born in the five FBH are expected to be tested
for DNA-PCR (75% of infants born to HIV-positive mothers). Documented HIV-positive as well as HIV-
negative infants who are still breast-fed (until 2-3 months after complete cessation of breast feeding) will be
followed up using HIV exposed infants registers. Orphan infants and children registered in care will be
referred to the available OVC care in the area.
M&E: CP will ensure quality of all components of the PMTCT program through supportive supervision,
Activity Narrative: clinical mentoring, familiarization of staff on the data collection tools, scrutiny of reports generated monthly
and feedback to centers. These reports provide data elements, and indicators to track the program
performance. The support supervision visits will include facility check list, exit interviews and quality
assessment of counseling (infant feeding & family planning), and success of referrals.
As part of the technical assistance to MoHSS, the CP team has been involved in the revision of the current
PMTCT guidelines with the aim to use more effective ARV prophylactic interventions as per WHO
recommendations for maximum reduction of MTCT.
During FY 2008, CP and partners will conduct an evaluation of the programs lifetime performance and
impact, including assessing breast feeding practices in all sites, since more than 90% of our PMTCT
mothers still chose this option.
CP in collaboration with MoHSS, HIV Clinician Society, and I-TECH, will support training of 60 health care
workers (public & private sector) in the new PMTCT guidelines.
All CP supported partners will continue community awareness, mobilization, and education with regard to
creating demand for the available PMTCT services in different health facilities.
In response to a demonstrated need and as a new part of the PMTCT program in FY 2008, eligible
pregnant and lactating women will be provided with nutritional supplementation in the form of EPAP.
Three randomized controlled trials in sub-Saharan Africa have demonstrated that safe male circumcision
(MC) reduces a man's chances of HIV infection by roughly 60 percent. MC rates in southern Africa are low,
however, and widely considered one of the drivers of the epidemic in the region. A regional estimate by the
World Health Organization (WHO) estimates that less than 20 percent of men in the region are circumcised.
It seems likely that MC rates in Namibia are low as well: for instance, a survey in 2004 of the National
Defense Forces of Namibia found that 26 percent of soldiers reported being circumcised (this estimate is
not necessarily representative of the larger male population, however). The 2006 Demographic and Health
Survey (DHS) will provide additional information on prevalence of MC in Namibia, and its results should be
available in September 2007.
Despite its new and somewhat controversial nature, MC is recognized by the Government of the Republic of
Namibia (GRN) as having an important role to play in HIV prevention; the GRN thus enthusiastically
supports the national roll out of an integrated MC initiative. The Ministry of Health and Social Services
(MOHSS) has set an ambitious goal of offering MC services in 40% of facilities (all three tertiary hospitals
and at least one district hospital per region) by the end of 2008. Although undoubtedly ambitious, this goal
should serve to galvanize political and medical momentum. The MOHSS recognizes that the initiative will
require very careful and sensitive planning, and is adamant that MC be implemented not as a standalone
intervention but rather as part of a national comprehensive prevention package. In early 2007, the MOHSS
created a MC task force with the responsibility to create a national MC strategy with supporting policies and
technical recommendations. Task force members represent MOHSS, USG, UNAIDS, WHO, and key
members of the NGO community including University Research Company, IntraHealth and Nawa Life Trust
(which are also USG-supported partners).
The MOHSS has requested USG support for the MC initiative. To better understand barriers and facilitators
to MC uptake and to properly inform future activities, the MOHSS is using FY07 funds from USG and
UNAIDS to conduct a situational assessment based on WHO's situational analysis toolkit. The situational
assessment will include: (1) a desk review and analysis of existing data on male circumcision in Namibia;
(2) qualitative research on current and historical MC practices, the MC acceptability across regions and
among both service providers and potential beneficiaries; (3) an assessment and mapping of current
medical facilities and their ability to carry out safe male circumcisions; (4) a stakeholders' meeting to
discuss the results and consider possible interventions; and (5) a summary report with recommendations.
Concurrently, the MOHSS will use PEPFAR FY07 funding to conduct a costing analysis (based on methods
used in other African countries) that will determine the cost and likely impact of providing male circumcision
in Namibia.
Because the MOHSS will base its national MC strategy, policy, and guidelines on the results of the
situational assessment and costing analysis (which will appear sometime in FY07), most MC activities
supported by the USG for FY08 cannot at this stage be defined in a detailed way and are only listed as
TBD. Once the results are out, USG Namibia will work closely with OGAC, MOHSS and the MC task force
to reprogram the FY08 funding in support of the strategy and recommendations adopted from the research.
Some general activities, however, have already been proposed: (1) training of MC service providers; (2) an
information, education, and communication strategy and intervention to address acceptability issues and
create demand; (3) MC-related commodity procurement; and (4) an MC policy and advocacy development
activity.
For instance, the MC task force has identified the following elements to be incorporated into the National
MC Strategy. First, the strategy will clearly define: (1) priority populations to receive clinical and counseling
services; and (2) primary and secondary target audiences for sensitization, education, and demand
creation; and (3) a national clinical and communications roll-out plan. The MOHSS expects that MC clinical
provision will be embedded into a package of prevention services that includes: (1) provider-initiated testing
and counseling (PITC) with comprehensive post-test counseling; (2) STI screening and treatment; and (3)
counseling on risk reduction behaviors with a focus on partner reduction and abstinence, as well as condom
provision and appropriate referrals to other health and social services. The MOHSS will develop standard
operating procedures and guidelines and an intensive capacity-building plan for service providers that will
result in the certification of facilities and service providers. This certification process will include require
quality-assurance mechanisms and a protocol for the management of surgical complications. The surgical
training will be based on the WHO/ UNAIDS/ JHPIEGO procedures for circumcision under local anesthesia.
The initiative might eventually require approved task shifting to senior nurses and midwives to alleviate the
burden on medical doctors (the national IMAI has been approved and IMAI training is being rolled out); the
situational assessment and costing analysis will include recommendations on cadre numbers, task shifting,
and training. Additionally, the MOHSS will also review the essential medicines list to accommodate lower
level facilities and commodity management systems. MOHSS will also investigate the procurement of
clinical MC kits and commodities, the specifications of which would be based on the recommendations
currently in development between OGAC, the Clinton Foundation, and SCMS.
The MOHSS understands the risk of not implementing a well-constructed communications and advocacy
strategy concurrent to the development of clinical services. The MOHSS will facilitate an intensive
sensitization process throughout the medical community to counteract apparently widespread attitudes and
resistance to MC. Building on its November 2007 "Engaging Men" Conference, the MOHSS will liaise with
stakeholders to conduct a highly sensitive dialogue with leaders and decision makers at the community
level to mitigate fears and misunderstanding, including the likelihood of an increase in disinhibited sex
behaviors. Although the MOHSS recognizes that USG funding cannot support traditional MC providers to
perform circumcisions, the MOHSS has prioritized traditional MC providers for information and education as
key community gatekeepers. All communications efforts -- whether in mass media or community or clinical
settings -- will employ messages that target male norms, the ABC prevention strategy, and sexual violence
against women.
In FY07, the MC task force has initiated this communications and advocacy process with sensitization about
MC by targeting the medical fraternity via the HIV Clinicians' Society, which is hosting a series of meetings
with key MC experts. Additionally, the MC task force is advocating with the national insurance body Medical
Aid to include adult MC within its insurance package. Right now, adult MC is only covered by national
insurance when indicated for medical reasons, and the cost of private circumcision services is prohibitive for
most Namibians.
Activity Narrative: This initiative will help create sustainable national services for MC in Namibia. It will leverage and
complement resources from other donors including UNAIDS and WHO. Discussions with MOHSS and the
MC task force suggest that FY08 USG resources might support the national MC initiative in the following
way: support clinical training, capacity building and supportive supervision within the public sector (ref:
ITECH 16758, $75,000) and faith-based sector (ref: Capacity 7459.08, $30,000); procurement of clinical MC
kits and commodities (this submission, 16762.08, 18058.08) for a total of $275,000); provide technical
assistance to the MOHSS on the creation of policies, guidelines and standard operating procedures, as well
as timely response to consumer concerns via the media (7459.08); integrate MC into the package of
services for prevention with positives within clinical settings; integrate MC messages to primary and
secondary target audiences within a comprehensive prevention campaign (5690.08 $160,000); mainstream
MC messages within all ongoing clinical, VCT, workplace and community mobilization activities, ensuring
inclusion within existing gender mainstreaming initiatives that address male norms and behaviors and
sexual violence (12342.08, 16501.08). All budgeted activities are allocated in the following manner: 25%
AB, 50% OP, and 25% CT.
