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
NEW/REPLACEMENT NARRATIVE
I-TECH/University of Washington's PMTCT Activities will include: (1) sponsoring joint Ministry of Health and
Social Services (MOHSS), Global Fund (GF), and PEPFAR support visits to at least 50 PMTCT sites; (2)
continuing to roll out digital video conference (DVC) training on the new PMTCT guidelines to reach all
appropriate health care workers; (3) providing refresher training on PMTCT to health care workers; and (4)
adapting and integrating infant feeding counseling tools into existing training curricula.
PMTCT is a national and USG priority. In FY08 187 health facilities in Namibia provided PMTCT services.
The program focuses on primary prevention of STI's including HIV in women of reproductive age;
prevention of unintended pregnancy in HIV-infected women; prevention of mother-to-child transmission
through the use of antiretroviral (ARV) medicines and other practices such as exclusive breastfeeding or
exclusive replacement feeding; provision of comprehensive care to HIV infected women and their partners;
and early diagnosis for infants. A national opt out testing strategy was adopted and integrated within the
national PMTCT guidelines and training curriculum in 2004.
1. The PMTCT program receives funds through different partners including the Global Fund (GF) and the
USG. In COP08 I-TECH provided technical support to the National Health Training Center (NHTC) to train
453 nurses on the provision of PMTCT services. To strengthen the quality of service provision at facility
level, I-TECH has conducted 25 support visits thus far and will conduct another 25 by the end of funding
year. With COP09 funds, I TECH will continue to support a minimum of 50 joint PMTCT site visits by the
MOHSS and the GF. The purpose of these joint visits is to provide on-site supportive supervision and to
identify challenges and gaps that the healthcare workers may have encountered with program
implementation.
2. In COP08 the MOHSS updated its PMTCT guidelines and has introduced a more effective regimen in
line with the World Health Organization (WHO) recommendations. The recommended ARV regimen for
PMTCT prophylaxis is AZT from 28 weeks or as soon as possible thereafter; single dose of nevirapine (SD-
NVP) and AZT/3TC at the onset of labor and single dose NVP to the baby after delivery; and further AZT
and 3TC for seven days postpartum to both mother and baby. To ensure consistency and quality of service
provision, I TECH has updated the training materials accordingly and will continue to conduct a series of
DVC sessions to orient health care workers on the new guidelines in FY 09.
3. Basic PMTCT training will continue to be supported by GF. I-TECH, in collaboration with MOHSS and
the GF, will develop a three-day refresher curriculum to update PMTCT service providers who were trained
in the original curriculum and will train at least 100 HCW through FY08. Due to the complex nature of the
new ARV prophylaxis regimen, it is anticipated that a large number of PMTCT service providers will require
updating. To complement the basic PMTCT training conducted by the GF, I-TECH will continue to provide
refresher training to at least 100 health care workers in COP09.
4. The national recommendation for HIV-positive women is to encourage exclusive breastfeeding for the
first four months for mothers who may not meet the AFASS criteria. It is therefore essential that healthcare
workers are equipped to support mothers to make informed decisions and to provide appropriate
information about breastfeeding techniques, the management of breastfeeding problems and safer sex
practices. I-TECH will strengthen this by providing support in revising the adapted infant feeding counseling
tools and integrating them into the training curricula for health workers use during infant feeding counseling
sessions in COP09.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16217
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16217 3871.08 HHS/Health University of 7384 1065.08 I-TECH $459,240
Resources Washington
Services
Administration
7354 3871.07 HHS/Health University of 4387 1065.07 I-TECH $390,831
3871 3871.06 HHS/Health University of 3133 1065.06 I-TECH $204,487
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $459,240
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
This activity includes two primary components: (1) developing and training case managers and expert
patients, and (2) training clinical and security staff within correctional systems.
1. ITECH will train case managers to deliver and support HIV prevention services within public sector
health facilities.
In COP08, Potentia was funded to recruit and hire 34 clinical case managers. Case managers will fall in the
chain of command of the Ministry of Health and Social Services Directorate of Special Programmes' Case
Management Unit. I-TECH's training will be built on successful case management models and will
incorporate:
a. Counseling on ART adherence
b. Prevention with Positives counseling
c. Coaching of patients regarding notifying and referring partners for HIV counseling and testing
d. Following-up of patients who "slip through the cracks" (defaulter tracing)
e. Facilitating support groups
f. Identifying resources and making patient referrals to other health and social services, including counseling
for drug/alcohol treatment and domestic violence
g. Encouraging men to seek services and to support their partners and children in doing the same.
Some delays have occurred in the start-up of this activity in 2008. These delays resulted from discussions
regarding merging this case management program with the work being done by voluntary "expert patients"
who provide supportive services to other patients, including navigating the facility- and community-based
services, adherence, and disclosure. The newly envisioned case management program will have these
expert patients working alongside case managers with backgrounds in psychology or social work. Both
case managers and expert patients will be trained by I-TECH.
2. In 2008, CDC supported an extensive review of HIV and TB activities within the correctional system of
Namibia. A team of correctional health experts from CDC Atlanta, and Namibia made numerous
recommendations to strengthen the HIV and TB services within correctional facilities. One recommendation
was to provide basic TB and HIV training to clinical and correctional staff so that they can have a higher
suspicion of HIV and TB; knowledge and skills to diagnose the diseases; and, where appropriate, link the
prisoners to counseling, testing and treatment services. I-TECH will train 80 correctional staff with COP09
funds.
For all trainings above, funding will include curricula development, printing costs, and equipment and
supplies. Additionally, I-TECH will be charged with logistical coordination for providing training, either by
digital video conferencing or in-person. In-person costs will include travel, housing, and meals and
incidental expenses for trainers and trainees.
Continuing Activity: 16758
16758 16758.08 HHS/Health University of 7384 1065.08 I-TECH $178,000
* Addressing male norms and behaviors
Estimated amount of funding that is planned for Human Capacity Development $103,418
Table 3.3.03:
This activity includes one primary component: training of health care service providers on practical clinical
skills to conduct male circumcision.
The Namibian government has responded to the compelling evidence that male circumcision (MC) has a
role to play in HIV prevention. The Namibian Demographic and Health Survey (DHS) results indicate that
the overall circumcision rate in Namibia among males aged 15 to 49 years is 21%. Cultural differences are
thought to underlie the considerable variability in MC rates between regions. Following an in-depth review
process, policy legislation on MC is currently being drafted for approval in Parliament. Once the necessary
legal framework is in place, I-TECH will complete the training of 25 service providers first initiated in FY08. I
-TECH will continue this activity in FY09 with training of an additional 40 health care workers who will be
involved in the MC initiative. The health care workers to be trained on MC will be identified with the
assistance of the Male Circumcision Task Force, and the MOHSS. Training on MC will include practical
surgical and clinical skills but will also focus on MC as part of counseling and testing, active exclusion of
STIs and their syndromic management where required, MC after care, as well as promotion of consistent
and correct condom use. I-TECH will work closely with Jhpiego, an international, non-profit health
organization affiliated with Johns Hopkins University, to replicate an initial Jhpiego/WHO Regional Skills
Course on Male Circumcision held in Zambia. The course covers medical aspects, before and after care,
and counseling and testing. Based on this course, I-TECH will develop a curriculum for Namibia. In
addition, I-TECH will create a follow-up support tool to ensure quality assurance as assessed through
supervisory post-training visits conducted by MOHSS.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $203,400
Table 3.3.07:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS
I-TECH will be supporting the same activities with the following modifications:
•I-TECH, in collaboration with the MOHSS, will develop a new prevention curriculum for a training which will
integrate PwP, STI, post-exposure prophylaxis, isoniazid preventive therapy, male circumcision, and
cervical cancer screening.
