AID/W is in the process of awarding a new Partnership for Health and Development Communication

(PHDC) cooperative agreement, the follow-on to the Health Communication Partnership. The mechanism

utilized will be a leader with associates. Duration of the award is for 5 years and the geographic scope is

worldwide. It is envisioned the award will be made in September 2007. In FY 2007, USG/Namibia allocated

funding to PHDC to support initial behavior change communication (BCC) capacity building, program

design, implementation, and monitoring and evaluation, to be made available to all PEPFAR-supported

partners in Namibia as appropriate.

The purpose of the award is to integrate agency-wide and inter-agency programming in BCC for strategic

health and development priorities, including BCC programs in health: family planning, child health, maternal

health, HIV/AIDS, and infectious disease. PHDC will focus on developing evidence-based, scaled-up BCC

programs, building in-country capacity and ensuring sustainability, integrating BCC programs in the wider

public health and development communities, and generating and sharing lessons learned.

Among the challenges and cross-cutting issues PHDC will address are coordination with USAID and other

USG collaborating agencies , host-country programs and other donors, foundations and alliances;

implementing programs to improve interpersonal communication among health care personnel and support

initiatives to improve the quality of health care including community involvement and oversight, exploit

innovations in information and communication technology with particular emphasis on working with mass

media to incorporate health information at minimal cost and ensure sustainable coverage, develop a clear

understanding of the determinants of human behavior and appropriate strategies to influence human

behavior in the defined areas of interest.

Areas for strengthening BCC among PEPFAR-supported partners include building knowledge among senior

and field staff in state-of-the-art approaches to behavior change, BCC theories and models, and how to

apply these theories and models in effective, cost-efficient interventions; building knowledge among

managers of BCC programs both in the public and private sectors so they may skillfully recognize

successful BCC programming, needed key elements, and appropriate costs; building skills in tailoring

programs and messages effectively to target audiences with a focus on moving beyond merely transferring

knowledge to influencing factors that impact behavior change; developing and standardizing training

curricula and manuals, and making sure that training for staff successfully evolves into top job performance

via long-term supervision and mentoring, with on-the-job evaluation and support; applying evidence-based

best and promising practices in the design, implementation and evaluation of mass media and interpersonal

BCC; and coordinating a national strategy for defining and reaching target audiences by region, risk factors,

and other factors; creating appropriate messages; ensuring high quality coordination between partners; and

synchronizing BCC breadth and depth between ongoing mass media campaigns and on-the-ground

interpersonal communications activities.

During FY 2008, the winning consortium will provide BCC capacity building for all PEPFAR-supported

partners in Namibia, and continue to implement activities during FY 2009. Although the approach and

technical assistance plan will be developed in partnership with USG Namibia, the PEPFAR-supported

partners and the GRN, possible activities might include the following: a national BCC capacity

building/mentoring program which would include a participatory assessment of BCC skills of those partners

that currently implement community-and-clinic-based BCC programs, and application of results to their

prevention programs; intensive on-site skill building with senior and field-level staff to convey in-depth

understanding of BCC models, theories, and application in the form of concrete interventions; intensive post

training, on-the-job mentoring, and supportive supervision for designing and testing interventions by

appropriately applying theories/models for already trained staff; an increased technical support/guidance

during programming planning, such as with annual work planning, and M&E and quality assurance plans;

facilitation for and coordination of a national BCC technical working group whose role might include

standardization and coordination of BCC messages, curricula, and incentive schemes; complementary

targeting of audiences; and sharing of resources, best practices, and lessons learned; media collaboration

to build sustainable capacity to incorporate health programming; and/or a feasibility study to explore working

with Namibian institutions of higher learning (nursing schools, etc.) to develop quality undergraduate and

graduate courses in BCC.

USG/Namibia will also investigate the possibility of conducting an evaluation looking at the application of

quality assurance and performance improvement models to BCC programs. Another evaluation possibility is

the design and measurement of mentor-based capacity building models that use blended learning

approaches to build sustainable Namibian capacity in all aspects of programmatic BCC design and

implementation.

AID/W is in the process of awarding the new Communications for Change (C-Change) cooperative

agreement, the follow-on to the Health Communication Partnership. The mechanism utilized will be a leader

with associates. Duration of the award is for 5 years and the geographic scope is worldwide. It is envisioned

the award will be made in September 2007. In FY 2007, USG/Namibia allocated funding to PHDC to

support initial behavior change communication (BCC) capacity building, program design, implementation,

and monitoring and evaluation, to be made available to all PEPFAR-supported partners in Namibia as

appropriate.