Strategic information on MC will be essential to guide and monitor scaling-up of the service. This will
support the development and dissemination of best practices as well as providing essential information for
program implementers and policy makers. As the service is rolled out and advocated in country, service
provision indicators will need to be incorporated into the routine monitoring and evaluation process. In
addition, specific process evaluation activities will be carried out to guide design of service provider training
curriculum and to optimize IEC campaigns to create demand for MC in the general population and to create
commitment among service providers.
These MC activities will have national coverage as they will both facilitate national policy development and
guidelines as well as support assessments that will inform service implementation in at least all 34 district
hospitalsation.
The following are new initiatives that are co-funded across program areas. USG proposes to support the
Government of the Republic of Namibia (GRN) integrated male circumcision initiative. This initiative
includes the roll out of clinical male circumcision services. The Capacity Project (CP) will support the
Ministry of Health and Social Services (MOHSS) in training and supervising FBO service providers, using
protocols and curricula developed in collaboration with the MOHSS and ITECH. CP training and supervision
support is funded 25% AB, 50% OP (activity7459.08) and 25% CT (activity 4736.08). CP will also support
the MOHSS national rollout of a facility-based Prevention with Positives initiative (ref: 4737.08). The CP will
support the MOHSS in training and supervising service providers, using protocols and curricula developed
in collaboration with the MOHSS and ITECH. CP will also train the regional supervisors in performance
improvement methodologies. CP training and supervision support for both elements is funded 10% AB, 10%
OP (activity 7459.08), 40% treatment (activity4737.08), 30% care (activity4735.08) and 25% CT (activity
4736.08).CP will also support the MOHSS efforts in strengthening prevention and treatment responses.
Based on guidance from the Global Technical Working Group sponsored by the Gates and Kaiser Family
Foundations, during the revision of training curricula for clinical staff, PwP and regional supervisors/ case
managers, MOHSS, CP and ITECH will revise protocols and materials to strengthen gender-sensitive HIV
prevention counseling and refer to CT and STI screening. Messages shall emphasize the importance of risk
reduction and prevention, and the limitations of ART. No additional funding for this element is required.
IntraHealth/Namibia, the Capacity Project is expecting as a result of its FY06/ 07 capacity building process
to transition to direct funding Lifeline/Childline (LL/CL) for FY 08. Pending results of the required pre-award
survey (responsibility determination), including a financial/organizational capacity evaluation and availability
of FY08 funding, i.e., continuing resolution (CR), it may initially have to enter into a Leader with Associates
Award under IntraHealth and move to direct funding when it meets all eligibility requirements under USAID
Acquisition and Assistance regulations. This process will ensure the continuity of program activities. The
direct funding mechanism will replace the Associates Award and be implemented as soon as it is deemed
eligible and approved by the Pretoria USAID Regional Contracting office.
The following is an existing program and funded via a sub-award with LifeLine Childline (LL/CL). It is
estimated that 9,000 new HIV infections take place every year in Namibia (NIP, 2005) which translates into
24 new infections daily. Most of these new infections will occur through heterosexual activities. The call for
accelerated and intensified prevention programs acknowledges that there is no meaningful and successful
treatment program unless prevention efforts are brought to scale
According to the 2000 Demographic and Health Survey (DHS) the median age of sexual debut in Namibia is
18 years for both boys and girls. The LL/CL school program, supported by PEPFAR since FY04, offers a
unique opportunity to reach pre-primary, primary and high school children with the most age-appropriate
messages on AB and life skill-based sexuality communication and HIV/AIDS education programs. This is in
line with the MTP III goal of reaching 100% of children with behavior change communication in primary
schools and behavior intervention in secondary schools and is undertaken recognizing the synergistic
efforts of other partners programs such as Ministry of Education (My Future is My Choice, Windows of
Hope) and Catholic Aids Action youth education programs (Stepping Stones, Adventure Unlimited).
In FY08, LL/CL will target children in school ages 7-18 to address attitudes and behavioral issues related to
abstinence, alcohol, abuse, violence, sexual predation, fidelity, intergenerational sex, as appropriate to the
school grade and age. LL/CL programs emphasize intergenerational sex as this is one of the main drivers of
the Namibian epidemic to which young girls are particularly susceptible. LL/CL employs a number of
interactive communication techniques depending on age. For grades one and two, LL/CL uses puppetry, for
grades five to seven, the interactive curricula Feeling Yes, Feeling No, and for grades nine to twelve (older
children and adolescent), the program Being a Teenager. This package of programs targets approximately
6% of total learners population in each age group across all 13 regions in Namibia. The approaches provide
youth with a good underpinning for decision making, building refusal and negotiation skills, empowering
them through accurate information on rights and source of assistance.
During FY08, LL/CL support teams will spend more time at each school; although this will mean less
schools and learners covered, the extra support will increase the message dosing and give real
opportunities for learners to grow in their understanding and capability for making responsible decisions and
for identification of issues and for referrals. These referrals, tailored to the age and needs of each child, will
be not only for typical welfare services but also include OVC care (linked to each school), and as
appropriate, STI screening for those sexually abused, CT with parental consent for those less than 16 years
of age, and referrals to care as needed. In the afternoons facilitators will continue to hold workshops with
teachers but add duty bearers, hostel wardens, parents, caregivers etc. They will receive training on child
abuse, rights and protection, together with tools on how to identify children needing help and referrals.
Teachers skills are developed to facilitate dialogue with abused children. Since program inception, this
approach has resulted in a significant increase in the number of abuse cases reported and referred for
counseling. LL/CL has been able to reach more than 10,500 youths in the last six months in more than 150
schools from all 13 regions. A step further will be undertaken in FY 2008 to reach out of school youth with
same or tailored prevention message in two pilot sites.
In FY07 and FY08, the LL/CL team will receive training in age-relevant gender messages from the Men and
HIV curriculum, so that from pre-school upwards girls and boys will be given opportunities to recognize
unhelpful and risk-related gender norms and be given tools to challenge these. During FY08, these norms
including risk of alcohol and substance abuse and will be integrated into all aspects of the program (activity
17061.08). LL/CL will also receive capacity building support in behavior change communications
LL/CL, with support from PEPFAR and UNICEF, will maintain its national (all 13 regions) Uitani Child Line
radio program by and for children. LL/CL estimates that the show reaches more than 100,000 members of
the public, essentially children. During FY07, 10 programs are being translated into Oshiwambo and
broadcast on the Oshiwambo radio service. During FY 2008, Oshiwambo programming will grow and a third
language will be introduced expanding the radio services to five languages. Uitani Child Line radio has been
operating since 2004, and is a highly regarded program that employs child participation. 35 children aged 8-
14 plan and record 52 programs per year, which are broadcast weekly on three stations. A radio drama,
written and produced by students of the Media Department of the College of the Arts as part of their
curriculum, is also broadcast weekly. The program content echoes and reinforces themes covered in the
schools which include critical life skills messages around decision making, abstinence and being faithful,
and access to trained counselors. In order to build the capacity of child presenters and producers, skills
Activity Narrative: building sessions are held 8 times per year in areas of broadcasting training, personal growth and peer
counseling. In FY 2007 they will be offered gender training using messages from the Men and HIV
curriculum and by FY08 will include topics which challenge risk-related gender and social norms, alcohol
and male circumcision mainstreaming as it relates to the broader set of prevention interventions.
During FY07 all LL/CL activities will be reviewed and revised as per the new National Standards and LL/CL
own child protection policy. LL/CL will develop themes around the Convention on the Rights of the Child. In
collaboration with Southern Africa Network against Trafficking and Abuse of Children (SANTAC), LL/CL
programs will address child trafficking. In FY08, LL/CL will mount a large-scale media campaign to highlight
child protection and stimulate uptake of services for children.
To ensure quality and performance improvement, effective supportive supervision of the program is done
through regular visits, mentoring and routine analysis of data. Monitoring of teachers reports, reported
abuse cases or referrals for counseling and overall youth sexual behavior including teenage pregnancies in
schools covered by LL/CL could provide a gauge of program effectiveness. During FY08, the Uitani radio
listeners will be assessed using a survey in collaboration with the Namibian Broadcasting Corporation,
NawaLife Trust and other stakeholders (activity 4048.08). This will assist in assessing program
effectiveness in terms of media reach and impact. LL/CL depends heavily on volunteers for its outreach
activities. The change in the labor law prohibiting the use of volunteerism is bound to affect these activities.
LL/CL will continue to lobby with other civil society organizations and NGOs for an exemption to allow
services to continue.