•I-TECH will assist the Ministry of Health and Social Services to develop a Five- Year Nutrition Strategy
•I-TECH will provide technical assistance on child growth monitoring promotion.
Please review the COP08 narrative:
This activity continues from COP07 and includes technical support for four elements: (1) Integrated
Management of Integrated Management of Adult Illness (IMAI) and Integrated Management of Childhood
Illness (IMCI) for facility-based palliative care for persons living with HIV/AIDS, (2) Strengthening the
integration of prevention strategies into HIV/AIDS training, (3) Clinical management of opportunistic
infections, and (4) Integration of nutrition efforts
(1) IMAI and IMCI. National leadership and implementation for facility-based palliative care for PLWHA is
outlined in Namibia's IMAI and IMCI Guidelines, which are based on the WHO IMAI and IMCI frameworks.
In COP 2007, I-TECH and APCA supported the Ministry of Health and Social Services (MOHSS) with
further development of the IMAI palliative care module to reflect the Namibian context and integration of
palliative care expertise from other African countries. Implementation and training will likely begin in
COP2008. This will include training of trainers (TOT) for nurses; adapting HIV-care related patient education
materials for use in facilities and communities; in-service and regional trainings that target the IMAI roll-out
sites; and on-site support visits to IMAI sites from Potentia staff.
Technical training and technical support will also be provided to health providers in the private sector in
partnership with the MOHSS and the HIV Clinicians' Society. Results will include nurse provision of
palliative care services at facility levels and improved linkages to community-based palliative care services,
including management of clients who are not yet eligible for ART and clients who have received their first
six months of ART at hospital-based Communicable Disease Clinics (CDCs).
Technical advancement for pediatric care will continue to be provided by the MOHSS pediatric care and
treatment training program and the MOHSS IMCI program. In combination with the other IMAI modules and
pediatric curricula, health care workers (HCWs) will be able to address key elements of the preventive care
package for adults and children (cotrimaxole prophylaxis, TB screening and INH prophylaxis, integrated CT,
HIV child survival interventions, clinical nutrition, HIV prevention strategies), other OI management, ART
adherence, routine clinical monitoring and systematic pain and symptom management. Costs associated
with the IMAI program are shared with I-TECH activities.
(2) Strengthened Integration of Prevention Strategies into HIV/AIDS Training. This component builds on
current efforts to strengthen HCWs ability to employ prevention strategies for HIV-infected adults and
children such as integrating simplified, age-appropriate messages on prevention, family planning, alcohol
reduction, STI care, and referrals to other health and social services.
HCWs play a key role in helping clients to reduce HIV risk behavior and are willing to address prevention
strategies for HIV-infected persons, but they are often constrained by a lack of information, training and
clarity on messaging. ART sites lack comprehensive guidelines/protocols and educational materials, as well
as a formal referral system for family planning, among other services. Sexually transmitted infections (STI)
remained a major challenge in Namibia; according to government reports more than 7.5% of Namibians
contract an STI each year and a total of 67,414 new STI cases were reported in 2006. STIs are
syndromically managed and surveillance is entirely paper-based, so these figures are unable to paint the
true picture of the STI burden in Namibia.
While the MOHSS established an STI control intervention for syndromic management, this program
receives relatively limited support from partners and little progress has been made in reducing the burden of
STIs in recent years. In addition, existing STI guidelines (which are currently being revised for an
anticipated 2008 release) and training modules lack appropriate prevention messaging, family planning and
guidance on support for disclosure of STIs, including HIV status. With COP08 funds, I-TECH is
collaborating with the MOHSS STI division to update its training to include appropriate information and
guidance on prevention messaging, disclosure, reduction in alcohol use and gender-based violence.
With COP 2008 funds, to update HCWs' knowledge and skills to reduce the burden of STI in Namibia, I-
TECH will use the updated training to conduct 20 ToTs and seven regional trainings, resulting in 260 trained
HCWs from 13 regions. In addition, with COP2008 funds I-TECH will "Namibianize" and disseminate
Information Education and Communication (IEC) materials developed by other sources. I-TECH has also
partnered with MOHSS' Primary Health Care Division to develop a family planning/HIV training module and
related IEC materials that will be incorporated in the PMTCT and ART guidelines training. This work will be
expanded in COP 2008 to include training of 50+ HCWs on prevention for HIV-infected persons and the
provision of FP and STI care for PLWHA. These "Prevention with Positives" (PwP) trainings have been
developed using materials from CDC's PwP Initiative.
(3) Clinical management of Opportunistic Infections. Clinical management of OIs is essential to the well-
being of clients living with HIV/AIDS. In COP2007, I-TECH trained 90 government physicians and
pharmacists in clinical management of opportunistic infections and 55 private practitioners will also have
received such training by the end of COP2008. I-TECH will also participate in the MOHSS revision of the
National Guidelines for the Clinical Management of HIV and AIDS. With COP2008 funds, I-TECH will
provide training for an additional 75 government physicians and pharmacists and 40 private practitioners
Activity Narrative: based on the new MOHSS guidelines.
(4) Nutrition: Routine nutrition counseling, assessment and monitoring of malnourished PLWHA and
children affected by HIV continue to be a challenge in Namibia. There is a critical need to build Namibian
capacity as there are very few public sector nutritionists and only one dietician in the country. Through
PEPFAR funding, I-TECH has placed a nutrition advisor in the MOHSS who has developed and
implemented a four day training program on HIV/AIDS and clinical nutrition for HCWs. Results to date
include 217 trained HCWs who recognize nutrition as a key component in delivering effective HIV treatment,
care, and support services. I-TECH also integrated clinical nutrition into several other HIV curricula,
including ART, management of opportunistic infections, dried blood spot PCR testing for early infant
diagnosis, TB training for nurses, pediatric HIV training for physicians, and PMTCT.
In COP 2008, I-TECH will continue support for the nutrition advisor who will support the MOHSS in
oversight of training and skills development in HIV/AIDS nutrition management, safe infant and young child
feeding, and improved technical support and monitoring of trained HCWs. The advisor will ensure
implementation of the monitoring tools and IEC materials developed in partnership with the Food and
Nutrition Technical Assistance (FANTA) Project in FY 2007 as well as ensure procurement of training
materials and anthropometric monitoring equipment for ART sites. The advisor will also support appropriate
implementation of the MOHSS and Red Cross nutrition program which includes referrals for nutritional
supplementation for adults and children on ART.