The purpose of the award is to integrate agency-wide and inter-agency programming in BCC for strategic

health and development priorities, including BCC programs in health: family planning, child health, maternal

health, HIV/AIDS, and infectious disease. PHDC will focus on developing evidence-based, scaled-up BCC

programs, building in-country capacity and ensuring sustainability, integrating BCC programs in the wider

public health and development communities, and generating and sharing lessons learned.

Among the challenges and cross-cutting issues C-Change will address are coordination with USAID and

other USG collaborating agencies , host-country programs and other donors, foundations and alliances;

implementing programs to improve interpersonal communication among health care personnel and support

initiatives to improve the quality of health care including community involvement and oversight, exploit

innovations in information and communication technology with particular emphasis on working with mass

media to incorporate health information at minimal cost and ensure sustainable coverage, develop a clear

understanding of the determinants of human behavior and appropriate strategies to influence human

behavior in the defined areas of interest.

Areas for strengthening BCC among PEPFAR-supported partners include building knowledge among senior

and field staff in state-of-the-art approaches to behavior change, BCC theories and models, and how to

apply these theories and models in effective, cost-efficient interventions; building knowledge among

managers of BCC programs both in the public and private sectors so they may skillfully recognize

successful BCC programming, needed key elements, and appropriate costs; building skills in tailoring

programs and messages effectively to target audiences with a focus on moving beyond merely transferring

knowledge to influencing factors that impact behavior change; developing and standardizing training

curricula and manuals, and making sure that training for staff successfully evolves into top job performance

via long-term supervision and mentoring, with on-the-job evaluation and support; applying evidence-based

best and promising practices in the design, implementation and evaluation of mass media and interpersonal

BCC; and coordinating a national strategy for defining and reaching target audiences by region, risk factors,

and other factors; creating appropriate messages; ensuring high quality coordination between partners; and

synchronizing BCC breadth and depth between ongoing mass media campaigns and on-the-ground

interpersonal communications activities.

During FY 2008, the winning consortium will provide BCC capacity building for all PEPFAR-supported

partners in Namibia, and continue to implement activities during FY 2009. Although the approach and

technical assistance plan will be developed in partnership with USG Namibia, the PEPFAR-supported

partners and the GRN, possible activities might include the following: a national BCC capacity

building/mentoring program which would include a participatory assessment of BCC skills of those partners

that currently implement community-and-clinic-based BCC programs, and application of results to their

prevention programs; intensive on-site skill building with senior and field-level staff to convey in-depth

understanding of BCC models, theories, and application in the form of concrete interventions; intensive post

training, on-the-job mentoring, and supportive supervision for designing and testing interventions by

appropriately applying theories/models for already trained staff; an increased technical support/guidance

during programming planning, such as with annual work planning, and M&E and quality assurance plans;

facilitation for and coordination of a national BCC technical working group whose role might include

standardization and coordination of BCC messages, curricula, and incentive schemes; complementary

targeting of audiences; and sharing of resources, best practices, and lessons learned; media collaboration

to build sustainable capacity to incorporate health programming; and/or a feasibility study to explore working

with Namibian institutions of higher learning (nursing schools, etc.) to develop quality undergraduate and

graduate courses in BCC.

USG/Namibia will also investigate the possibility of conducting an evaluation looking at the application of

quality assurance and performance improvement models to BCC programs. Another evaluation possibility is

the design and measurement of mentor-based capacity building models that use blended learning

approaches to build sustainable Namibian capacity in all aspects of programmatic BCC design and

implementation.

All capacity building inputs provided to implementing partners will be in the form of training of trainers

(TOT), and these inputs are counted as direct targets. Each organization's TOT will then train their

constituents, which is captured in this submission as indirect targets, but reported directly by each partner.

The impact of this investment is widespread and contributes considerably to building sustainable capacity in

BCC planning, implementation and design by Namibian partners and organizations. Partners for which the

program will provide support include all current prevention partners (DAPP, MOHSS community counselors,

Potentia-supported regional supervisors and case managers, The Capacity Project and supported partners,

PACT and PACT-supported partners, SMA, Nawa Life Trust, Project Hope, URC, AED, CORD, and TBD

partners (Alcohol). The coverage of this program will be national as it will work across USG agencies,

implementing partners, and the Government of the Republic of Namibia line Ministries and offices.