ITECH 16758.08, $75,000) and faith-based sector (ref: Capacity 16130.08, $30,000); procurement of
clinical MC kits and commodities (this submission, ref: 16548.08, 16762.08 for a total of $275,000); provide
technical assistance to the MOHSS on the creation of policies, guidelines and standard operating
procedures, as well as timely response to consumer concerns via the media (ref: Capacity 16130.08);
integrate MC into the package of services for prevention with positives within clinical settings; integrate MC
messages to primary and secondary target audiences within a comprehensive prevention campaign (ref:
NLT 5690.08, $160,000); mainstream MC messages within all ongoing clinical, VCT, workplace and
community mobilization activities, ensuring inclusion within existing gender mainstreaming initiatives that
address male norms and behaviors and sexual violence (ref: EngenderHealth 8030.08). All budgeted
activities are allocated in the following manner: 25% AB, 50% OP, and 25% CT.
to transition to direct funding two sub-grantee partners, Catholic Health Services (CHS) and
Lifeline/Childline (LL/CL) for FY 08. Pending results of the required pre-award survey (responsibility
determination), including a financial/organizational capacity evaluation and availability of FY08 funding, i.e.,
continuing resolution (CR), these 2 organizations may initially have to enter into a Leader with Associates
Award under IntraHealth and move to direct funding when they meet all eligibility requirements under
USAID Acquisition and Assistance regulations. This process will ensure the continuity of program activities.
The direct funding mechanism will replace the Associates Award and be implemented as soon as the 2
organizations are deemed eligible and are approved by the Pretoria USAID Regional Contracting office.
It is estimated that 9,000 new HIV infections take place every year in Namibia (NIP, 2005) which is
translated into 24 new infections daily. Most of these new infections will occur through heterosexual
activities and driven by concurrent multiple partnership. IntraHealth/Namibia through The Capacity Project
(CP), with its implementing partners, is supporting every effort to curb this trend and aims to meet the
incidence reduction MTP III goal. The call for accelerated and intensified prevention programs
acknowledges that there is no meaningful and successful treatment program unless prevention efforts are
brought to scale.
Targeting the general population within health facility catchments areas, the activities under CP support
comprise a range of prevention interventions that include condoms promotion and distribution, post
exposure prophylaxis (PEP), community outreach and mobilization with prevention messages around the
ABC approach. During FY 2008, these campaigns will include male circumcision (MC) as an intervention
and the prevention with positives (PwP) initiative.
As per existing agreement with MoHSS, all FBH are part of the condom distribution chain. This is included
in a comprehensive promotion package of abstinence, fidelity and correct and consistent condoms use.
During FY 2008, condoms will continue to be distributed through an increasing number of outlets (180
outlets) in and around the FBH catchment areas. This includes all healthy facilities, VCT centers, Cuca
shops and shebeens. This will ensure increased availability of condoms and potential use during high-risk
sexual behavior.
To ensure increased knowledge and skills to promote HIV/AIDS prevention through behavior change
communication, LL/CL will continue to train counselors using a comprehensive skill building approach
(about 200 counselors during FY08). An estimated 24,000 people (female and male) will be reached
through outreach prevention activities by all CP partners, representing 8% of the total catchment population
within FBH districts. Community awareness and mobilization will focus on high risk messaging. Therefore,
Behavior Change Communication (BCC) promoting monogamy, reduction of sexual partners and emphasis
on the role of cross-generational sex will be addressed with correct and consistent use of condom. The
operational teams (district coordinators and volunteers) will deliver messages through different platforms
that include schools within 50 km radius, teachers, women and men groups, church groups, community and
traditional leaders, social events partnering with Nawa Soccer, support groups.
Social capital mobilization is already happening using stakeholder meetings in each district where
councilors, traditional leaders and healers, community and other FBO organizations, PLWHA and
volunteers are meeting on quarterly basis. CP will endeavor to continue supporting this platform to ensure
critical issues such as male norms relating to the HIV prevention and Male Circumcision (MC) are
addressed. Issues of stigma and discrimination, violence and coercion against women will also be
addressed. To reduce women vulnerability to the epidemic, increasing efforts will be made to give them
access to the currently available support group income generating activities (Andara, Nyangana and
Oshikuku), currently constituting 75% of the support group membership.
To address male norms and behavior, LL/CL training curriculum will include cultural and social male norms
and behavior that contribute to domestic and sexual violence. The training will ensure that all trained
counselors are familiar with how to motivate men to obtain their participation. These activities will be linked
to the male mobilization program taking place within the C&T centers. At service delivery points, CP and
partners will strengthen the model of invitation cards for male partners for couple counseling and increased
male responsibility in PMTCT. This model is starting in FY 2007 and by 2008 will be scaled up. Currently
less than 2% of PMTCT women are counseled with their partners. Bringing this activity to scale should yield
at least 20% testing as couple or referred partners.
Integration of prevention programming into care and treatment has become imperative in CP supported
sites. The growing number of PLWHA calls for specially targeted prevention programs to ensure they don't
become a pool of HIV transmitters. PwP explores systematic interventions to reduce the spread of HIV to
family and sexual partners (consistent and correct condom use especially for discordant couples, partner
reduction, C&T for the family, PMTCT, family planning), STI screening and treatment, and ensures
comprehensive individual and family care that addresses the physical and psychological well being of HIV
infected person and encourages disclosure. Namibia is one of the three PEPFAR focus countries chosen to
implement the PwP model. As part of this model, the emphasis on STI program mainstreaming is critical. In
all FBH facilities, STI clients will continue to be offered routine HIV TC and all HIV positive clients will be
screened for STI. Refresher training courses (on site and out of site) will be done in collaboration with other
stakeholders (MoHSS, I-TECH, HIV Clinicians Society).
The PwP initiative will include alcohol abuse as it affects new infections and interferes with ART adherence.
CP will continue to work with its partners to roll out alcohol brief motivational interviewing (BMI) at both
treatment and C&T sites. This evidence-based concept is being tested in FY 2007 in Rehoboth and by 2008
its practical implementation will be assessed and a roll-out program designed for other FBH sites.
LL/CL will use the opportunity of the Oshikango border town to address the special needs of migrant
population, truck drivers and commercial sex workers. This activity will be monitored through routine report
identifying number of these groups accessing services at C&T.
To mitigate the impact of HIV/AIDS on FBH employees, workplace programs will be strengthened to
address the needs of support staff and their families with regards to HIV/AIDS education, peer education,
prevention and care initiatives, stigma and discrimination reduction, confidentiality issues as well as overall
reinforcement of infection control policy within the hospital settings. This program will engage the MoHSS
Activity Narrative: focal people who have been appointed regionally to oversee its implementation. In most FBH, committees
are in place but not functional; the program is likely to reach more than 500 workers and their families.
PEP for both occupational exposure and rape survivors will continue to be provided in all CP supported
health facilities as per the current Namibian ART guideline. This will continue to be linked to the infection
control unit to reinforce messages on universal precautions. During FY06, 52 clients were provided with
PEP within the five FBH of which 30 were occupational exposure and 22 post rape.
With CP staff actively involved in the National Male Circumcision task force, the drive towards full scale up
of safe MC as part of a comprehensive prevention package within the five FBH by FY08 will be achieved
through strong advocacy for the MoHSS to finalize policy guidelines. The task force is currently paving the
way for a situational analysis followed by national stakeholder consultation meetings before full fledged MC
implementation. CP will play a major role in the advocacy campaign and share with HIV clinician society,
UNAIDS and WHO in the technical response to the media with correct information dissemination, evening
lectures, national training on MC SOP in line with WHO/UNAIDS Technical Manual and ultimately service
delivery.
This activity is a continuation of a program of activities initiated under the FY07 COP (ref: FY074442.08)
and supports the OGAC global initiative on gender. Harmful male norms and behaviors and a lack of
positive, societal and family roles for boys and men were identified by USG/Namibia implementing partners
during the development of the FY07 COP and for follow-on activities under the FY08 COP as some of the
leading challenges in dealing with long-term behavior change in Namibia. Specific issues include
widespread prevalence of intimate partner violence, sexual assault, and child abuse throughout the country
as well as widespread abuse of alcohol which fuels violence and sexual coercion. Masculine norms support
and perpetuate male infidelity, transactional sex and cross generational sex and between older men and
younger girls is common. Lower rates of male participation in HIV/AIDS care and treatment services,
especially in PMTCT, C&T and ART, mean that men do not receive much needed services. The Namibia
National Medium Term Plan (MTPIII) 2004-2009 acknowledges these challenges and includes interventions
targeting gender inequality and violence and alcohol abuse.