To enhance regional nutrition expertise, I-TECH will recruit and deploy two regional nutrition mentors via
Potentia. Under the supervision of the MOHSS and the nutrition advisor, the mentors will guide initial and
follow-up training, provide on-site clinical support and follow up visits and serve as key technical assistance
(TA) for the many community-based food and nutrition projects. To ensure sustainability, regional nutrition
mentors will be absorbed into MOHSS staff. Continuation of the four-day training for health workers is
essential and COP 2008 funds will support training for additional 175 health workers from the 13 regions.
With funding from the Clinton Foundation for ready-to-use therapeutic feeding (RUTF) and roll-out of a pilot
program in COP2007, I-TECH will also support five regional trainings for HCWs to identify and treat severe
acute malnutrition (SAM) in HIV-infected children. The goals are to improve early detection of HIV status,
timely management of (SAM) with leveraged RUTF food support, entrance to pediatric ART, and referrals
and treatment of HIV-related conditions in HIV infected children.
As part of a USG-supported partnership between I-TECH, MOHSS and the FANTA Follow-On Project, an
extended nutrition and HIV course will be developed in COP2008 to equip at least 13 regional HCWs to
strengthen and supervise clinical nutrition in ART sites. These workers will focus on supervising clinical
nutrition assessment, improving counseling on safe infant and young child feeding, expanding education on
managing HIV symptoms and effective nutritional management with ART. Development of the course will
begin in COP2008.
For the newly funded certificate program in nutrition at the University of Namibia (UNAM) I-TECH will
provide a trainer to facilitate the short-course, materials and secure training venue; the FANTA Follow-On
Project will provide TA for development of the course. The certificate program will result in a longer-term
cadre of Namibian professionals with a high level of nutritional knowledge who will fulfill the consistent
clinical nutrition human resource gaps for the MOHSS and other line Ministries, NGO and private sector
partners.
Continuing Activity: 16218
16218 3841.08 HHS/Health University of 7384 1065.08 I-TECH $697,852
7349 3841.07 HHS/Health University of 4387 1065.07 I-TECH $638,515
3841 3841.06 HHS/Health University of 3133 1065.06 I-TECH $381,037
Estimated amount of funding that is planned for Human Capacity Development $565,042
Table 3.3.08:
PHE: Improving Clinical Outcomes Through Patient Education
Estimated amount of funding that is planned for Public Health Evaluation $376,519
Table 3.3.09:
I-TECH will support the same activities with the following modifications:
• I-TECH, in collaboration with the Ministry of Health and Social Services, will develop a new curriculum for
a comprehensive prevention training which will integrate PwP, STI, post-exposure prophylaxis, isoniazid
preventive therapy, and male circumcision into one course. This course will be used to roll-out prevention
with persons living with HIV and AIDS throughout Namibia. Namibia is participating in the centrally-funded
PWP initiative. The curriculum and job aids used in this initiative will be modified and adapted for this new
course.
• I-TECH will develop a concise practical on-site training course for nurses and doctors to enhance their
skills in doing PAP smears for cervical cancer screening. Clinical Mentors and Nurses Tutors in the regions
will pilot the training in three sites, training six nurses/doctors per site. Following the pilot training, training
will be done in six further sites, six participants per site.
This area includes the following components: (1) Training of health care workers, (2) Support for I-TECH
clinical mentors, (3) Training for public and private physicians and pharmacists, and (4) Support for task-
shifting and continued rollout of Namibia's Integrated Management and Adult Illness (IMAI) and Integrated
Management of Childhood Illness (IMCI) Guidelines.
1) Training of health care workers. Capacity building of doctors, nurses and pharmacists in ART is an
essential component to providing quality management of patients with HIV and it forms part of the package
offered by the International Training and Education Center on HIV (I-TECH) in collaboration with the
Ministry of Health and Social Services (MOHSS) and funded by the USG. Through 2007, I-TECH has
trained more than 6,300 health care workers (HCWs) in various HIV and AIDS topics. This number includes
nearly 2,000 physicians, pharmacists and nurses trained in ART, comprehensive pediatric HIV care,
tuberculosis (TB) and other opportunistic infections (OIs), and integrated management of adult and
adolescent illnesses (IMAI).
I-TECH provides in and pre-service training on HIV and AIDS for HCWs both in private and public settings.
It also provides MOHSS with curriculum and training material development experts and with development of
monitoring and evaluation systems for training in Namibia. In addition,
I-TECH provides MOHSS with technical advisors and clinical mentors (CMs) to provide on-site capacity
building and quality improvement for ART care through supportive supervision. With COP07 funds, I-TECH
supported four experienced HIV physicians as CMs in the major ART sites in four regions (Khomas,
Otjozondjupa, Oshana, Kavango). These CMs also provide mentorship in Ohangwena, Caprivi and
Omusati ART sites.
2)Support for I-TECH clinical mentors (CMs). In collaboration with MOHSS and the USG team, I-TECH will
second a fifth CM with COP08 funds. This CM will be assigned to Ohangwena region, home to 12.5% of
Namibia's population with an HIV prevalence rate of 27% and >3,200 HIV patients on ARVs. CMs provide
on-site clinical supervision and mentoring to ART sites by reviewing challenging cases with local doctors
and identifying aspects of the guidelines which are not operationalized by the local ART doctors. The CMs
then ensure appropriate guideline utilization and follow-up.
To ensure skills transfer and sustainability, CMs train recently qualified Namibian doctors to become ART
providers. CMs also assess training needs, and routinely provide didactic and hands-on training to address
knowledge and skills gaps. CMs review clinics to improve systems including rational patient flow to reduce
patient waiting time. They also promote a multi-disciplinary approach to HIV care, and support ART
pharmacists and nurses in their provision of ART services.
One recent achievement of the CM program is the systematic implementation of Isoniazid Preventive
Therapy (IPT) for eligible patients within the ART clinics, which resulted in >2,500 HIV-positive persons
starting IPT for TB. In COP08, the CM program will continue serving the initial seven regions. CMs will
continue to assist in HIV-related national physician training and to contribute to the development and
revision of HIV-related guidelines and training manuals. Moreover, as per MOHSS request, a sixth clinical
mentor will be recruited and deployed in Karas Region's major ART site, supporting ART sites in all its
districts. Karas Region has a population of 69,329 and an HIV prevalence rate of 23%.
3) Training courses for public and private physicians and pharmacists. To increase ART training capacity of
local physicians, I-TECH initiated one physician TOT course for 14 doctors with FY 2007 funds. This
activity will continue in COP08 with two physician TOT courses, one for 14 state doctors and one for 14
private doctors. With COP07 funds, I-TECH also updated the ART curriculum to be in line with the new
treatment guidelines. I-TECH will have carried out four ART in-service training courses, training 150
government physicians by the end of FY 2007.
With COP08 funds I-TECH will conduct four sessions of the four-day ART course for 120 government
physicians and pharmacists, and will also develop a curriculum for two-day advanced refresher course for
government doctors and pharmacists who have already taken the basic course. This curriculum will be
operationalized by conducting two refresher courses, each for 20 physicians and pharmacists.
Many working Namibians belong to medical aid schemes and some receive ART care from private doctors.
The regulation of the ART prescribing practices of private doctors is not yet well-established in Namibia. In
addition, private pharmacists often lack the appropriate training and knowledge to advise private doctors in
order to ensure appropriate ARV provision in line with the national guidelines. To overcome this challenge
and to ensure quality and unified ART service provision in both public and private settings, I-TECH has
provided training to 112 private doctors and pharmacists in collaboration with the Namibia HIV Clinicians'
Activity Narrative: Society.