Additionally, the program will coordinate closely with special initiatives, including gender, alcohol,

Prevention with Positives and male circumcision (Activities 12342.08, 17057.08, 4737.08. 16762.08) to

ensure all BCC strategies are consistent in quality and messages and sufficiently adapted to the Namibian

context. The strong behavior change elements involved in programs focused on changing male norms and

increasing male involvement in aspects of prevention, care and treatment, as well as reducing violence,

sexual coercion and cross-generational sex will be important emphasis areas of this BCC component.

The program will liaise closely with the USG/SI team in Namibia to ensure that there is optimum

understanding, adaptation, and integration of results and recommendations into the service delivery and

communications programs from program evaluations, PHEs, the BSS+ and KAP studies as appropriate.

Activity Narrative: AID/W is in the process of awarding the new Communications for Change (C-Change) cooperative

This is a new activity for FY 2008 that will implement data auditing for community based partners focused

on prevention. It will leverage prevention activities particularly those being supported through Development

Assistance People to People (DAPP) (activity 7356)

This activity is intended as both an external audit of community-based partners who work in prevention and

a data quality audit, with a capacity-building focus on improving services and data quality among these

partners (it may be expanded to other partners in the future). To date, because PEPFAR initially

emphasized the rapid roll-out of services, community-based prevention partners have not been subject to

either sort of audit. Now that roll-out of prevention services has occurred to some extent, the time is ripe to

ensure that these partners are implementing audit-worthy prevention services and collecting and reporting

audit-worthy data. This approach seems consonant with PEPFAR's current focus on ensuring the quality of

services being delivered and with its longstanding emphasis on ensuring data quality, which has so far been

somewhat neglected.

The data quality audits will contribute to Strategic Information by helping to ensure that the results we are

reporting both up and down the information chain are trustworthy. The program audits will contribute to the

Prevention Program Area by ensuring that the prevention services being delivered meet minimum

standards of quality.

The partner for this activity is to be determined, but the auditor would be external to the organizations being

audited. Rather than this being solely an auditing activity, however, the auditor would be carefully chosen

and briefed on their intended role as both auditor and capacity-builder, as has been done in South Africa,

for instance, where data quality assessments have served both auditing and capacity-building functions.

Also following the lead of South Africa, we intend for the auditor to issue compliance notices to each partner

who is in serious breach of compliance with mandatory guidelines (to be established). Each partner will

have a specified amount of time - and technical assistance from the USG country team - to get their

programs in compliance, or risk losing funding. Naturally, getting partners in compliance will be done via

close conversations with the partners themselves, so that losing funding should rarely occur.

The program audits will include (but not be limited to) an assessment of the following: (1) Does the activity

have clearly defined goals, objectives, target behaviors, and target audiences? (2) Do the approaches used

by partners reflect best or promising practices? (3) Is there adequate supportive supervision and quality

monitoring during all phases of the project? (4) Does the partner make best use of existing resources within

its implementation community and actively link into referral systems? The data quality audits will include

(but not be limited to) an assessment of the following: (1) Is the partner accurately collecting and

appropriately storing the source data? (2) Are the records kept accurately reflected by the reports? (3) Are

quality control measures in place for aggregating and reporting on data? (4) Are results being used to make

program decisions? (5) Are results shared both up and down the information-flow system, so that they

directly feed into both appropriate action (up) and an appreciation for the importance of data collection and

reporting (down)? (6) Are reports being generated in a timely and user-friendly manner?

Although COP08 will be the pilot for this activity, Global Fund-Namibia is already doing data assessments

with some of its partners, so there should be opportunities for wrap-arounds in the future. In fact, the data

quality audits proposed here will be based in part on the methodology Global Fund uses for its data quality

assessments. Provided the pilot audits go well, the audits will be expanded beyond prevention programs to

include those community-based partners working in palliative care, with orphans and vulnerable children,

and providing treatment services. The program synergies are currently between SI and Prevention, but

would expand as the audits expand to include other program areas. The synergy will result in SI getting

better data from its partners and in prevention program ensuring that quality services are being offered and

reaping the benefits of improved data for decision-making in prevention.

The populations indirectly targeted are the general population, youth, most at-risk populations (MARPs),

and persons living with HIV/AIDS (PLWHAs), since they are the focus of prevention programs in Namibia.

The more directly targeted populations are the staff of the prevention partner organizations themselves.

The emphasis areas are local capacity building (in that improved capacity for delivering high-quality

services and collecting high-quality data should result); strategic information (in that higher quality data

should be collected and reported as a result of this activity); and PHE/targeted evaluation (in that this is a

targeted evaluation of prevention programs' quality of service and quality of data).