In FY07, the Ministry of Health and Social Service (MOHSS), Ministry of Gender Equity and Child Welfare
(MGECW), Ministry of Safety and Security (MOSS), and Ministry of Defense (MOD) formed a Men and
HIV/AIDS steering committee, and took a leadership role in the mainstreaming of gender throughout their
sectors and for USG-supported clinical, community-based and media-driven interventions. This signaled a
strong start for the Men and HIV/AIDS initiative, and a unique opportunity for inter-ministerial ownership and
engagement in a movement which will influence in a sustainable manner deeply rooted Namibian male
norms and behaviors impacting HIV/AIDS. The Men and HIV/AIDS initiative in Namibia has three
components: a national strategy that employs an intensive and coordinated approach to addressing male
norms and behaviors that can increase HIV/STI risk; the provision of technical assistance (TA) to
implementing partners applying evidence-based approaches to integrate into existing programs and to
develop innovative programs; and an evaluation component that investigates the effect of gender
mainstreaming programming on self-reported behaviors. EngenderHealth (Engender) and Instituto
Promundo (IP) will facilitate the first two components; PATH the evaluation component. An interagency
USG gender task force in Namibia supports and coordinates all of these activities and the program receive
valuable support from the OGAC gender team.
The Men and HIV/AIDS technical approach is based on the evidence-based best practice program, Men as
Partners (MAP), developed and tested by Engender in sub-Saharan Africa and the Indian subcontinent.
MAP employs group and community education, and service delivery and advocacy approaches to promote
the constructive role men can play in preventing HIV, and improving care and treatment if they understand
the importance of gender equity issues and safe health practices via behavior modeling in their families and
communities. MAP programmatic approaches have been evaluated and have shown an increase in men
accessing services, supporting their partners' health choices, increased condom use and decrease in
reported STI symptoms.
To date, the Men and HIV/AIDS initiative has had a strong start. In collaboration with the inter-Ministerial
task force, Engender and IP developed a TA support plan and have initiated gender mainstreaming capacity
building activities within prevention, care and treatment activities with more than 30 PEPFAR-implementing
partners. Several partners were designated as key in-country resources in different areas (information,
education, communication (IEC) development, group education, training, and service delivery). The partners
are diverse, including FBOs and CBOs, and these partners engage many different groups of men, including
young men, religious leaders, teachers and soldiers. In addition, PATH has finalized the evaluation protocol
and is initiating the baseline study.
With FY07 re-programmed and plus up funds, additional monies were allocated to support a number of Men
and HIV/AIDS activities: to the MOHSS for a national Men and HIV/AIDS conference, to the MOD and
MOSS for mainstreaming gender throughout the uniformed services peer education programs; and to the
Ministry of Information and Broadcasting (MIB) to weave supporting messages throughout its national
HIV/AIDS mass media campaign, Take Control. Engender/IP received additional country funding for TA and
to hire a gender expert to coordinate the initiative in country.
In FY08, USG will strengthen and expand the Men and HIV/AIDS initiative. Engender and IP will continue to
focus on the providing TA to in-country partners. One of the USG's top priorities in strategic planning and
TA for implementation will be assisting partners to make choices based on optimizing the feasibility and
effectiveness of interventions and their potential for sustainability and scale-up. Another priority will be
strengthening the national and regional networks to discuss challenges and lessons learned in gender
mainstreaming. The initiative will support selected networks to implement joint activities at the local and
regional levels to advocate for male involvement in HIV. As feasible, these will be linked to global events
that focus on issues related to gender and HIV and AIDS: e.g., 16 days of activism, Father's Day, and World
AIDS Day.
Issues and behaviors to be targeted in FY08 include alcohol use and abuse, multiple concurrent partners,
transactional sex, condom use, and male violence. Building on partnerships with private and public sector
organizations, the initiative will continue to mobilize social capital to focus on the issue of male involvement
in HIV. This year, a specific focus will be on identifying ways that additional private sector organizations can
be mobilized to work with the network of partners already involved in Namibia's Men and HIV/AIDS
initiative. In addition, advocacy work will be continued with the government to ensure that male engagement
principles and approaches are integrated into government initiatives related to HIV/AIDS.
Overall during FY 2008-09, the USG/Namibia will ensure that a male engagement lens is applied to all
aspects of programming from program design and implementation to monitoring and evaluation. Technical
assistance will focus on further building the capacity of in-country partners including those listed above to
serve as resources through ongoing mentoring and supervision to ensure that male engagement is
mainstreamed into existing HIV and AIDS prevention, care, and treatment programs. Ongoing supervision
and monitoring will be provided in a variety of ways: through joint program design, implementation, and
training; in-country field visits and discussions on ways to address challenges, and feedback through email
and phone discussions with a core group of partners and in-country resources. One key area of focus will
be TA related to Behavior Change Communication (BCC) (activity 12342.08) with the aim of making sure
that partners not only effectively transfer knowledge to men about risky behaviors and safer behaviors, but
that the men are equipped to change their behaviors and are supported to do so by environmental factors.
BCC TA to USG partners will take the form of mentoring and on-the-job learning, and will be aimed at
Activity Narrative: strengthening the overall quality of their BCC programming, including design, implementation, quality
assurance and monitoring and evaluation (activity 16501.08). Another key area will be addressing alcohol
use and its relationship to unsafe health practices, and the Men and HIV/AIDS initiative will drawn on TA
and support from the comprehensive alcohol program (activity 17057.08).
This $66,000 will be used to support the evaluation component of the Men and HIV/AIDS Initiative.
IntraHealth will award this funding to LifeLine/ChildLine, who is working with EngenderHealth to implement
the intervention component of the evaluation in the field.
to transition to direct funding Catholic Health Services (CHS) for COP 08. Pending results of the required
pre-award survey (responsibility determination), including a financial/organizational capacity evaluation and
availability of COP08 funding, i.e., continuing resolution (CR), CHS may initially have to enter into a ‘Leader
with Associates Award' under IntraHealth and move to direct funding when they meet all eligibility
requirements under USAID's Acquisition and Assistance regulations. This process will ensure the continuity
of program activities. The direct funding mechanism will replace the Associates Award and be implemented
as soon as CHS is deemed eligible and approved by the Pretoria USAID Regional Contracting office.
This is an ongoing activity and includes five elements: clinical care; spiritual care; expansion of pediatric
care; integration with other services; addressing challenges to referrals; and improved nutritional care.
Clinical Care: By the end of COP 2007, Capacity Project (CP) will have supported the implementation of
the clinical components of the preventive care package and clinical treatment in the five Faith Based
Facilities (FBF) and six health centers/clinics in Namibia. The following elements of clinical palliative care
are delivered in CP facilities: prevention and treatment of OIs (CTX prophylaxis for eligible HIV positive
clients and HIV exposed infants and TB screening); INH prophylaxis (on eligibility criteria with increasing
number since mid FY 2007); pain and symptoms management (including opioids), nutritional assessment
and multi micronutrient supplementation; and screening, treatment referral for other conditions such as
malaria and diarrheal disease. CP staff are active members of the National Palliative Care Task Force. The
Task Force will continue to advocate for increased availability and use of opioids and promote the use of
pediatric formulations at different health facilities levels. While access is available in select areas the lack of
awareness and training on opioid use is inhibiting rollout of pain control. The program will continue working
with the Task Force for scale up of sensitization, training, clinical mentoring and supportive supervision for
wider expansion of pain management.
Spiritual Care: During COP 2008, spiritual care for PLWHA through trained clergy will be added to
complement CP clinical care in order to allow PLWHA to express their feelings, their spirituality in order to
alleviate psychological burden and improve coping capabilities. End of life care, including hospice care, will
also be reinforced through skills update with I-TECH as they update their training module on palliative care
with help from APCA and the National Palliative Care Task Force. CP will initiate and support the TOT
training of clergy (with APCA materials) to ensure a qualified pool of clergy who will be equipped
(communication skills and appropriate messaging) to support the spiritual component of palliative care for
the HIV clients, their families and care-givers. Prior to this training, a baseline KAP study will determine the
training needs amongst clergy and will be used to assess the impact of the intervention.