With COP08 funds, I-TECH will, in collaboration with the MOHSS and the HIV Clinicians Society, develop a
basic ART training curriculum with pre- and post- test assessments targeting private doctors and will train
60 private doctors using this curriculum. I-TECH will further develop an advanced ART course for private
doctors and this course will be given to 40 private doctors and pharmacists. I-TECH will collaborate with a
USG-funded partner (Capacity Project) to implement this activity.
Program data at the end of March 2007 showed that 13% (ART-HIS) of patients on ART were children. A
variation between sites exists; in some sites only 3% of patients on ART were children. Anecdotal reports
from different sites suggested that some doctors were not comfortable treating children with ART. Thus
there is a need to train more health workers on this subject. With COP07 funds, in collaboration with local
pediatric experts, I-TECH has developed a comprehensive pediatric HIV care curriculum; to date 71 doctors
have been trained. With COP08 funds I-TECH will conduct four pediatric HIV care courses for 75
government doctors. I-TECH will develop a curriculum targeting private doctors and 25 private doctors will
receive this training. In addition, I-TECH's clinical team will provide supportive supervision for the newly
trained doctors with on-site technical assistance.
3)Rollout of task-shifting, IMAI and IMCI. With COP07 funds I-TECH assisted the MOHSS to adapt World
Health Organization (WHO) IMAI and IMCI guidelines, training manuals and information education and
communication (IEC) materials to support and expand the decentralization of ART services in Namibia.
The IMAI and IMCI programs support the delivery of ART within the context of primary health care, based at
first-level health facilities. This strategy entails task shifting from specialized to less specialized health care
workers, from doctors to nurses and from nurses to community counselors. Thus far I-TECH has trained 24
district managers, 20 trainers of trainers, 32 service providers, and 13 expert patient trainers, all of whom
will be deployed within four pilot health facilities in four regions. Expert patients are PLWHA on HAART, who
are trained to portray patients in role plays and to give feedback to health workers on their skills. With
COP08 funds, I-TECH will conduct eight IMAI/IMCI regional training courses for 125 HCWs.
I-TECH has recruited a nurse mentor who will provide technical assistance for IMAI/IMCI implementing sites
and four additional nurse mentors will be recruited and deployed in the roll-out sites in FY 2008.
Furthermore, I-TECH will integrate IMAI/IMCI content within National Health Training Center and University
of Namibia pre-service curricula. Patient adherence to treatment is known to be the most important factor
determining the clinical outcome of ART. With COP07 funds, I-TECH supported an update of the
adherence counseling curriculum as well as conducted one TOT and five regional training courses, training
a total of 120 HCWs. With COP08, I-TECH will continue to provide support to MOHSS in Adherence
Counseling, covering the costs of ongoing review of the curriculum and one TOT plus five regional trainings
for 145 HCWs.
Continuing Activity: 16221
16221 3866.08 HHS/Health University of 7384 1065.08 I-TECH $1,872,980
7350 3866.07 HHS/Health University of 4387 1065.07 I-TECH $1,503,562
3866 3866.06 HHS/Health University of 3133 1065.06 I-TECH $666,287
Estimated amount of funding that is planned for Human Capacity Development $1,408,949
• I-TECH will develop a new nutrition training curricula to train Health Care Workers to effectively monitor
growth of children.
• I-TECH will assist the MOHSS Primary Health Care Directorate to develop a Five-Year Plan for Nutrition.
• I-TECH will sponsor five local health care workers (physicians/nurses) to visit the Botswana pediatric
center of excellence and to take part in a two-week on-site training at a high-performing pediatric clinic.
• I-TECH will procure additional pediatric textbooks and materials to assist with capacity development and
training in pediatric care.
Activity Narrative: National Guidelines for the Clinical Management of HIV and AIDS. With COP2008 funds, I-TECH will
based on the new MOHSS guidelines.
Estimated amount of funding that is planned for Human Capacity Development $188,347
Table 3.3.10:
• Five local health care workers (physicians/nurses) will be sent to the Botswana pediatric center of
excellence for a 2 week on-site training at a high-performing pediatric clinic.
• Additional pediatric textbooks and materials will be procured to assist with capacity development and
training in pediatric treatment.
essential component to providing quality management of adult and pediatric patients with HIV and it forms
part of the package offered by the International Training and Education Center on HIV (I-TECH) in
collaboration with the Ministry of Health and Social Services (MOHSS) and funded by the USG. Through
2007, I-TECH has trained more than 6,300 health care workers (HCWs) in various HIV and AIDS topics.
This number includes nearly 2,000 physicians, pharmacists and nurses trained in ART, comprehensive
pediatric HIV care, tuberculosis (TB) and other opportunistic infections (OIs), and integrated management of
adult and adolescent illnesses (IMAI).
Namibia's population with an HIV prevalence rate of 27%. Ohangwena has >3,200 HIV patients on ARVs,
of which 15% are pediatric patients. CMs provide on-site clinical supervision and mentoring to ART sites by
reviewing challenging cases with local doctors and identifying aspects of the guidelines which are not
operationalized by the local ART doctors. The CMs then ensure appropriate guideline utilization and follow-
up.
Society.
Activity Narrative: USG-funded partner (Capacity Project) to implement this activity.
Table 3.3.11:
This is a continuing activity and includes: (1) TB and TB/HIV co-management training for public and private
physicians and pharmacists, (2) salary support for clinical mentors who promote and teach HIV/TB
integration practices, (3) TB and TB/HIV training of trainers for nurses, (4) salary support for an Integrated
Management of Adult and Adolescent Illness (IMAI) nurse mentor, and (5) community-based Directly
Observed Therapy (DOT) training for field supervisors.
Namibia is ranked second in the world for prevalence of tuberculosis (TB) with a rate of 717 cases/100,000
population (WHO 2008 report). TB/HIV co-infection is also a major challenge in Namibia. In 2007, 54% of
TB patients nationwide were tested for HIV, and of those patients, 59% were HIV-positive. The Ministry of
Health and Social Services (MOHSS)'s 2006 TB Management Guidelines supported the Directly Observed
Therapy Short Course (DOTS) strategy with increased community involvement, introduced the use of Fixed
Dose Combination (FDC) medication to improve adherence, emphasized the need to screen all TB
suspects for HIV, to screen all HIV clients for TB and to provide Isoniazid Preventive Treatment (IPT) to all
eligible persons with HIV, among other initiatives. As of May 2008, Namibia had reported 300 cases of
Multidrug Resistant TB (MDR TB) with at least 12 cases of Extremely Drug Resistant TB (XDR TB). With
technical assistance from I-TECH, MOHSS produced "Revised Guidelines for the Management of MDR TB,
Poly-Resistant TB, and Mycobacterium other than TB (MOTT)" in which additional second line medicines
were approved and some infection control recommendations were made. I-TECH, in collaboration with the
MOHSS, revised the TB curriculum for physicians and pharmacists in line with the new guidance.
The I-TECH training activities in COP 2009 will be done in collaboration with others working on TB-HIV
training activities, including: the Global Fund, MOHSS, and Tuberculosis Control Assistance Program
(TBCAP).
1. By the end of 2008, 75 state doctors and pharmacists and 60 private practitioners will have been trained
in the updated curriculum on management of TB. In COP09, I-TECH will conduct three TB training courses
for 60 government medical officers and pharmacists and two courses for 30 private practitioners. In
addition to these trainings there will be four Advanced ART courses where Advanced TB and TB/HIV co-
management will be included as part of the curriculum, as mentioned already in the Adult Care and
Treatment section.
2. With COP08 funds, I-TECH supported four experienced HIV physicians as Clinical Mentors (CMs) who
provided mentoring in eight of the 13 Regions in Namibia (see Adult Care and Treatment section). In
COP08, CMs mentored health care workers (HCWs) on ensuring HIV testing of all TB suspects, TB
screening of all HIV clients and provision of IPT to all eligible HIV clients. Another area of focus was
enhancing the awareness of district HCWs on the need for TB infection control and what simple measures
could be implemented to achieve better control. CMs assisted districts to identify and implement possible
improvements such as advocating with management for keeping patients with active TB separate from
people with HIV/AIDS, separating patients with MDR TB from other patients, enhancing air exchange by
keeping windows open and installing reverse flow fans in strategic windows on the TB wards, encouraging
HCWs to wear respirator masks when working with patients with active TB, and having patients wear
surgical masks when appropriate. In COP09, I-TECH, in collaboration with the MOHSS, will expand its
involvement in improving TB infection control to all other district hospitals covered by CMs and will also
focus on strategies for outpatient departments. HIV testing of all TB suspects and patients, and provision of
IPT to all eligible HIV positive clients will continue to be promoted.
3. The TB program receives funds through different partners including Global Fund (GF) and the USG. TB
trainings for nurses are mainly funded through GF. In FY08 482 nurses were trained at the regional level
with funds provided by GF. I-TECH provided training materials for all the trainings. In COP09, I-TECH will
continue to support TB trainings by training an additional 20 training of trainers and continue to provide
associated training materials. I-TECH will provide training materials for the training of 340 nurses in TB (17
training courses). Nurses in the private sector see many patients but often lack the necessary knowledge
and skills to recognize and manage TB according to the National Guidelines. By the end of 2008, I-TECH
will have trained 80 private nurses in the management of TB. In COP09 I-TECH will continue this activity
and will conduct four courses for a total of 80 private nurses as requested by the National Tuberculosis
Control Program (NTCP).
4. The Integrated Management of Adult and Adolescent Illness (IMAI) program includes training in TB/HIV
primarily aimed at nurses. In COP08, I-TECH recruited an IMAI nurse mentor who provides on site clinical
supervision and ensures appropriate guideline utilization in the provision of care and treatment. The IMAI
nurse mentor will continue in COP09.
5. Community-based DOT is an important part of the Directly Observed Treatment Short course (DOTS)
strategy supported by the MOHSS in its efforts to combat TB/HIV. Field supervisors are stationed at district
level in most regions of Namibia. They supervise the work of TB field promoters (stationed at health
facilities) who in turn manage the DOT supporters for individual patients with TB/HIV within the community.
A gap has been identified by MOHSS whereby the field supervisors and TB field promoters have been
trained by different NGOs and MOHSS staff, resulting in incomplete and non-standardized understanding of
TB/HIV management. By the end of COP08 I-TECH will have developed standardized training materials for
training the field supervisors as training of trainers, allowing them to go to the field and train the TB/HIV field
promoters working in their facilities. Training materials will include a standard curriculum as well as flip
charts derived from the training curriculum for field supervisors to use in their training. After the
development of the materials, I-TECH will then conduct two training courses to train 34 field supervisors in
2008. In COP09 I-TECH will continue to support this activity by training an additional 34 field supervisors.
Continuing Activity: 16219
16219 3870.08 HHS/Health University of 7384 1065.08 I-TECH $387,500
7353 3870.07 HHS/Health University of 4387 1065.07 I-TECH $206,818
3870 3870.06 HHS/Health University of 3133 1065.06 I-TECH $115,487
* TB
Estimated amount of funding that is planned for Human Capacity Development $387,500
Table 3.3.12:
I-TECH/University of Washington components of this activity include: (1) training of health care workers in
the provision of counseling and testing (CT), couples counseling, and rapid testing; (2) training of physicians
in provider-initiated testing and counseling (PITC); (3) training of new community counselors and refresher
training for existing community counselors; and (4) development of a curriculum for provision of counseling
and testing and psychosocial support for children.
Quality HIV Counseling and Testing (CT) services are an essential component of successful HIV and AIDS
programs. As access to antiretroviral treatment is scaled up in Namibia, there is a critical opportunity to
simultaneously expand access to HIV prevention, which is paramount in turning the tide of Namibia's HIV
epidemic. Without effective HIV prevention, there will be an ever increasing number of people who will
require HIV treatment. HIV counseling and testing services stand out as the primary interventions which
play a pivotal role both in treatment and in prevention.
Increased access to HIV testing and counseling is essential to promoting earlier diagnosis of HIV infection.
This can in turn maximize the potential benefits of life-extending treatment and care, and allow people with
HIV to receive information and tools to prevent HIV transmission to others.
In Namibia, as in many other low and middle income countries, the primary model for HIV testing has been
the provision of client-initiated voluntary counseling and testing services. Increasingly, provider-initiated
approaches in clinical settings are being promoted (i.e. health care providers routinely initiating an offer of
HIV testing in a context where the provision of, or referral to, effective prevention and treatment services is
assured).
The current reach of HIV testing services remains low in Namibia. This is mainly due to a shortage of
skilled health care workers nationally. Only a small percentage of those who need voluntary counseling and
testing, because they may have been exposed to HIV infection, have access to it. Even in settings in which
voluntary counseling and testing is routinely offered, such as programs for prevention of mother-to child
transmission, the number of people who avail themselves of these services remains low.
Concerned by persistent late diagnoses of HIV infection and a high proportion of people with HIV who are
unaware of their HIV status, and in light of evidence that people who are aware of their HIV status reduce
risk behaviors, the Ministry of Health and Social Services (MOHSS) of the Republic of Namibia has
introduced provider-initiated HIV testing and counseling (PITC) in all public health facilities in the country.
PITC can be an important addition to the range of approaches available for scaling up HIV CT and
facilitates access to HIV treatment, prevention, care and support services.
Stigma and discrimination continue to deter people from having an HIV test. To address this, the
cornerstones of HIV testing scale-up must include improved protection from stigma and discrimination as
well as assured access to integrated prevention, treatment and care services. The conditions under which
people undergo HIV testing must be anchored in a human rights approach which protects their human rights
and pays due respect to ethical principles. Young people require special attention to their needs through
the provision of confidential youth friendly health services.
To achieve this program objective and to contribute to the PEPFAR prevention goal, I-TECH (through
Potentia) recruited and deployed a Counseling Programs Advisor to the MOHSS Counseling and Testing
Unit. The main role of the advisor is to assist the MOHSS in developing effective HIV CT guidelines and
training materials as well as to provide supervision to the training agency subcontracted by the MOHSS to
train counselors. The advisor also trains health care workers and community counselors
To date more than 1000 health care workers have been trained and are offering CT services in health
facilities country wide. A total of 525 community counselors have been trained to date and are
complementing health care workers (HCWs) in offering CT services. I-TECH has collaborated with the
MOHSS in integrating the PITC component into the CT guidelines as well in the training materials.