Pediatric Expansion: Building on a relatively good trend of pediatric ART uptake (17.5% of all ART users
with FBH), CP-supported sites will aim at maintaining the pediatric palliative care priority by increasing entry
points to care and treatment. These include PMTCT services, in-patient and out-patient departments (early
presumptive diagnosis), TB clinics and MCH services. From the 6th week of age, HIV exposed infants are
provided with CTX as per national guidelines. However, tracing infants missing follow up visits remain a
major challenge to the program. Many factors are contributing to the defaulting of a number of HIV exposed
children such as distances, transport costs, and migration of parents. Follow ups in nearby health facilities
are being done for some of them but the weak reporting linkages between different satellite facilities and the
ART/PMTCT site limit the flow of data. The coverage of CTX prophylaxis among the HIV positive pediatric
clients receiving care in the FBH is above 80%. In addition, infant feeding counseling, micronutrient
supplement, access to early infant diagnosis (DNA-PCR at 6th week as per current algorithm), assessment
and management of pain and linkage to routine child care (immunization, Vitamin A, growth monitoring and
promotion) will be actively provided. To appropriately cover psycho-social needs of children affected and/or
infected by HIV, CP will continue to support training of HCW in the FBH and MoHSS sites using the child
counseling curriculum developed in COP07 in collaboration with other training partners.
Integration with Other Services: During COP 2008, clients and their families will continue to be provided
with high quality counseling and testing (CT), mainly through provider-initiated prevention counseling.
Topics include encouraging family enrollment into HIV services and behavioral counseling through ongoing
prevention messages (safer sex, reduction of partners and risky behavior) that are integrated into care and
treatment settings as well as referral for support groups activities (3 of 5 districts have functional support
groups). Family planning counseling, STI screening and treatment will form part of PwP approach as every
client registered in care will be offered this service at every visit in the same integrated approach as for TB
screening. The new ART client monitoring tool endorsed by the MoHSS captures data on family members
and partners (tested or not) that will help in providing clients and their families with the basic preventive
package in a family-focused approach. In addition, this tool allows registration of all diagnosed HIV+ clients
in what is called a pre-ART register that includes element of clinical palliative care and gives opportunity for
routine clinical and immunological follow up and lays ground work for optimal time of ART initiation.
Pregnant women enrolled in the PMTCT program are also targeted for PC services. They are provided with
the same basic preventive care package as described earlier with emphasis on couple counseling, safer
sex (including during pregnancy and breast-feeding). In general entry to care for women is facilitated
through PMTCT. Use of TB, STI clinics and possibly male circumcision services will be likely to canvass for
more men and increase their participation.
Addressing Referral Challenges:
Transportation is one of the barriers to initial access to care and to ongoing adherence. Entry to care may
be delayed and for those already on treatment early development of resistance can be expected. By
identifying sites likely to experience such barriers (through a front-end analysis), CP will pilot "Transport
Vouchers" program. The program will be implemented in select sites in accordance with decentralization of
HIV/AIDS services and roll-out of services to satellite facilities (IMAI). The "Transport Voucher" program will
be a short-term solution (2-3 years) to improve early entrance to clinical care services and to prevent early
development of resistance. This will represent yet another opportunity for Public-Private Partnership by
engaging private transport owner (taxis, buses) and/or petrol station owners. In COP07, CP focused on
improving the bi-directional referral to ensure the continuum of care in the FBF. This activity will be
continued in FY08 to ensure increased collaboration with all CBOs, maintenance of directory of district
home-based palliative care service providers, providing a platform to discuss referral mechanisms and
reduction of missed opportunities. Where applicable, DAPP will be engaged to explore areas of
strengthening care services through its TCE.
Activity Narrative:
Clinical Nutrition: During 08, CP will support its partners in reviewing progress of the Kitchen Corner
Initiative which was piloted in two FBH in 07. Without decentralized nutrition/HIV expertise in Namibia to
address nutritional and dietary aspects of HIV/AIDS, this initiative is aimed at providing nutritional
counseling and assessment, follow up of growth monitoring of HIV exposed babies, education and
demonstration, and promotion of safe food and hygiene practices for clients enrolled in care and treatment.
Capacity Project will reinforce nutritional messages (including safe infant and young child feeding
strategies), promote use of local food, ensure all IEC materials are available and conduct in-service training
on nutrition and HIV. Technical support in nutrition and HIV will be provided by the ITECH Nutrition Advisor
and the MoHSS.
Building on COP07 success, CP will continue to collaborate with the MoHSS, other USG partners (CDC/I-
TECH) and the HIV Clinicians Society (HCS) in facilitating palliative care training (~20 HCW during FY08)
with special emphasis on pediatrics pain assessment and management. An opportunity to improve overall
palliative care practice in private sector is provided through engaging private practitioners during these
trainings.
Based on a catchment population of ~300,000 for all FBF across 5 regions, and with an average HIV
prevalence rate of 20%, it is estimated that 30,000 people are living with HIV/AIDS. By the end of COP07,
FBF will be providing clinical palliative care to 15,000 (50%) while 10,000 (33%) will be receiving HAART.
CP will continue to ensure provision of high quality service through the use of information provided by the
ART client monitoring system, regular supportive supervision, and site visits.
In the faith-based hospitals (FBHs), TB clinics are directly managed by the Ministry of Health and Social
Services (MoHSS) while Odipo health center serves as a Directly Observed Therapy site. The TB clinics are
linked to counseling and testing (CT) sites in their respective hospitals, either under the same roof or
nearby. All patients accessing services from other hospitals departments (inpatients, special clinics and
OPD outpatients) are evaluated for TB and offered HIV C&T. In the 4 Catholic Health Services (CHS)
hospitals, the TB wards have certified sites for counseling and rapid HIV testing and have trained staff to
conduct the tests. In the Lutheran Medical Services LMS, the TB clinic is housed in the same building as
C&T, allowing for close physical and operational linkages. The close collaboration of the hospital TB clinics
and CT sites in all FBHs allows a successful referral system between TB clinics and HIV services (CT, care
and treatment) and facilitates routine CT for majority of TB patients.
As part of the TB/HIV collaborative activities, Capacity Project (CP) will support regular monthly meetings
between the TB program staff and the ART site staff to discuss issues related to referral, data collection and
completeness, and other programmatic issues. In the ART sites and PMTCT rooms in the faith-based
facilities, Capacity will continue to update staff skills on screening HIV patients for TB in every follow up
visit, clinical monitoring of the patients during consultations, referral for laboratory services, and offering
Isoniazid prophylaxis to eligible patients in addition to cotrimoxazole prophylaxis, micronutrients
supplementation and CT for other family members. Suspected TB patients are offered clinical examination,
sputum direct microscopy and X-ray when applicable to confirm the TB diagnosis.
Clinical staff from the hospitals, clinics and ART sites will be trained on TB/HIV management in
collaboration with MoHSS and other USG partners (I-TECH). ART clinics staff will be continuously updated
in the identification and management of TB/HIV cases and sensitized to rapidly triage for TB signs and
symptoms and fast-track to TB diagnosis services. History of previous diagnosis and treatment will be
elicited in order to identify suspected MDR cases, and refer them for the necessary laboratory tests and
appropriate treatment. In collaboration with the Tuberculosis Control Assistance Program (TBCAP), CP will
strengthen collaborative TB/HIV activities and doctors in the ART sites will initiate TB treatment for all
confirmed TB cases and subsequently refer the patients to the TB clinic/ward accordingly. Eventually, the
ART and TB management at facilities will be transformed to "one stop shop" for both diseases.
In line with the strategic shift from just HIV testing sites, standalone VCT sites staff will be trained in TB
screening using standardized questionnaire and will refer accordingly. In COP08, CP will recruit or offer full-
time jobs for the current part-time nurses in the standalone VCT sites to make sure there is enough clinical
staff to support the lay counselors in TB screening and other clinical tasks.
Oversight of TB screening for pediatric patients is of great concern. HIV-positive children enrolled in the
care and treatment program will be screened for TB in every follow-up visit. Pediatric TB patients and their
care-givers will be offered HIV CT services. For screening of TB, CP-supported facilities will adopt the
national standard operating procedures and operate within the national TB control guidelines. CP will also
work closely with MoHSS on task shifting so that staff members from satellite facilities will be able to refer
patients suspected to have TB and HIV co-infection to the district facilities. These patients will be fast
tracked to confirm or exclude the TB diagnosis.
Due to the high co-morbidity of TB and HIV, infection control measures within ART sites will be enhanced
by ensuring timely diagnosis of suspected TB patients and initiation of treatment to prevent nosocomial
transmission. Faith-Based Facilities (FBF) have been cognizant of the need for proper infection control. For
example, in the extension of the ART sites in the Lutheran Medical Service (LMS), where the TB district
clinic is housed, steps were taken to ensure proper ventilation in the waiting area and consulting rooms
where TB patients are served, reducing the risk of exposure. CP will continue to advocate for such
considerations in facilities renovations and will review all the ART sites to make sure they are appropriate
for infection control.
During COP08, CP will continue to support the HIV Clinician Society as part of private-public partnership.
The private sector treats about 20% of HIV patients in Namibia. Training of private practitioners will improve
the quality of services rendered and also increase their attention to identifying and appropriately treating
those with TB co-infection. In collaboration with NTCP, 40 private practitioners and 25 HCW from the public
sector, faith-based facilities will be trained on TB/HIV management. Special training emphasis will be on
screening, diagnostic aids and adult and pediatric TB and its management.
Data collection to integrate information on TB and HIV has been a problem. By end of 07, a reliable tool for
linkage between TB and HIV services, the electronic ART patient monitoring system will have been
implemented by the MoHSS according to WHO recommendations. This system captures data on TB and
HIV and allows monitoring and evaluation of the referral system and the quality of the services. Data
collection will be strengthened by regular reviews of data collection tools and data analysis at the facilities
by the ART and TB teams. Data collection will also be strengthened for the private practitioners through
supportive supervision.
In collaboration with TBCAP, regular data review will be undertaken to evaluate the quality of services being
provided. Quality of HIV CT services in the TB units will be undertaken on a regular basis as part of the
facilities quality assurance program which involves supportive supervision by CT and laboratory
supervisors.
The PEPFAR supported program will leverage the MoHSS/Global Fund resources. These Global Fund
resources are used to support personnel and operational costs of the TB program in all districts. Therefore,
CP supported sites will incur minimum TB program cost as the focus will be mainly on areas of training, skill
update, supportive supervision and strengthening of linkages and HIV collaborative activities system.
hospitals.
continuing resolution (CR), these 2 organizations may initially have to enter into a ‘Leader with Associates
Award' under IntraHealth and move to direct funding when they meet all eligibility requirements under
USAID's Acquisition and Assistance regulations. This process will ensure the continuity of program
activities. The direct funding mechanism will replace the Associates Award and be implemented as soon as
the 2 organizations are deemed eligible and are approved by the Pretoria USAID Regional Contracting
office.
In October 2007 with USG support, IntraHealth through the Capacity project (CP), assumed management of
the New Start (NS) network of ten standalone VCT centers and three hospital-based Catholic Health
Services (CHS) CT sites. This move merged the highly successful and high volume Lutheran Medical
Services (LMS) site at Onandjokwe hospital and one more CHS integrated site (Rehoboth) into the NS
network. Equally, in COP 2007, the Anglican Medical Services (AMS) began offering C&T services at the
Odibo health centre.
At the end of COP 2007, the USG will support ten NS VCT centers and six integrated CT sites. Under COP
2008, the CP will continue to move towards the priority focus of provider initiated testing and counseling
(PITC) in clinical settings and improving access for HIV positive individuals to services (other clinical,
preventive, social, psychological and spiritual care). Capacity Project will continue counseling and support
for HIV negative individuals. The USG will also strengthen linkages to care and treatment for stand alone
VCT sites. This paradigm shift in NS will further the USG goal of increasing the number of individuals
receiving their HIV test results and consequently HIV care and treatment.
By mid-08 the standalone VCT site in Rundu will either be integrated into the state hospital setting or be re-
located in very close proximity to the hospital. All patients presenting with symptoms of HIV disease at
integrated sites will be offered HIV testing as part of the diagnostic testing in an "opt-out" approach ensuring
at all times that the testing is voluntary with strict confidentiality. During COP 2008 under the NS umbrella,
seven integrated C&T sites and nine VCT sites will test 65,000 first time clients using the three different
approaches of client-initiated, provider-initiated and diagnostic testing.
Under COP 2006 funding, PMTCT was rolled-out to 25 rural facilities (CHS and LMS) and evolved into a
wrap-around activity utilizing both CDC (through deployment of community counselors) and USAID support.
Due to the isolated nature of the areas served by these PMTCT sites, community members began to also
access CT services there. Under the CP support, these PMTCT points will continue to offer another CT
access opportunity for rural Namibians.
Under COP 2008, the CP will increase quality of C&T provision and services through sharpening,
consolidating and updating the training and supervision of CT counselors and developing an effective,
functional and measurable referral system utilizing reliable software. The management of the NS network
will be led by a highly trained and functional team blending medical and social work professionals.
The CP team will continue to link with NawaLife in an advisory capacity as they expand an aggressive
demand creation campaign for HIV testing. This partnership will increase testing numbers at both NS and
MOHSS testing sites. The recruitment of community mobilizers in most sites will also enhance this demand
creation activity.
The effective and uninterrupted supply of rapid tests and medical consumables will be accomplished
through a continued partnership with Supply Chain Management System (SCMS). The needs for more
storage space in some of the testing sites will be discussed with SCMS and USG partners.
The CP will continue partnering with the Namibia Institute of Pathology (NIP) (16165) who will provide
clinical quality assurance oversight at all rapid testing sites with an emphasis on assisting with the roll-out of
outreach testing services. The CP will work closely with the MoHSS as a member of the CT technical
working group providing support and technical expertise on both clinical and counseling issues.
The CP proposes to introduce two new set of activities at five NS pilot sites: Walvis Bay, Tonateni, CCN
Windhoek center, Oshikuku and Rundu as the integration of activities evolve. The part time nurses at four of
these sites will be moved to full time in order to supervise and coordinate the expansion of services offered
at these sites to include clinical services such as TB screening, nutritional assessments, referrals and
advice on male circumcision, implementation of prevention with positives (PwP) initiative which involves STI
screening, condom promotion and distribution, family planning, couple counseling including discordance
and gender-based violence issues, alcohol screening through brief motivational interviewing approach. The
nurse will also lead the NS referral process, build strong linkages with the hospitals, coordinate the follow-
up with clients to ensure the referral contact was made when possible. She will further serve on the
regional referral committee to ensure that the system remains functional. In addition, CP will collaborate
with TBCAP to offer community based TB DOT in the CT sites, as needed, as part of the current initiative
that uses several community points (using containers) to increase the TB DOT coverage. The expansion of
services to a comprehensive package moves CT from traditional HIV testing to multipurpose one-stop
centers for prevention and care activities. As a result, quality is expected to improve significantly but cost
per client might also be driven higher.
The second expansion activity carried out at these pilot sites will be outreach HIV CT which will allow hard-
to-reach communities, mobile population in high prevalence areas access to CT and link them to care.
These outreach activities, to be undertaken under MOHSS guidance and in collaboration with other
stakeholders, is likely to increase testing numbers at lower cost.
Under COP 2007, Capacity Project is bringing the CT training program in line with the minimum standards
for training which were set by the MoHSS. In COP2008, Capacity Project will continue to work the MoHSS
and ITECH to complete training for both NS and LL/CL counselors during COP 2008. Special effort will be
made to ensure that accurate information is understood and reinforced about the window period, the
importance of adequate prevention counseling with negative testers, TB referrals for all positive testers,
Activity Narrative: alcohol and HIV, and gender based violence. Staff will also be trained to conduct brief motivational
interviewing for alcohol abuse.
Community Mobilizers will continue to be trained and updated in carrying out pre-test informational sessions
with potential clients. This intervention will decrease the amount of pre-test counseling time spent with each
client allowing more time in post-test counseling to ensure that effective referral services and prevention
planning occurs. Community Mobilizers will also actively work to increase male participation in CT services
through engaging men including informational barbecues, male only expert speaker sessions and village
based discussion sessions covering topics such as partner reduction, the role of men in PMTCT and the
challenges of fidelity. Focus group discussions will be conducted with men in various NS sites in order to
understand their reluctance to access CT services. This will guide in tailoring services to male needs and
guide strategies for men involvement. Results of these focus group discussions will also be shared with
NawaLife and incorporated into the demand creation campaigns.
The CP training and supervision team will continue to ensure high quality of service at NS centers through
recruitment and retention of qualified staff and a systematic monitoring and evaluation plan. The CP team
will attempt to institute standardized minimum hiring requirements and a standardized salary structure for all
NS partners. Elevated educational and experience requirements will build quality staffing into all NS sites
and adequate salaries will decrease attrition and inefficient repetition of trainings. Center staff cadres will
mature and become more effective. On the other hand, supportive supervision visits using check list and
scoring system, mystery client surveys, analysis of client exit interviews, suggestion boxes and focus group
discussions will ensure continuous quality improvement of C&T activities across all NS network.
to transition to direct funding Catholic Health Services (CHS) in FY 08. Pending results of the required pre-
award survey (responsibility determination), including a financial/organizational capacity evaluation and
availability of FY08 funding, i.e., continuing resolution (CR), CHS may initially have to enter into a ‘Leader
with Associates Award' under IntraHealth and move to direct funding when it meets all eligibility
Under treatment, care and support, the Capacity Project supports six ART service outlets run by the
Catholic Health Services (CHS) and the Lutheran Medical Services (LMS), in rural and semi-urban settings,
managing both adult, and pediatrics patients, and aiming to expand access to all persons who need ART
services. These services are integrated with VCT and PMTCT in a model of care allowing close
collaboration and strong linkages. An ART pharmacy is on site at each location. Through June 2007, 9,635
patients were started on treatment in these facilities; 1678 (17.5%) were children and 6287 (65%) were
females. To increase male participation during FY 2008, CP supported sites to use community mobilization
campaigns including male conferences, PMTCT invitations and repeated messages addressing male
norms. In addition, CP will expand to a new site in Omuthiya clinic and will support Anglican Medical
Service (AMS) by recruiting a medical officer who will run the ART, PMTCT, and TB programs at Odibo
Health Center. Two other sites will be established in consultation with MOHSS.
Good pediatric ART trends will continue through strengthened linkages between entry points such as
PMTCT and outpatient and inpatient departments with ART services, as well as with Maternal and Child
Health Services. Counseling and psycho-social support for children will be enhanced with the training
program being finalized during FY 2007.
Data indicate that 78% of patients starting HAART in the 5 Faith Based Hospitals (FBH) were still receiving
it, leading productive lives, their health status having improved. To keep pace with change, CP will train all
ART staff in the revised guidelines for viral load testing at six months for all starting patients and later on
based on clinical and immunological criteria. Smooth cooperation with local Namibia Institute of Pathology
(NIP) for specimen collection will be ensured. Furthermore, CP will partner with MSH to pilot adherence
monitoring tools in all FBH to deal promptly with poorly adherent patients while also increasing efforts in
active defaulter tracing using all available resources. ARV drug resistance monitoring will be done by NIP in
collaboration with WHO and other USG partners. CP-supported sites will offer their collaboration and
advocate to be part of selected sites.
Given the changes and complexity in ART provision, training and continued medical education remain a
cornerstone in achieving high quality. Based on the updated guideline, CP will collaborate with its
implementing partners to develop standard operating procedures (SOPs) to ensure adherence to quality. As
part of its continued Public Private Partnership (PPP) initiative, CP will continue to ensure that private
clinicians and private pharmacists, whom we reach through professional interest organizations, are
adequately trained and updated on the national ART guidelines to provide high quality HIV care in the
private sector. During FY 2008, 200 HCW are expected to be trained. CP staff and its partners will continue
to be involved in the Technical Advisory Committee activities for continuous review of the ART guidelines
and will also assist as facilitators in most of the training sessions across the country for both private and
public health care workers (HCW).
During FY 2008, to increase access to HIV chronic care, and maintain rapid scale-up of effective ART and
prevention services. All service delivery points in the facilities will continue to be made aware of active
rather than passive case findings and referral mechanism for in-patients, TB patients, STI patients, PMTCT
mothers, young children from MCH services with signs and symptoms or HIV exposed infants. HCW will
continue to be updated in provider-initiated HIV testing and counseling (PITC) approach. The continuum of
care will be facilitated by ensuring effective referral mechanism with community health care providers.
In the CP supported standalone VCT sites (ten in eight regions across Namibia), referral mechanism will
continue to be strengthened to ensure all HIV + clients are enrolled into care and treatment services through
confidential rather than anonymous referral.
Capacity of the ART sites to receive and manage referral from standalone VCT facilities will be enhanced
by designating case managers who will guide the patients through the process. The case managers will
also track and give feedback to the referring units. The referred HIV+ patients will continue to be offered on-
going adherence counseling; clinical assessment; CD4 testing; opportunistic infection (OI) prophylaxis and
treatment, screening for TB, palliative care i.e. pain control, hospice care (terminal care), etc; nutritional
assessment as well as assessment of ART eligibility. A facility-based prevention with positives (PwP)
initiative involving interventions to reduce the spread of HIV to sexual partners (consistent and correct
condoms use especially for discordant couples, and partner reduction, FP counseling and STI screening
and treatment) and to children (PMTCT, family planning), disclosure, comprehensive individual and family
care that addresses the physical, and psychological well being of HIV infected person will be officially
initiated during FY 2008 in FBH treatment sites and further, CP will support the MOHSS' national roll-out.
The PwP also includes the Brief Motivational Interviewing which is being piloted in Rehoboth ART site
during FY 2007 with the aim to reduce risky alcohol drinking among patients in HIV related services. To
ensure successful implementation of the PwP initiative and support MOHSS' efforts in strengthening
prevention and treatment responses, CP will recruit and train regional supervisors/case managers using
protocols and curricula developed in collaboration with the MOHSS and ITECH.
All HIV+ patients not eligible yet for ART will be followed on a regular basis (at least every 6 months) to
ensure they continue to receive a comprehensive care package and ART as needed in a timely way. The
quality of care will be assured through the above mentioned ART system that comprises the pre-ART and
the ART registers. The pre-ART register (care register) is intended to register in continuous care all HIV+
from diagnosis to treatment initiation aiming at routine clinical and immunological monitoring and provision
of basic health care package. The system is also designed to generate a monthly cohort analysis that can
be used locally, regionally and at the national level for effective patient and program monitoring with
feedback to all sites. Platforms such as the national review meeting initiated by MOHSS and individual
partner review meeting such as FBH review meetings will serve to share lessons learned and disseminate
Activity Narrative: best practices.
In addition, all patients enrolled in the care program will receive support and referral for other needs not
provided in the care package, such as income generating activities, spiritual support, psychological support,
community based palliative care services and OVC as per identified needs.
Once eligible for HAART initiation, patients are provided with HAART as per the national guidelines,
transferred in the ART register and followed up accordingly. During FY 2008, the national decentralization of
ART service is expected to gain momentum. CP will support the referral systems whereby the clinically
stable patients will be cared for through satellite health facilities by Integrated Management of Adults &
Adolescents Illness (IMAI) trained staffs. FBH staff will continue to support and transfer knowledge to other
HCW from satellite facilities while training, supervision and clinical mentoring will be assured through
performance improvement approaches. In view of the growing number of patients enrolled in care,
consultations with MOHSS will continue to consider piloting task-shifting, whereby nurses in the ART sites
will be empowered to fully care for stable patients prescribing refills under the supervision of the ART
medical officers.
All CP supported partners will continue community awareness, mobilization and education to create
demand for the available ART services. This will involve other stakeholders such as community-based and
faith-based organization, traditional leaders and healers, church leaders, teachers, youth groups, support
groups as well as members of the regional and constituency aids committees.
The program sustainability will be ensured through continuous training of indigenous HCW and the technical
support provided to the MOHSS Human Resource Information System (see OHPS area).
Capacity Project (CP) will endeavour to support all its implementing partners [Catholic Health Services
(CHS), Lutheran Medical Services (LMS), Anglican Medical Services (AMS), LifeLine/Childline (LL/CL),
Catholic Aids Action (CAA), Evangelical Lutheran Church AIDS Program (ELCAP), Walvis Bay Multi-
Purpose Centre (WBMPC), Democratic Resettlement Community (DRC), Development AIDS from People
to People (DAPP), HIV Clinician Society (HCS) and Pharmaceutical Society of Namibia (PSN)] in the use
of information for effective programme management. This will be done through improving and harmonising
data collection tools; ensure data coordination, data mining and analysis and ultimately dissemination and
use for evidence-based programme planning and improvement. The following are some of activities in
different programmes areas.
For Care and Treatment: strengthening of support system to data clerks for continuous improvement of data
quality and timely reporting. By the end of FY 2007, MOHSS-endorsed data collection tools will be used for
PMTCT (ANC), ART, Pharmaceutical services and TB in all FBHs to ensure effective routine monitoring and
evaluation. The data will flow monthly from facilities to national level where it will be consolidated in a
national database. Analysis and feedback will be provided to respective regions and districts and ensure the
sharing of best practices in relevant programme areas.
For the ART programme -- using the current MOHSS-approved tools -- the quality of care will continue to be
ensured through patient and program management systems. These tools allow for the monitoring of
longitudinal patient clinical records as well as cohort analysis. Monthly and quarterly reports are easily
generated from the system. CP will continue to provide its technical support to the maintenance of this
WHO-endorsed system. As part of its quality assurance activities, CP staff will continue to provide direct
supportive supervision visits to all its implementing partners using check lists (MOHSS developed) and
scoring system as well as join the MOHSS supervisory team in different regions and districts as per current
collaboration. The ART patient monitoring system also captures data about the status of family members,
thus helping in providing patients, their partners, and their families with a comprehensive package of
prevention, care & treatment services. Workload analysis will continue to be done to ensure that the CP-
supported workforce meet the demand and continue to delivery high quality and efficient services.
With regards to C&T services, during FY 2008, CP will continue to ensure the quality of services through
direct support supervision visit with check list, scoring system as well as analysis of client exit interviews (to
assess client satisfaction), mystery client surveys, focus group discussion, and suggestion box. Other
routine quality assessment activities aiming to improve programmatic decision-making will also be
conducted. CP will continue to maintain the C&T database that will be implemented in FY 2007 for all C&T
sites.
In addition, Lifeline/Childilne's (LL/CL) general counseling database will capture data concerning counseling
session (crisis line, gender-based violence) and the analysis of this database will provide necessary
information for future training needs. Training database that captures training sessions, facilitators, training
participants and their score, language and region where they serve will also be enhanced
During FY 2008, a PMTCT impact evaluation will be conducted in all Faith-Based Hospitals (FBH) using
essentially CP staff. The aim of this study would be to evaluate the PMTCT programme's achievements with
regards to reduction of transmission rate and overall effectiveness. Based on the current retention in care of
78% of patients on HAART for more than 2 years (2004-2006), CP will initiate an operational analysis of
factors associated with longer retention on HAART. This will assist the programme in designing strategies to
increase retention in care. In addition, adherence monitoring tools will be implemented and tested in
collaboration with MSH. As part of Palliative care strengthening, a baseline and follow-up Knowledge
Attitude and Practice (KAP) study with clergy on HIV/AIDS palliative care will provide data on training needs
and will allow not only the adaptation of the African Palliative Care Association (APCA) training material but
also the evaluation of the programme effectiveness. In the prevention programme areas, with collaborative
efforts of other stakeholders, CP will initiate an analysis of the demand and supply of condoms in the FBH
catchment areas. CP will also support LL/CL in conducting a listernership survey for its radio program in
collaboration with Nawa Life Trust as a complementary part to their communication/media survey. This
survey will aim at establishing the population reached and the programme impact
In order to strengthen implementing partners' SI capability, CP will support the training of 25 staff members
from operational levels on M&E through workshops organised with the help of local and regional consultants
in collaboration with RM&E and other USG partners. This will aim at ensuring capacity building of the
partners for a sustainable monitoring system and routine evaluation activities with special emphasis on data
quality, analysis, and use.
CP staff are active members of the national M&E technical working group committee and as such will
continue to support the strengthening of this committee which in turn supports the activities of the MOHSS
Response M&E division. One of the major activities is the National multi-sectoral monitoring and evaluation
of HIV/AIDS programme. Working towards its full implementation will ensure that Namibia follows the "three
ones" principles of UNAIDS.
Finally, CP will work with the MOHSS Research unit, the RM&E subdivision, and other USG partners to
revive the national research agenda and ensure the wealth of data gathered during the past PEPFAR
implementation years can be systematically and rigorously investigated to produce information for planning
and decision making based on Namibian evidence. Community meetings will be fostered to disseminate in
layman language critical information pertaining to the different programme areas in order to increase
community ownership and involvement.
During COP06 and COP07, IntraHealth/Capacity Project (CP) partnered with the MoHSS stakeholder
leadership group (SLG) to strengthen existing human resource information systems (HRIS). Working with a
comprehensive SLG covering all users and producers of Human Resource for Health (HRH) data has
helped ensure ownership of system strengthening efforts. Working together, the SLG agreed on
implementation goals including establishment of a charter to define the group's mission, primary roles and
responsibilities and decision making processes as well as development of data sharing agreements among
and between HRH data managers. In COP08, CP will build on the success of the SLG focusing specifically
on: (i) developing the data collection and reporting tools necessary to provide essential indicators as defined
by the SLG; (ii) supporting infrastructure improvements where HRH data are collected; (iii) improving links
between MoHSS HRIS systems and the existing Office of Prime Minister (OPM) system; (iv) providing
training to better assist the data collection and improved infrastructure.
With work in COP07 heavily focused on strengthening central level systems, we propose to work with the
SLG to link the private and public sector systems and to focus on expanding the access to and use of data
at the district level in COP08. For information to reach the MoHSS in a timely manner and in order to move
to a fully computerized HRIS, the regions require computers, reliable internet connectivity, and basic data
entry training. As a first step, CP can host a data collection and training conference with regional
representatives. Two regions may be selected, ideally one urban and one rural, to participate in a pilot
program. In addition to including the districts in system strengthening efforts, it will be important to include
the private sector to ensure complete in-country representation of health worker data. Private sector HRH
data integration includes working with professional councils and FBOs to securely share data in compatible
formats. CP can provide technical assistance to support development of these linkages and integration of
private sector systems with the MoHSS HRIS. To ensure sustainability, CP will continue training on data
quality as well as the effective use of data in influencing policy and management decisions. Training on data
use not only supports the utility and continued strength of HRIS systems but also provides support for many
key cross-cutting areas including identifying gender issues, looking for incentive and retention trends and
examining distribution of staff with specific areas of specialty. During COP07, CP will support its partners
mainly Life Line/Child Line (LL/CL) and VCT sites by creating software that captures training sessions,
trained staff, facilitators, participants' scores, language and region of service. During COP08, CP will
continue the support and maintenance, as well as training of more staff, to handle this software. During
COP07, CP assessed the internal operations and management practices of the VCT partner organizations.
This assessment focused on the HRM and supervision practices in particular and identified a number of
weaknesses that were undermining the performance and quality of CT service delivery. In COP08, CP will
continue to strengthen the HRM processes within the VCT partner organizations, particularly in the areas of
supervision, and policies and practices to support staff retention, motivation and development. In the case
of the Catholic Health Services (CHS), Lutheran Medical Services (LMS), and LL/CL, the focus of system
strengthening - particularly in the area of HRM, will transition from establishing the essential framework of
HR procedures, processes and policies - which was the focus during COP06 & COP07 - to performance
improvement. In COP08, CP will build on this essential "framework" by strengthening and, where
necessary, establishing performance management, supervision and staff development systems. The
Namibian HIV Clinicians Society (HCS) has been a key partner in training private and public health care
providers and has become one of the main actors in promoting quality HIV care in Namibia. The ability of
the Society will be further strengthened to respond to the need for continuous professional development
through regional branches. With the assistance from CP, the HIV Clinicians' Society will organize
professional development seminars, meetings and case discussions for at least 200 participants throughout
the country, including private and state practitioners and pharmacists. The Society will facilitate the
dissemination of scientific information and lessons learned to its members. For this purpose, CP will support
the capacity of HCS to organize training sessions and seminars, and facilitate networking among clinicians.
CP will support HCS by supporting the recruiting and the training of financial and administrative staff. On
strategic planning for PEPFAR indicators, provision of palliative care other than clinical palliative care will be
requested to report such activity. FBHs provide facility-based clinical palliative care as well prevention
palliative care. To expand the services, CP is planning to initiate spiritual care provision in the FBHs for the
HIV patients and their families. The first step is to train clergy on HIV related issues and link these skilled
clergy to the ART sites. During COP08, CP with its affiliates will train 12 clergy from different congregations
using the African Palliative Care Association (APCA) training manual. The clergy will serve in the faith-
based hospitals and other hospitals whenever needed to provide spiritual care to the HIV patients and their
families.
CP will continue supporting its local partners on managerial, financial and administrative capacity through
training of their staff. During COP 08, CP will train 24 staff from the 11 different organizations/partners. CP
will cooperate with PACT as some of the CP partners are also partners to PACT. In LL/CL, in order to build
the capacity of child presenters and producers in the radio programme, skills building sessions are held 8
times per year in areas of broadcasting training, personal growth and peer counseling. In FY07 they will be
offered gender training using sessions from the Men and HIV curriculum and by FY08 will include topics
which challenge risk-related gender norms. With CP staff actively involved in the National Male
Circumcision task force, the drive towards full scale up of safe MC as part of a comprehensive prevention
package within the 5 FBHs by COP 08 will be achieved through strong advocacy for the MoHSS to finalize
a policy guideline. The task force is currently paving the way for front-end analyses that will be followed by
national stakeholder consultation meetings before full fledged MC implementation. CP will play a major role
in the advocacy campaign and share with HIV clinician society, UNAIDS and WHO in the technical
response to the media with correct information dissemination, evening lectures, national training on MC
SOP in line with WHO/UNAIDS/JHPIEGO Technical Manual and ultimately service delivery.
CP and its partners will ensure the performance improvement and the quality of services will be of high
standard through continuous supervisory and support visits and reports from trained staff and their
organizations in different program areas.
Activity Narrative: IntraHealth/Namibia, the Capacity Project is expecting as a result of its FY06/ 07 capacity building process t