Furthermore, I-TECH has helped the MOHSS develop a national community counselor training curriculum
that is now being used as the standard curriculum for the training of HIV community counselors nationwide,
including those staffing public facilities and outreach units (new in FY 2009 COP).
With the FY 2009 COP funds, I-TECH will train 250 health care workers (HCWs) on the provision of CT
services and 250 HCWs on the provision of couple counseling. An additional 200 HCWs will be trained on
HIV Rapid Testing. Fifty doctors will be trained in PITC to enable them to make an offer of CT to patients.
Furthermore, in FY 2009 COP, 100 community counselors will be trained and deployed to health facilities
on a national level. With FY 2009 COP funds, I-TECH will develop a child counseling curriculum which will
be a stand alone course to guide the provision of CT services for children as well as guide service providers
on the provision of psycho-social support to children infected and affected by HIV.
Continuing Activity: 16220
16220 3868.08 HHS/Health University of 7384 1065.08 I-TECH $480,924
7351 3868.07 HHS/Health University of 4387 1065.07 I-TECH $397,518
3868 3868.06 HHS/Health University of 3133 1065.06 I-TECH $270,987
Estimated amount of funding that is planned for Human Capacity Development $480,924
Table 3.3.14:
In FY2009 COP, this continuing activity will support seven components: (1) training workshops in various
health sector tools; (2) training workshops in monitoring and evaluation (M&E); (3) training workshops in
health information systems; (4) workshops for review of existing M&E frameworks and plans; (5) support for
basic program evaluation of the Integrated Management of Adult and Adolescent Illnesses (IMAI) approach;
(6) System for Program Monitoring (SPM) trainings; and (7) data triangulation:
The Ministry of Health and Social Services (MOHSS), Response Monitoring and Evaluation (RM&E) sub-
division is tasked via the Medium Term Plan III (MTP-III) to monitor the effectiveness of Namibia's HIV/AIDS
response. The MTP-III, which covers the time period from 2004 - 2009, outlines a comprehensive vision to
combat HIV/AIDS in Namibia. The RM&E unit is tasked with collecting and reporting on the data necessary
from the relevant stakeholders to monitor the HHIV/AIDS response. The RM&E unit has developed a
strategic M&E plan, the purpose of which is to guide the country's response through the use of critical
information on core indictors. However, inadequate human resources, insufficient funding, and lack of
technical capacity have hindered the country's ability to develop and implement a cohesive and effective
national M&E system.
This activity will focus on training to support the RM&E unit of the National AIDS Program and the National
Health Information System (HIS) unit in building capacity for the collection, analysis, and reporting of
surveillance and routine health information related to HIV/AIDS. Training workshops will build capacity in
personnel working directly or indirectly for the MOHSS to collect, summarize, analyze, and disseminate
HIV/AIDS, TB and STI strategic information, and thus advance the USG priority to use SI for program and
policy improvement. This activity will leverage USG-supported technical advisors, equipment, and
personnel provided to the MOHSS with PEPFAR and Global Fund support and relates to a variety of other
activities focused on data quality and use.
To support these efforts, the USG will use the expertise of I-TECH, which has been supporting the MOHSS
in training healthcare workers in skills and theory related to HIV/AIDS since 2003. I-TECH, in collaboration
with CDC, will assist the MOHSS in coordinating training workshops, on data collection and processing, for
those responsible for M&E/HIS around the country. I-TECH will assist the MOHSS in coordinating travel,
venue, accommodations, and meals for the workshops listed below, while technical instruction and
facilitation will be the responsibility of topic-area specialists.
I-TECH will also continue to support and strengthen the M&E capacity of partners such as the University of
Namibia (UNAM) and National Health Training Centers (NHTC) as well as the Regional Health Training
Centers.
These funds will support the following sub-activities:
1. Training workshops in various health sector tools. This is a continuing activity from FY2004 COP -
FY2008 COP. The USG will support six central training workshops, with 15 persons per training, including
data clerks and HIS officers. The training will build their data entry, management, and reporting capacity so
that they will be proficient in using the MOHSS management information systems for
ART/PMTCT/VCT/TB/STI. Data clerks, analysts and other selected participants of these workshops will
also receive Training of Trainers (TOT) so they can give workshops in the regions where they work. This
activity will train a total of 120 people.
2. Training workshops in M&E. This sub-activity is a continuation from FY2008 COP. The USG will
support one national training workshop for MOHSS personnel (national and regional) and selected partners
to build their capacity in the theory and practice of M&E for HIV/AIDS programs. Persons from other line
ministries involved in HIV/AIDS, as well as other key partners, will also be trained. I-TECH will provide for
travel, accommodations, and meals for participants as well as the meeting facilitators. This activity will
support the training of 30 people.
3. Training workshops in health information systems. This sub-activity is a continuation from FY2007 COP.
The USG will support six regional workshops to build capacity in the electronic Namibian Routine Health
Information System. Each regional training workshop will last five days and will accommodate 15
participants. Regional training workshops will place in Tsumeb, Otjiwarongo, Windhoek, Oshakati, Rundu,
and Swakopmund. These training courses will build capacity for health information systems officers to use
the National electronic system. This activity will support the training of a total of 180.
4. Workshops for the review of existing M&E frameworks and plans. Monitoring and evaluation of the
HIV/AIDS/TB response is guided by nationally approved guidelines and a framework to organize
implementation of these guidelines. Though the national guidelines provide broad M&E direction, it is critical
that sub-national (regional and organizational) M&E plans be developed and implemented. This activity will
support five workshops to review the national M&E plan and to review, develop where needed, and
implement regional and institutional M&E plans.
5. Support basic program evaluation of IMAI. The MOHSS in Namibia has adopted the IMAI approach to
realize expansion and decentralization of ART services. This strategy entails task shifting from specialized
to less specialized health care workers, from doctors to nurses, and from nurses to community counselors.
The task of prescribing treatment and monitoring patients living with HIV has shifted from doctors to nurses
at first level facilities. In FY2009 COP, I-TECH will roll out IMAI to an additional 32 sites. In order to assess
the impact of IMAI, I-TECH will collaborate with the MOHSS to evaluate its effectiveness and use the results
to modify the program to more effectively decentralize services and improve their quality.
6. System for Program Monitoring (SPM) trainings. This activity will support M&E training activities for
program implementers and program managers, including key personnel from all government sectors
involved in HIV/AIDS activities as well as relevant non-government organizations. With the assistance of a
Activity Narrative: Regional M&E expert, an M&E curriculum for the country was developed based on international standards
and the criteria used by PEPFAR, Global Fund, UNAIDS and the National AIDS committee (NAC). The
SPM is the system by which all non-health sector HIV/AIDS related activities are reported through the
Ministry of Regional and Local Government to the NAC. The national M&E tools will also be covered in
these training workshops. A total of six trainings will be supported with 15 people per training, for a total of
90 people trained.
7. Data Triangulation. An aspect of this activity that is continuing from FY2008 COP is data triangulation.
Through the University of Washington partnership with the University of California San Francisco (UCSF), I-
TECH will continue to assist with the data triangulation exercise which was started in collaboration with
UCSF, the MOHSS, UNAM and CDC. The aim is to build capacity in Namibian program officers, M&E
personnel, and the academic and research community to triangulate data from multiple sources, including
surveillance, program data, and special studies. This triangulation activity will provide much needed
information which will be used to address key program and policy questions.
Triangulation is a short-hand term for synthesis and integrated analysis of data from multiple sources for
program decision making. It is a powerful tool used to demonstrate program impact, identify areas for
improvement, direct policy changes, and direct new and enhance existing programs. It strengthens
understanding of complex health issues and provides support for making evidence-based public health
decisions. The goal of this activity is twofold: to conduct the country-driven data triangulation process to
answer key questions prioritized by the country team, and to build the long-term in-country capacity of local
stakeholders to use data from multiple sources to provide an evidence base for program and policy decision
-making.
The process is guided by the in-country team, led by the MOHSS, and in close collaboration with USG staff.
The first stage of the triangulation exercise has been completed, priority questions have been identified, and
a task-force formed. The activity will move forward to the next stages of gathering source documents,
synthesizing data, and organizing a stakeholder workshop for joint analysis and interpretations of data. The
MOHSS and CDC agree that this exercise will be valuable in order to take advantage of the vast amount of
data that are currently gathered annually to answer country-specific questions. This continuing
collaboration is important to build in-country capacity in the methods used to conduct triangulation and will
ultimately allow for the in-country team to continue with the triangulation process to answer future questions
that can be used for decision-making. The in-country team and the Triangulation Task Force who will all
benefit from this capacity-building exercise in the methods of data triangulation will total 35 people.
Continuing Activity: 16223
16223 3872.08 HHS/Health University of 7384 1065.08 I-TECH $965,089
7355 3872.07 HHS/Health University of 4387 1065.07 I-TECH $313,807
3872 3872.06 HHS/Health University of 3133 1065.06 I-TECH $13,728
Estimated amount of funding that is planned for Human Capacity Development $900,000
Table 3.3.17:
This activity includes I-TECH's training and technical support to: (1) Namibia's digital video conferencing
(DVC) network, (2) the University of Namibia's nurses training program, (3) the Ministry of Health and Social
Services' (MOHSS) National and Regional Health Training Centers, and (4) MOHSS' Directorate of Special
Programmes.
1. Digital Video Conferencing (DVC) I-TECH, with support and technical assistance from CDC and other
partners, has been using DVC to save time and resources and to bridge distances to inform, train and work
with people in remote locations simultaneously. DVC has provided opportunities to rapidly share and build
on practical experience by allowing those who have been trained to give rapid feedback to trainers and to
address local challenges by consulting with colleagues throughout the country. Benefits arise from reduced
travel time, lodging, fuel and travel costs and significant increases in the number of people trained and
updated on policy guidelines.
With PEPFAR funds, the necessary components for a successful DVC program are in place and the
program is expanding. Program components include the installation of equipment (camera system and
peripherals) in a network of training centers and hospitals, staff trained to operate and communicate through
the equipment, informational materials adapted for videoconferencing and regional visits by the DVC
technical team to provide technical support and maintain equipment. The topics addressed using DVC
include: ART, PMTCT, VCT, OI, TB, nutrition, and psycho-social issues related to HIV and AIDS as part of
pre-service and in-service training carried out by I-TECH and partners. Since the start of the DVC
Programme, 125 sessions have been held, with a total attendance of 5,869.
Activities during FY2009COP will strengthen and expand the partnership between MOHSS, I-TECH, CDC
and other partners in using DVC for training and managing HIV and related health problems. DVC will
continue to be used for training events, meetings, interviews, budget discussions, curriculum reviews and
communicating prevention strategies, as well as for dealing with management issues.
There are currently 12 DVC sites across the country. Six of these sites are based at Health Training
Centres (Windhoek, Keetmanshoop, Otjiwarongo, Oshakati, Rundu, Engela), one at the MOHSS
Directorate of Special Programmes (Windhoek), two at hospitals in Katima Mulilo and Opuwo, one in the
MOHSS Regional Directorate office in Swakopmund, one in Luderitz Hospital, and one at the I-TECH office
as a testing site. Two new sites are going on-line at the Grootfontein Hospital and the Onandjokwe Training
College for Nurses.
With FY2008COP funds, I-TECH developed training materials and manuals for DVC operators. The DVC
team also successfully hosted the second annual DVC Technical Conference, where over 40 participants
attended. The team also achieved great success in presenting the second Annual DVC Film Festival which
showcases African films with HIV themes.
With FY2009COP funds, four new DVC sites will be initiated, which will ensure coverage in all thirteen
regions for the first time. DVC operators will be recruited and employed by I-TECH for all sites outside the
Health Training Network (where Resource Centre Assistants are already employed by I-TECH). This will
begin to develop local capacity for DVC. It is anticipated that these positions will eventually be absorbed
into the future MOHSS staff establishment. These operators will be trained alongside staff responsible for
operating the equipment at all 13 Regional Councils.
With FY2009COP funds, I-TECH will also improve communications between national and regional sites with
the installation of internet connections, including wireless connections at NHTC, and provision of conference
phones. DVC operators at new sites will receive laptops. DVC activities and schedules will be posted on a
DVC Website to be designed and managed by the I-TECH DVC Technician. I-TECH will expand the
capabilities of existing systems by procuring additional equipment including spare parts, laptops and
microphones. I-TECH will also assist the MOHSS IT Department in building its capacity.
I-TECH will increase participation by creating more links between health facilities, NGOs and other line
Ministries in the prevention of HIV infection and the provision of services. DVC will continue to target public
and private sector healthcare workers but also increase participation from multiple sectors through the
involvement of Regional AIDS Coordinating Committees (RACOCS).
To ensure sustainability and national capacity building, the DVC network is now largely managed by
Namibians. The DVC Team is headed by the I-TECH DVC Manager, supported by a DVC Program
Advisor, who liaises with the Head of Information Services at the National Health Training Centre (NHTC),
as well as with Resource Centre Assistants at regional sites. Technical support is provided by the I-TECH
DVC Technician.
An assistant to the DVC Manager will be employed by I-TECH to enable proper management and
harmonization of the expanding National DVC Network together with the Distance Learning Program. I-
TECH plans to strengthen the use of DVC within the Pre-Service sub-division of NHTC and the 13
RACOCs.
The DVC Technician, with support from I-TECH and CDC Systems Administrators, will manage and
maintain DVC equipment using an ‘Integrated Logistics Support Plan' designed by the DVC Technical
Consultant. DVC Assistants and Operators will continue to liaise with the I-TECH DVC Manager and the
Head of Information Services at NHTC to implement the program by inviting local audiences and assisting
in moderation, as well as assisting local presenters to prepare materials for DVC sessions. They will work to
draw more participants from districts outside the main towns where the equipment is located.
The DVC Technical Advisory Group will continue to promote the use of DVC in Namibia and explore how to
get better service from equipment suppliers and service companies through technical consultations,
Activity Narrative: research and an annual DVC Technical Conference. Exploration of DVC/IT technical capabilities, creative
applications and further evolution of the program will continue to be supported by the DVC Technical
Consultant and the DVC Program Advisor. Plans are underway to institutionalize this working group under
the auspices of the MOHSS, possibly within the information technology unit.
The DVC Schedule will expand from an average of 91 to 150 events per year and increase annual
attendance from 3,681 in FY2008COP to 5,000 in FY2009COP. Participation in events will diversify to
include more line Ministries, NGOs and community workers involved in HIV and AIDS activities. Due to
unforeseen difficulties experienced with repairing DVC equipment in FY2008COP, these targets will not be
increased from COP2008COP levels.
FY2009COP topics and training will continue to cover subjects in core HIV and AIDS curricula (ART,
PMTCT, laboratory, OI, TB, HCT/RT, IMAI,Nutrition, etc) and provide opportunities for specialists to reach
remote sites. As courses or programs evolve, new topics will be included. Pre-service HIV and AIDS
training of HCWs through NHTC will develop further to involve interaction between students at different sites
through joint lessons and debates. Quantitative and qualitative evaluation data will be collected and
regularly entered into the DVC database, which will be further refined to document and assess impact and
to improve the program.
2. University of Namibia (UNAM). The HIV/AIDS epidemic in Namibia has posed challenges to tertiary
institutions in general and to the University of Namibia in particular, because tertiary institutions have the
potential to be an instrument of change and can also play an active role in mitigating the impact of
HIV/AIDS.
Nursing education at UNAM is striving to improve the quality of nursing education, and ultimately improve
the quality of HIV nursing care provided. However, inadequate comprehensive training on HIV/AIDS
prevention, care, and treatment for most practicing doctors, nurses, and pharmacists still remains an
obstacle to rapid scale-up of quality programs. Since FY2004COP, PEPFAR has funded I-TECH to
collaborate with the MOHSS to address this gap by increasing the capacity of pre-service nurse training
programs at UNAM. I-TECH provides a technical advisor, training and curriculum experts, and pre-service
lecturers for the institution.
In FY 2007 COP, I-TECH provided technical assistance to integrate HIV content into both the existing four-
year pre-service Diploma in Nursing and Midwifery Sciences program and the Advanced Diploma Course in
Health Promotion, Clinical Diagnosis, Treatment, and Pharmacotherapy. I-TECH then oriented over 20
UNAM lecturers on the revised curriculum and trained over 25 lecturers in physical examination. The
integrated curriculum enhances the production of more knowledgeable and skilled professional nurses in
HIV/AIDS and TB care. In addition, this training will likely reduce HIV transmission resulting from unsafe
medical practices.
To ensure the implementation of the new curriculum and to strengthen HIV/AIDS and TB integration into pre
- and in-service training., I-TECH recruited and deployed, via Potentia, three Assistant Lecturers (Clinical
Instructors) at UNAM campuses in Windhoek and Oshakati to teach and to follow up with students at their
clinical sites.
UNAM has increased its intake of nursing students in response to the severe shortage of skilled health care
workers and needs continued support in the classroom and clinical training settings. To meet this need, I-
TECH upgraded two part-time lecturer positions to full time and recruited and deployed two additional
clinical instructors and one lecturer via Potentia. In addition, I-TECH has continued to conduct orientation
workshops for UNAM lecturers. Furthermore, to enhance the quality of pre-service education, I-TECH has
continued to support training activities aimed at building capacity of lecturers in HIV/AIDS care. I-TECH
also procured computers, LCD projectors, printers and furniture, and training materials such as anatomical
charts and textbooks on physical examination.
In FY2009COP, I-TECH will support the integration of IMAI & palliative care, STIs and the revised PMTCT
Guidelines into the pre-service curriculum. In addition, I-TECH will support development and integration of
HIV /AIDS content into the Clinical Instructors Curriculum which is a new Certificate Course.
I-TECH will recruit and deploy three Lecturers to strengthen UNAM's School of Public Health and three
Assistant Lecturers to assist in teaching the Clinical Instructors course.
Other I-TECH activities in support of UNAM will include:
- Procuring a vehicle to support site visit activities. These support activities are essential to reinforce transfer
of learning and to enhance clinical follow-up of students.
- Providing training activities aimed at building capacity of lecturers in HIV/AIDS care.
- Procuring standard office equipment, including a photocopier , a fax machine, a scanner, furniture,
computers, and printers.
- Providing training to faculty in HIV/AIDS and its subsets.
- Offering refresher courses to faculty in line with revised National Guidelines.
- Conducting orientation workshops in newly developed assessment tools.
- Continuing to revise the Advanced Diploma curriculum
- Supporting the development of assessment/M&E tools.
- Hiring an administrative assistant to provide routine office support to the staff at UNAM.
3. National Health Training Center and Regional Health Training Centers (NHTC and RHTCs). Since
FY2004COP, PEPFAR has funded I-TECH's collaborate with the NHTC and its five RHTCs to train new and
existing health care workers (HCWs) in HIV/AIDS, including pediatric care and treatment. I-TECH provides
NHTC with technical advisors, training and curriculum experts, and pre and in service tutors.
I-TECH also provides technical assistance to integrate HIV content into the two-year course for NHTC's
enrolled nurses' certificate course. The two-year course was adapted to suit the training needs of auxiliary
nurses with ten or more years of practical experience. This course requires revision in FY2009COP in order
to meet the needs of the new incoming class of students which will include those who have not completed
Activity Narrative: secondary school and have no prior experience.
The MOHSS has increased its intake of students at NHTC and RHTCs in response to the severe shortage
of health care workers and needs continued support in the classroom and clinical setting. With
FY2009COP funds, I-TECH will continue to support activities that cut-across all program areas and are
linked with personnel support provided by Potentia.
I-TECH support to NHTC and RHTCs will include:
- Hiring 20 pre- and in-service tutors within the NHTC and RHTCs, via Potentia, to meet programmatic
needs
- Hiring five additional pre-service tutors within NTCS and RHTCs, via Potentia
- Procuring additional vehicles and a photocopier to support the delivery of training and site visit activities
- Sponsoring two staff persons to attend regional long-term training in instructional design.
4. MOHSS Task-shifting Pilot. With FY2009COP funds, I-TECH will use its cadre of clinical mentors to
assist the MOHSS' Directorate of Special Programmes with establishing pilot sites for task-shifting ART
services from doctors to nurses. These pilots will be based on existing task-shifting successes in Rwanda
and other countries. In these models, physicians see only new patients, pediatric patients, and patients with
complications. All other patients are managed by nurses who have access to physician consultation by
phone at any time and in person at least once per week. Models from other countries have demonstrated
that such patients managed by nurses do as well, if not better, than patients managed by physicians.
Continuing Activity: 16224
16224 3869.08 HHS/Health University of 7384 1065.08 I-TECH $622,985
7352 3869.07 HHS/Health University of 4387 1065.07 I-TECH $373,257
3869 3869.06 HHS/Health University of 3133 1065.06 I-TECH $242,487
Estimated amount of funding that is planned for Human Capacity Development $597,985
Table 3.3.18:
