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
This continuing activity has two main components: (1) support for a CDC PMTCT technical advisor (TA)
placed in the Ministry of Health and Social Services (MOHSS), and (2) support for two PMTCT field support
nurses who cover the northern regions of Namibia and are based at Oshakati State Hospital.
USG will to continue to work closely with MOHSS at the national, regional and service levels in the 34
health districts to provide technical expertise during the roll-out and strengthening of PMTCT services, to
monitor the implementation at existing service delivery sites, and to support expansion of services from 238
facilities currently providing PMTCT services to all 258 antenatal care (ANC) sites nationally.
Namibia began PMTCT services in early 2002 at two public hospitals. In late 2002, the Global AIDS
Program of HHS/CDC began its collaboration with Namibia's MOHSS by providing technical assistance in
PMTCT, VCT, TB/HIV, surveillance, and ART services. The overall responsibilities for coordinating and
rolling out of PMTCT services lie with the MOHSS Primary Health Care (PHC) Deputy Director in the Family
Health Division. A PMTCT Coordinator employed through the Global Fund and a full-time USG-supported
PMTCT TA assist the Deputy Director in carrying out these activities. The USG also supports training,
information systems, logistics and technical assistance to the national PMTCT program. Specific activities
include:
1. Support for a PMTCT Technical Advisor to the MOHSS. This position will support a national counterpart
in the PHC Directorate with PMTCT program roll-out, and will be involved with developing and revising
guidelines related to PMTCT. The training of health workers to build their competencies to be able to
deliver quality PMTCT services is an important area of responsibility for the PMTCT TA. The TA will assist
with curriculum development activities for PMTCT, early infant diagnosis of HIV, ART, Pediatric ART,
Integrated Management of Adult Illness (IMAI), infant feeding, and other related curricula. In addition,
supervisory support visits will be undertaken to provide mentoring and technical backstopping to the
regions. Monitoring the effectiveness of the PMTCT program is an ongoing activity through the MOHSS
Health Information System, and the TA will support the regions with utilization of information generated from
the PMTCT database.
2. Funding for two HHS/CDC PMTCT field support nurses who cover the northern regions and are based at
Oshakati State Hospital. Working with Ministry staff at the national, regional, and district level, these nurses
conduct crucial supervisory support visits to current and newly-operational PMTCT sites to provide on-site
monitoring, training, and assessment of the quality of services, patient flow, and record keeping as well as
to identify challenges and needs.
The roll-out of rapid testing in PMTCT also requires hands-on support to health facilities. The
CDC/Oshakati staff also support sites to integrate the wide range of HIV prevention, treatment, and care
services into the clinical setting and improve linkages with local non-governmental organizations (NGOs).
Approximately 25% of women do not deliver in health facilities and these nurse supervisors assist with the
identification and training of traditional birth attendants in PMTCT. They are stationed in Oshakati State
Hospital, the largest hospital in the north, where the MOHSS has allocated office space to HHS/CDC in
order to facilitate logistical, material, and technical support to the area.
The field nurses have been assisting health facilities in four regions (Oshana, Oshikoto, Ohangwena and
Omusati). In FY2009 COP they will expand their support to Kunene and Kavango regions. CDC/Oshakati
field nurses partner with other programs to identify needs, facilitate and implement supportive programs.
This activity leverages resources with the Global Fund, which is funding a PMTCT Coordinator, training,
diagnostic PCR testing, and three PMTCT trainers at the national level.
Pending clarification/approval from the OGAC PHE working group, CDC will continue to support a Public
Health Evaluation of infant feeding practices in the context of HIV. This activity will roll into 2009, but will be
supported by FY2007 COP funds, as well as Global Fund resources.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16238
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16238 3856.08 HHS/Centers for US Centers for 7390 1157.08 $416,648
Disease Control & Disease Control
Prevention and Prevention
7357 3856.07 HHS/Centers for US Centers for 4389 1157.07 $360,120
3856 3856.06 HHS/Centers for US Centers for 3128 1157.06 $108,986
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $559,448
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 one primary component: continuing support of a CDC Prevention Technical Advisor to
the Ministry of Health and Social Services (MOHSS) Directorate of Special Programmes on HIV prevention
and behavior change communication.
In late 2002, CDC's Global AIDS Program of HHS/CDC began its collaboration with Namibia by opening an
office in the MOHSS National AIDS Coordination Program (now known as the Directorate of Special
Programmes) to provide technical assistance in PMTCT, VCT, TB/HIV, surveillance, and ART services. In
response to requests from the MOHSS, CDC has gradually formed a team of technical advisors at the
national level, including two direct hires, and technical advisers in the areas of adult and pediatric
care/treatment, PMTCT, VCT, SI, palliative care, and laboratory services. While the MOHSS has made
substantial progress in terms of rolling out treatment, PMTCT, and VCT in the emergency phase of
PEPFAR, less attention has been given to establishing a comprehensive systematic national prevention
strategy based on best practices and evidence-based interventions.
In 2007, the Director of Special Programmes recognized the shortcomings and lack of leadership in
prevention and requested the support of a behavioral scientist to build local capacity in the use of evidence-
based approaches to design national prevention programs. This assistance is critical as it will come as the
MOHSS is staffing the "Expanded National Response" subdivision and implementing WHO's
Communication for Behavior Change Interventions (COMBI) program within the Directorate. Both of these
efforts focus on behavior change and strategic communications. Therefore, the local environment is well
suited for continued assistance from a USG Technical Advisor (TA) on prevention.
In 2008, the MOHSS hired a prevention coordinator for the first time with PEPFAR support. The MOHSS
prevention coordinator will provide technical leadership and vision on prevention issues and the USG
prevention advisor will work closely with his MOHSS counterpart to plan and implement prevention
programming.
The TA will work with the MOHSS to develop capacity to provide national leadership on the most evidence-
based prevention strategies available, including behavioral change interventions and medical interventions
(e.g. circumcision, microbicides, etc.) as they become available. The TA will support a process to adapt
best practices from other countries and to promote dissemination of best practices from within Namibia at
the national and international level. This will include ongoing support to the head of the Counseling and
Testing unit in the Directorate to roll out, monitor, and evaluate the Prevention with Persons Living with
HIV/AIDS (PwP) intervention through community counselors and health workers. The PwP initiative
incorporates "be faithful" messaging to discordant couples and thus contributes to AB efforts. This TA will
further support Namibia's Male Norms Initiative, with particular emphasis on:
a. defining and promoting strategies that result in abstinence or sexual postponement for adolescent boys,
b. male partner reduction,
c. greater willingness to access services,
d. transactional and trans-generational sex,
e. power inequities between men and women, and
f. abuse of alcohol.
The TA will also support efforts to streamline DAPP's training curricula for field officers and to harmonize
messaging with other in-country prevention efforts. The TA will work with DAPP to adopt curricula
incorporating AB messaging proven to be effective.
In a new initiative begun with COP08 funding, Potentia will hire and I-TECH will train 34 case managers with
psychology or social work backgrounds for deployment to ART and ANC sites throughout the country. The
TA will play a key role in developing scopes of work, hiring criteria, and selecting suitable candidates, as
well as for assisting I-TECH with developing a training curriculum for this cadre. These case managers will
contribute to AB efforts by facilitating support groups, providing couples and PwP counseling, and referring
clients for health and social services that can support prevention efforts.
Continuing Activity: 16239
16239 8001.08 HHS/Centers for US Centers for 7390 1157.08 $157,500
8001 8001.07 HHS/Centers for US Centers for 4389 1157.07 $150,000
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Increasing women's access to income and productive resources
* Increasing women's legal rights
* Reducing violence and coercion
Estimated amount of funding that is planned for Human Capacity Development $226,885
Table 3.3.02:
This activity includes one primary component: support for the replication and expansion of the National
Male and Female Leadership Conferences on HIV/AIDS.
In February 2008, the Ministry of Health and Social Services (MOHSS) convened a conference for
Namibian male leaders entitled "Namibian Men and HIV/AIDS, Our Time to Act." The meeting was chaired
by the President of Namibia, His Excellency Hifekepunye Pohamba. The goal of this meeting was to
engage male leaders in order to enhance their involvement in the response to the HIV/AIDS epidemic.
Through plenary and breakout sessions, the forum provided an opportunity for leaders to discuss the factors
that play a role in male involvement and to solicit their opinions on future activities that would attract and
involve men in HIV/AIDS activities. The meeting was attended by over 150 male leaders, including the
Prime Minister, parliamentarians, and ministers, as well as military, business, and religious leaders. Some
of the specific commitments made by men at the conference include:
a. Serving as role models for HIV testing,
b. Replicating the Male Conference at the regional level,
c. Promoting responsible drinking to consumers and alcohol vendors,
d. Exploring the role of male circumcision in HIV prevention,
e. Encouraging and supporting interventions developed by and targeted towards men, and
f. Integrating messages about HIV/AIDS in speeches.
Leaders raised the level of awareness about the relationship between men's behavior and the spread of
HIV, discussed ways in which men can participate in the response to the epidemic, and encouraged men to
make a strong commitment to prevent the spread of HIV.
In May 2008, UNAIDS and the MOHSS convened the first Namibian Women Leaders Conference on
HIV/AIDS. The conference provided a platform for female leaders to come together and discuss HIV/AIDS
and its impact in their homes and communities. The conference was initiated by the First Lady of Namibia,
Her Excellency Penehupifo Pohamba. The meeting was attended by political officials (Cabinet Ministers
and Deputy Ministers, Members of Parliament and National Council, Governors, Mayors/Deputy Mayors),
civil society leaders, private sector leaders, doctors, members of academia, etc. Female leaders came up
with numerous recommendations to address HIV on the personal, community, and national level.
Many male and female leaders who attended the conferences were motivated to participate in the May 9th
National HIV Testing Day.
In COP09, CDC will support the MOHSS with the replication of the National Male and Female Conferences
on HIV/AIDS as well as the rollout of similar conferences at the regional and district level. The replication of
the national conferences will help measure progress in achieving stated commitments and outline further
action items. The regional conferences will help attract traditional and community leaders.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $75,000
Table 3.3.03:
The funds from this activity cover 75% of salary and personnel-related costs for a Palliative Care Technical
Advisor to the Ministry of Health and Social Services (MOHSS). The remaining funds are reflected in the
Pediatric Care and Support (PDCS) program area.
The MOHSS is gradually shifting tasks from physicians to nurses, enabling nurses to provide palliative care,
and to manage clients not yet eligible for ART and those who have received their first six months of ART at
hospital communicable disease clinics. This transition is part of MOHSS' decentralization plans to support
comprehensive HIV/AIDS care for Namibian communities, as outlined in the Integrated Management of
Adult Illness (IMAI) and Integrated Management of Childhood Illness (IMCI) guidelines, which are based on
standards set forth by the World Health Organization (WHO). The IMAI and IMCI guidelines set forth a
framework for decentralized HIV/AIDS training, service delivery standards, and task shifting of care to
district and community levels. Namibia's 13 regions are anticipated to complete the roll-out of IMAI to
selected health centers and clinics in their catchment areas by 2009.
As a result of continued training and roll-out of IMAI and IMCI in Namibia, expertise in provision of care
services is improving. In FY 2006 COP, the USG and its partners, including the MOHSS, began receiving
technical assistance from the African Palliative Care Association (APCA) and a USAID Regional Technical
Advisor for HIV/AIDS Palliative Care. Support from APCA will continue in FY 2009 COP. While significant
program accomplishments are underway with this technical support, there remains a critical need to have
an in-country, experienced, full-time palliative care technical advisor who is dedicated to development,
decentralization, monitoring and evaluation of HIV-related palliative care in Namibia. The technical advisor
will assist with continued roll-out and quality assurance of HIV-related adult and pediatric care services,
including support for the national IMAI and IMCI programs. The position was first approved in FY 2007
COP through the CTSGlobal/Comforce mechanism. In FY 2009 COP, this position will be converted to a
locally employed staff (LES) position for a qualified Namibian.
In this position, the technical advisor will:
1. Directly support MOHSS care programming at facility levels, including support for implementation and
monitoring of IMAI and IMCI.
2. Support the current MOHSS Coordinator for Palliative Care and Opportunistic Services in the
Directorate of Special Programs to develop that individual's expertise and leadership.
3. Serve as a liaison to the MOHSS Case Management Unit's implementation efforts; CDC's HIVQUAL
Coordinator; the extensive I-TECH trainings and mentorship programs; the IMAI site nurses and their
referring district ART doctors.
4. Collaborate closely with the MOHSS Family Health Division, which is responsible for community-based
palliative care, clinical nutrition and family planning/HIV integration, as well as USG partners to address
other critical program gaps. This includes partnering with:
a. MOHSS' Nutrition Subdivision and I-TECH's Nutrition Advisor to ensure that developments in clinical
nutrition are well integrated into HIV/AIDS palliative care programs;
b. MOHSS' Family Health Division in the Primary Health Care Services Directorate and the Global Fund to
strengthen the delivery of community-home based care and the integration of palliative care at home and
community levels;
c. MOHSS ART sites, Central Medical Stores, and SCMS to address gaps in procurement and supply
chain management for home based care kits and essential palliative care medications.
The technical advisor will emphasize key palliative care priorities across program areas and will include the
provision of the preventive care package for adults and children which includes:
a. Cotrimoxizole prophylaxis for Stage III, IV disease or CD4<300 and for HIV-exposed/infected children,
b. TB screening and the "three Is" (infection control, isoniazid preventive therapy, and intensified case
finding),
c. Integrated counseling and testing,
d. Infant feeding counseling for HIV-positive mothers,
e. Child survival interventions for HIV-positive children,
f. Growth monitoring and immunizations,
g. Clinical nutrition counseling,
h. Anthropometric measurement, monitoring, referral, micronutrient supplementation and targeted nutrition
supplementation for severely malnourished people living with HIV and AIDS (PLWHA) who are on ART,
i. Prevention strategies which include balanced ABC prevention messaging, condoms, support for
disclosure of status, referral for PMTCT services, reduction in alcohol use and gender-based violence
including assistance as needed through government centers for abused women and children.
Key palliative care priorities also include other opportunistic infection management, ART adherence, routine
clinical monitoring, and systematic pain and symptom management. Closer partnerships with districts and
communities will allow increased opportunities to expand safe water and hygiene strategies as well as to
expand access to malaria prevention for PLWHA and their families. It is also anticipated that a complete roll
-out of IMAI task-shifting will ultimately result in MOHSS' development of a national palliative care policy
that allows nurses to prescribe narcotics and symptom-relieving medications. Technical support from APCA
(#8043) will support this activity.
The technical advisor will ensure gender-sensitive approaches, including equitable training and support of
male and female health care workers, with the goal of equal access to services for PLWHA and their
families throughout USG-supported programs.
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Table 3.3.08:
FY 2009 COP funds will be used to support: (1) Salary and personnel-related costs for CDC's HIVQUAL
Technical Advisor, and (2) a portion of the costs of general office management, travel and training related to
the continued rollout of the HIVQUAL program in Namibia.
Funding for HIVQUAL is split between HTXS, PDTX, HBHC and PDCS because the program focuses on
quality improvement of clinical services in all four areas.
1. HIVQUAL Technical Advisor. Funding for this activity will be specifically directed for HIVQUAL Namibia
in-country activities through the CDC/Namibia office and led by the HIVQUAL Technical Advisor. This
activity will expand on the HIVQUAL work which began in Namibia in FY 2007 COP to reach 16 ART sites.
In FY 2009 COP the program will add new sites throughout all 13 regions to reach all 34 public and faith-
based district hospitals. In addition, all health centers providing HIV care and treatment will be targeted
during FY 2009 COP. These funds will be used to support salaries and benefits for the locally based
HIVQUAL Technical Advisor.
Since FY 2007 COP, PEPFAR has funded a technical advisor to assist the Ministry of Health and Social
Services (MOHSS) with rollout of the HIVQUAL program via a non personal services contract. By FY 2009
COP, this position will be converted to a personal services contract (PSC). While increasing costs
somewhat, this conversion is necessary for two primary reasons: (1) to reflect the inherently governmental
functions of these positions, and (2) to rectify the double taxation of these positions by both the US and
Namibian governments. The double taxation results from the lack of a ratified bilateral agreement between
the two countries that covers non-PSC positions. While reducing taxation costs, this conversion will result
in increased ICASS costs.
2. HIVQUAL program administration, travel and training. FY 2009 COP funds will be used to support
general administration of the HIVQUAL program, as well as in-country travel for quality improvement (QI)
coaching and training costs related to rolling out the HIVQUAL program in adult treatment settings as
outlined below.
In FY 2009 COP, HIVQUAL activities will be conducted under the leadership of the MOHSS Directorate of
Special Programs (DSP) in close collaboration with the HIVQUAL Technical Advisor. The US-based
HIVQUAL team will provide technical support for quality improvement specifically in adult treatment. The
HIVQUAL project will support capacity building for QI for health facilities managed and supported by four
local organizations, namely MOHSS, Catholic Health Services, Lutheran Health Services, and Anglican
Health Services. The improved quality of care at these facilities is expected to benefit the estimated 71,900
adult patients on treatment by March 2010. These treatment estimates are obtained from the MOHSS HIV
estimates report released in June 2008 based on Spectrum projections.
Specific activities will include:
a. QI training;
b. Assessment of quality management programs at the participating clinics;
c. Performance measurement (at six-month intervals) of selected core indicators;
d. Ongoing QI coaching at participating sites;
e. Promotion of consumer engagement in HIV care;
f. Regular conference calls with the US-based team;
g. Development and dissemination of QI related IEC materials including the HIVQUAL International
Newsletter.
Planned activities will strengthen systems of care and documenting strategic information in health care
facilities. An important emphasis of this approach is to develop providers' skills for collecting and using
performance data within their own organizations to improve their systems of care. Use of facility-level data
derived from the national health information system for the purpose of improving quality is an important goal
of HIVQUAL.
HIVQUAL is uniquely facility- and region-specific. At the clinic level, QI methods can be adapted to each
organization's particular systems and capacities. An assessment tool to measure the capacity of the quality
management program at each facility is used which not only measures the growth of quality management
activities but also guides the coaching interventions. Aggregate facility-specific data can provide population
-level performance data that indicate priorities for national quality improvement activities and campaigns.
Publication and dissemination of these data will be done under the auspices of the MOHSS.
Regionally, networks of providers who are engaging in quality improvement activities can work together to
address problems that are unique to each area, including, for example, human resource shortages and
coordination of care among multiple agencies as well as adherence to care services. QI training will be
conducted for groups of providers. The project will work in partnership with all treatment partners who will
help disseminate QI improvement strategies and activities throughout their networks.
The concept of QI using the HIVQUAL model is still relatively new in Namibia. Consequently, a great deal
of in-person advocacy and training will be required to increase awareness and buy-in of the initiative by
health care providers at peripheral sites. Advocacy material for QI will be printed and disseminated to
health care facilities.
Effective leadership in quality and safety in health care means having access to the most recent information
and practical experience. The sharing of best practices is necessary to learn from each other's experiences
and promote quality improvement. The national coordinators of HIVQUAL under the Case Management
Unit of the MOHSS will thus participate in QI conferences to learn from others and share experiences.
Special Note: While not directly funded in this program area, CDC's Deputy Director of Programs will
Activity Narrative: further support the MOHSS' adult treatment activities. This position is funded under systems strengthening
and is currently vacant. The Deputy Director of Programs position will be held by a medical officer who will
spend most of his or her time working with the MOHSS Directorates of Special Programmes and Primary
Health Care to establish and rollout guidelines and policies as well as to provide field support and technical
assistance in the areas of PMTCT, VCT, TB/HIV, medical prevention, and adult and pediatric care and
treatment services.
Continuing Activity: 17364
17364 17364.08 HHS/Centers for US Centers for 7390 1157.08 $171,968
Estimated amount of funding that is planned for Human Capacity Development $444,073
Table 3.3.09:
The funds from this activity cover 25% of salary and personnel-related costs for a Palliative Care Technical
Advisor. The remaining funds are reflected in the Adult Care and Support (HBHC) program area
The Ministry of Health and Social Services (MOHSS) is gradually shifting tasks from physicians to nurses,
enabling nurses to provide palliative care, and to manage clients not yet eligible for ART and those who
have received their first six months of ART at hospital communicable disease clinics. This transition is part
of MOHSS' Integrated Management of Adult Illness (IMAI) and Integrated Management of Childhood Illness
(IMCI) guidelines, which are based on standards set forth by the World Health Organization (WHO). The
IMAI and IMCI guidelines set forth a framework for decentralized HIV/AIDS training, service delivery
standards, and task shifting of care to district and community levels. Namibia's 13 regions are anticipated to
complete the rollout of IMAI to selected health centers and clinics in their catchment areas by 2009.
These funds will support a technical advisor to the MOHSS for continued roll-out and quality assurance of
HIV-related adult and pediatric care services, including support for the national IMAI and IMCI programs.
This position was first approved in FY 2007 COP through the CTSGlobal/Comforce mechanism. In FY
2009 COP, this position will be converted to a locally employed staff (LES) position for a qualified Namibian.
decentralization, monitoring and evaluation of HIV-related palliative care in Namibia.
2. Support the current MOHSS Coordinator for Palliative Care and Opportunistic Services in the Directorate
of Special Programs to develop that individual's expertise and leadership.
4. Collaborate with the MOHSS Family Health Division, which is responsible for community-based palliative
care, clinical nutrition and family planning/HIV integration
5. Work with USG partners to address other critical program gaps. This includes partnering with:
a) MOHSS' Nutrition Subdivision and I-TECH's Nutrition Advisor to ensure that developments in clinical
b) MOHSS' Family Health Division in the Primary Health Care Services Directorate and the Global Fund to
c) MOHSS ART sites, Central Medical Stores, and SCMS to address gaps in procurement and supply
provision of the preventive care package for adults and children. Elements of this package include:
a. Cotrimoxizole prophylaxis for Stage III, IV disease or CD4<300 and for HIV-exposed/infected children;
finding);
c. Integrated counseling and testing;
d. Infant feeding counseling for HIV-positive mothers;
e. Child survival interventions for HIV-positive children;
f. Growth monitoring and immunizations;
g. Clinical nutrition counseling;
supplementation for severely malnourished people living with HIV and AIDS (PLWHA) who are on ART; and
communities will allow increased opportunities to expand safe water and hygiene strategies as well as
that allows nurses to prescribe narcotics and symptom-relieving medications. Technical assistance from
APCA (#8043) will support this activity.
male and female health care workers with the goal of equitable access to services for PLWHA and their
Estimated amount of funding that is planned for Human Capacity Development $25,000
Table 3.3.10:
FY 2009 COP funds will be used to support one component: a portion of the costs of general office
management, travel and training related to the continued rollout of the HIVQUAL program in Namibia.
Funding for this activity will be specifically directed for HIVQUAL Namibia in-country activities through the
CDC/Namibia office and led by CDC's HIVQUAL Technical Advisor. This activity will expand on the
HIVQUAL work which began in Namibia in FY 2007 COP which a goal of reaching 16 ART sites. In FY
2008 COP the program will add at least 18 new district sites throughout all 13 regions of the country and
reach all 34 public and faith-based district hospitals. In FY2009COP, HIVQUAL will further target at least
five health centers providing pediatric HIV treatment. Specifically, these funds will be used to support
general office management for the HIVQUAL program in Namibia, as well as travel and training costs
related to rolling out the HIVQUAL program to improve pediatric care and treatment as outlined below.
In FY 2009 COP, HIVQUAL activities will be conducted under the leadership of the Ministry of Health and
social Services (MOHSS) Directorate of Special Programs (DSP) in close collaboration with the HIVQUAL
Technical Advisor. The US-based HIVQUAL team will provide technical support for quality improvement
specifically in adult treatment. The HIVQUAL project will support capacity building for QI for health facilities
managed and supported by four local organizations, namely MOHSS, Catholic Health Services, Lutheran
Health Services, and Anglican Health Services. The improved quality of care at these facilities is expected
to benefit the estimated 5,900 pediatric patients on treatment in these facilities by March 2010. These
treatment figures were obtained from the MOHSS HIV Estimates report released in June 2008 based on
Spectrum projections.
further support the MOHSS' adult treatment activities. This position is funded under systems strengthening
Estimated amount of funding that is planned for Human Capacity Development $25,795
Program Budget Code: 12 - HVTB Care: TB/HIV
Total Planned Funding for Program Budget Code: $3,657,504
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
In COP 09, the US Government (USG) will continue to work with the Namibian government and other partners to improve access
to and quality of tuberculosis (TB) care to those infected with HIV and TB. To ensure that appropriate care is available to these
individuals, a well-functioning and well-supported TB program is essential. PEPFAR works in close collaboration with both the
Global Fund (GF) and the TB Control Assistance Program (TBCAP) which support DOTS program strengthening, essential to
good HIV-TB care. TBCAP is funded through both PEPFAR and Child Survival and Health (CSH) TB funds. Current GF activities
focus on strengthening the National TB Control Program (NTCP) through supportive supervision, drug resistance monitoring,
facility renovation, the Communication for Behavioral Intervention (COMBI) communication and social mobilization campaign, and
national expansion of cost-effective community-based care. TBCAP resources have also been used to complement GF support in
order to attain national coverage of essential TB interventions. TBCAP also focuses on fortifying the management capacity of the
NTCP through training and staff support, expansion of TB control and infection control strategies, and community mobilization and
education. PEPFAR builds on this foundation by addressing particular issues among those who are dually infected with HIV and
TB, and provides essential funding and technical assistance to strengthen laboratory capacity for TB.
According to the 2007/2008 NTCP Annual Report, Namibia reported 15,244 patients with all forms of TB, translating to a Case
Notification Rate (CNR) of 722 per 100,000 population in 2007. This CNR is the second highest in the world, after Swaziland
(WHO TB report 2007). Erongo, Hardap, Karas and Oshikoto regions had CNRs of 1,000 and above.
Also according to the NTCP 2007/2008 Annual Report, the national treatment success rate increased from 70% in the cohort
started on treatment in 2004 to 76% in the cohort of 2006. The defaulter rate declined from 13% to eight 8% in the same period.
The death rate declined from 8% to 7% and transfer out rate decreased from 7% to 6%.
Coordination between TB and HIV programs is exemplified by TB patient testing for HIV through provider initiated testing and
counseling (PITC), which has continued to increase over the years. Fifty-four percent (54%) of TB patients had known HIV status
in 2007, compared to 30% in 2006 and 16% percent in 2005. Fifty-nine percent (59%) of TB patients tested for HIV were HIV
positive in 2007 compared to 67% percent in 2006.
COP 09 resources will complement the activities supported by the Global Fund and TBCAP support by ensuring the integration of
HIV/TB training, basic community-level TB/HIV care, and community DOTS within USG-supported community and home-based
care programs. With COP 09 support, TB/HIV curricula and training programs will be standardized at the community and home
based care levels.
Namibia is in the process of strengthening TB-HIV collaboration on the national, regional, district, and clinic level. In 2008,
Namibia revived the National TB-HIV Coordinating Committee, the core role of which is to enhance collaboration between the
national TB and HIV programs. One of the identified priorities for this committee is to collaborate on the implementation of "3 Is,"
as identified by WHO. The 3 Is include intensified case finding, isoniazid preventive therapy, and infection control.
Intensified Case Finding activities will be supported in COP 09, enhancing the current Namibian HIV guidelines that recommend
TB screening for all patients in HIV care and treatment settings. Support will be provided to encourage use of clinical
management protocols that include specific screening questions related to TB in HIV care and treatment settings. The extent of
TB screening in HIV settings has been difficult to assess because of variable documentation. In PEPFAR-supported HIVQUAL
sites these data are routinely captured. Through experience gained through HIVQUAL, partners will be supported to appropriately
collect the necessary data.
MOHSS will expand TB case finding in HIV home-based care and treatment settings, as well as VCT settings. Some VCT clients
are currently screened for TB using a five question screening tool; however, there is no documentation system to capture these
data. In COP 09, data systems will be developed and implemented to capture TB screening in VCT settings. In addition, a health
care facility based case management program initiated with COP 08 funds will strengthen HIV and TB referrals for co-infected
persons and their partners.
In addition, Community based partners (i.e. Catholic AIDS Action) will use TB screening questions in home-based care settings to
identify TB suspects whom they will refer to facilities for TB diagnosis. These organizations will also have dialogue with facilities to
ensure seamless referral of clients to facilities as well as from facilities to communities.
Isoniazid Preventive Treatment (IPT) is currently emphasized in the TB and HIV guidelines in Namibia. In 2007, 4,257 PLWHA
received IPT. In 2009, the TB program will conduct an extensive evaluation of the IPT program to identify strengths and
weaknesses, and improve roll-out and evaluation of the program nationwide. In the Oshakati District Hospital, the HIV Case
Management Unit has established "Pre-ART" clinics. In this setting, health care workers concentrate on the roll-out of IPT
services. Uptake and completion of IPT services in the Pre-ART clinic has been more successful than in other settings. The
MOHSS is interested in expanding this model to other TB-HIV high burden areas of Namibia with COP 09 support.
Infection control
In 2007 and 2008, the MOHSS requested infection control consultation and assessment visits from CDC Atlanta, KNCV and
WHO. The majority of the assessments took place in TB care and treatment settings, with a primary focus of preventing the
spread of X/MDR TB. In 2009, MOHSS will implement recommendations to improve infection control measures in TB care and
treatment settings. COP 09 funds will also support expansion of necessary infection control practices (ICP) in health care settings
such as provision of respirators and masks to HCW and masks to TB patients. COP 09 will fund supportive supervision and
implementation of facility-based nosocomial transmission guidelines. TB-related ICP will be integrated with MOHSS infection
control guidelines.
The MOHSS is also committed to improving infection control in HIV care and treatment settings as well. The TB and HIV
program will work closely with the MOHSS Quality Assurance Division to strengthen the following:
• Finalization of infection control policies and guidelines
• Development and implementation of standard operating procedures for infection control in TB HIV care and treatment settings
• Strengthening of the human resource capacity through ongoing training and supervision
• Provision of additional international infection control technical assistance
• Continual assessment and upgrades (renovations) of health care facilities to meet international standards for infection control
• Implementation of health care worker screening programs
Surveillance for and management of drug-resistant TB
In 2008, Namibia reported over 300 cases of multidrug resistant TB (MDR TB), and as of October 2008, approximately 20 cases
of Extensively Drug Resistant TB (XDR TB) have been confirmed. In addition, in 2008, the MOHSS conducted a TB drug
resistance survey with global Fund resources. In COP 09, PEPFAR will support a follow-up TB drug resistance survey.
Few health facilities are equipped to deal with the new challenge of X/MDR TB, especially with regard to the medical management
of these patients and implementation of infection control practices. With PEPFAR support, the MOHSS is developing and
implementing a comprehensive X/MDR TB rapid response plan in Namibia based on recommendations from several consultations
and technical assistance visits on X/MDR TB in 2008 from South Africa, WHO, KNCV, and CDC.
The MOHSS ordered additional second line drugs to treat X/MDR TB patients, and set up an X/MDR TB Clinical Consultation
Team to advise on the management of the treatment of the X/MDR TB cases within the country. In addition, the MOHSS is in the
process of setting up eight centers of excellence within the country for the management of X/MDR TB. In 2009, the MOHSS will
continue the process of addressing treatment, infection control, and laboratory issues that the international consultations identified
as necessary to better manage and prevent X/MDR TB in Namibia.
The TB program, like all other programs in Namibia, continues to face shortages of staff. In COP09, TBCAP and Potentia will
support key positions within the Ministry's existing staff structure.
In order to prevent drug resistant TB from developing, the MOHSS, with PEPFAR support, will strengthen the coverage areas for
community-based DOTS in COP 09 by exploring the addition of community-based DOTS to existing partners such as DAPP and
Project Hope.
The NTCP recommends that all TB patients with HIV co-infection be provided with cotrimoxazole preventative therapy (CPT).
ITECH will continue training of HCWs emphasizing routine CT for TB patients; IPT, CPT, and ART for eligible TB/HIV patients
(including children); and stronger links between TB and HIV/AIDS services. Facility and community-based programs will promote
use of IPT for those eligible.
In addition, CDC and TBCAP will support training on the revised Electronic TB Register (which includes HIV data). In COP 09,
continued support to the Namibian Institute of Pathology will also ensure that the necessary infrastructure is in place to
accommodate the increased demand for diagnostic testing. Finally, MOHSS is currently exploring the possibility of enhancing
nutritional support for TB and TB-HIV patients in COP 09.
Table 3.3.12:
This activity includes three primary components: (1) continued technical support for the Electronic TB
Register (ETR), (2) partial support for salary and related personnel costs for a continuing Technical Advisor
for Laboratory Services, and (3) support for salary and related personnel costs for a TB Laboratory Advisor.
Both advisors will be assigned to the Namibia Institute of Pathology (NIP).
1. Electronic TB Register. Namibia is one of several southern Africa countries that adopted the ETR
developed by the BOTUSA Project (Botswana-CDC collaboration) in Botswana. The ETR records
information on HIV status and use of ART in TB/HIV patients and is used to measure key indicators and
monitor expansion of HIV care and treatment among TB patients. The ETR is expected to further contribute
to enhancements in TB surveillance, and inform improvements in TB prevention, early detection, and
treatment. In FY 2009 COP, CDC will continue to support the Ministry of Health and Human
Services' (MOHSS) ongoing implementation of the ETR through a local contract with WAMTech of South
Africa. WAMTech is the sole provider of ETR software and support.
The provision of accurate data and tools for surveillance, program management and supervision has
become increasingly essential. The ETR was developed to provide more efficient and useful collection,
compilation, and analysis of TB data on an ongoing basis. The register is a Microsoft.net based computer
software program that was developed using the World Health Organization (WHO) and International Union
Against TB and Lung Disease recording and reporting formats. Many features of the ETR are derived from
a TB surveillance project in southern Africa supported by USAID and CDC Headquarters in the United
States.
As of June 2008, Namibia has reported over 300 cases of multidrug resistant TB (MDR TB), and as of
October 2008, approximately 20 cases of Extensively Drug Resistant TB (XDR TB) have been confirmed.
The MOHSS is interested in adding an X/MDR component to the ETR to enhance monitoring and
surveillance of X/MDR TB cases.
This activity leverages resources with the USAID-funded TBCAP and Global Fund support to the MOHSS.
2. Technical Advisor for Laboratory Services. The CDC/Namibia office has seconded a laboratory technical
advisor to the Namibia Institute of Pathology (NIP) since 2005. The original scope of work for this position
was to serve as a liaison between CDC, NIP, and the MOHSS to build capacity and to ensure quality for
HIV bioclinical monitoring. Since then, the technical advisor has become more involved in strengthening
NIP's capacity for TB diagnosis, including culture and DST. He has worked closely with the International
Laboratory Branch Consortium (ILBCP) to facilitate short- and long-term technical advisors to work
alongside NIP staff. This collaboration aims to build staff expertise and to upgrade the TB laboratory, with
an ultimate goal of obtaining accreditation. The laboratory technical advisor salary is reflected in HVTB
(0.20 FTE) and the HLAB Program Areas (0.80 FTE). The lab technical advisor has also provided technical
assistance for a 2008 TB drug resistance survey, and assists MOHSS and NIP with laboratory issues
related to the diagnosis and ongoing monitoring of X/MDR TB cases in Namibia.
3. TB Laboratory Advisor. FY 2009 COP funds will support an advisor to provide mentoring and on-the-job
training to NIP technologists and technicians performing TB culture and drug sensitivity testing, both at the
national and peripheral level. As is possible, this advisor will provide similar support to private laboratories
in the country.
A number of independent assessments of the TB program in Namibia have indicated that TB laboratory
services need to be improved and expanded. While short-term assistance from the ILBCP has been
beneficial, long-term assistance in this area is essential given staff turnover, the lack of attention that can
currently be given to peripheral labs, and the need to implement a comprehensive response to increasing
numbers of drug-resistant cases of TB in Namibia. In our previous COP's, this vacant position was
envisioned as a non-personal services contract. In FY 2009 COP, this position will switch from a non-PSC
to a locally employed staff (LES) position. We feel that sufficient capacity now exists within the country to
hire a Namibian, which will also reduce costs associated with the position.
The addition of an LES TB Laboratory Advisor will enhance communication, coordination, and institutional
memory between CDC and NIP over the long-term, since we expect that Namibian LES technical staff
would remain with the program for longer than the typical contract period of a non-PSC position. This
addition will also allow the senior CDC Laboratory technical advisor to focus more thoroughly on laboratory
system strengthening activities and moving key programmatic activities forward.
Special Note: In 2008, funds were identified and reprogrammed to support the development, printing, and
dissemination of TB training materials and job aids to public and private health care providers. These
materials will focus on symptom recognition, treatment regimens, HIV/TB co-infection considerations,
X/MDR TB, and adherence counseling. These materials will be disseminated to public and private health
care providers via the MOHSS, I-TECH, and the Namibia AIDS Clinicians Society. This funding will not be
continued in FY 2009 COP as the majority of costs were one-time expenses for development of these
materials. Any future printing and dissemination costs will be minimal and paid for from other MOHSS,
Global Fund, or PEPFAR funds.
Continuing Activity: 16240
16240 7974.08 HHS/Centers for US Centers for 7390 1157.08 $333,750
7974 7974.07 HHS/Centers for US Centers for 4389 1157.07 $175,000
Estimated amount of funding that is planned for Human Capacity Development $160,995
This area includes one component: Salary and related personnel costs for CDC's Counseling and Testing
Technical Advisor.
Since 2005, PEPFAR has funded a technical advisor to assist the Ministry of Health and Social
Services' (MOHSS) National Counseling and Testing Coordinator via a non personal services contract. By
FY 2009 COP, this position will be converted to a personal services contract (PSC). While this conversion
will increase costs somewhat, it is necessary for two primary reasons:
(1) to reflect the inherently governmental functions of these positions, and
(2) to rectify the double taxation of these positions by both the US and Namibian governments. The double
taxation results from the lack of a ratified bilateral agreement between the two countries that covers non-
PSC positions. While reducing taxation costs, this conversion will result in increased ICASS costs.
The CT Technical Advisor has and will continue to play a key role in the deployment of community
counselors to public health facilities, outreach teams, and correctional facilities. MOHSS established the
community counselor cadre in 2004 to assist doctors and nurses with provision of HIV prevention, care, and
treatment services, most importantly by providing HIV counseling and testing (CT) services to PMTCT, TB,
and STI patients as well as to partners of persons on ART whose HIV status is unknown. CCs are further
trained to provide adherence, supportive, and STI/TB counseling, as well as to link and refer patients from
health care delivery sites to community HIV/AIDS and TB services.
With FY 2008 COP support, the number of CCs will increase to 650 by December 2008. New initiatives will
place CCs in correctional facilities in 2008 and on outreach teams in 2009. Policy development, quality
assurance, and support to field services are important aspects of the technical advisor position. The
advisor will continue to provide technical assistance to the head of the Counseling and Testing Unit within
MOHSS' Directorate of Special Programmes to increase access to CT services and provider-initiated
testing and counseling (PITC) in the clinical setting.
The advisor will also guide the national program in the continued implementation of national CT guidelines
and will support the regions and districts in implementation and monitoring of program effectiveness. He
will continue to support the unit with the roll-out and supervision of counseling and testing sites in health
facilities, correctional facilities, and newly-initiated outreach teams.
Each MOHSS outreach team will consist of a camper van; four community counselors (two to provide
counseling and testing and two to coordinate logistics and supplies); a nurse; and a driver. Teams will use
community input to develop a monthly schedule of visits to remote communities. The date of visits to each
community will be kept consistent (e.g. the first Thursday of each month) so that there will be minimal
confusion about where and when the team will visit.
For each outreach team, CT services and prevention education will be implemented first. The advisor will
assist with implementation as well as a concurrent evaluation program. The evaluation program will be put
in place to determine cost per client, success in reaching first-time testers, coordination between the
outreach teams and community partners, community receptiveness, and success in linking HIV-positive
clients to care and treatment services.
The advisor further plays a key role in the recruitment, training, and allocation of CCs for CT services and to
support other programmatic areas, including PMTCT, AB, condoms/other prevention, TB/HIV, and care and
treatment services. Within ART sites, CCs provide adherence and couples counseling, among other
responsibilities. The advisor will be intimately involved with CDC advisors in the MOHSS' continuing
implementation of the prevention with positives initiative at the national level.
Lastly, the technical advisor will continue to serve as the co-chair of the National HIV Testing Day (NTD)
steering committee. This event was first held in 2008 with the goal of expanding access to CT. Using
outreach points and expanded hours, over 33,000 persons were tested over the course of the three-day
event. Of those who tested, nearly two-thirds were first-time testers. The advisor will continue to play a key
role in NTD planning and implementation, as well as similar testing events coordinated with World AIDS
Day.
Estimated amount of funding that is planned for Human Capacity Development $297,900
Table 3.3.14:
In a continuation from COP08, this activity will provide funding for 0.7 FTE for a laboratory scientist
seconded to the Namibia Institute of Pathology (NIP) by CDC. To reflect the TB responsibilities of this
position, the remaining 0.3 FTE is funded through the HVTB program area.
The laboratory scientist provides support to NIP for strengthening HIV diagnosis in young infants,
introducing HIV incidence testing into routine antenatal surveillance, continuing surveillance for HIV drug-
resistance, improving TB diagnosis and quality assurance. Since FY05, CDC has placed a laboratory
scientist at NIP as a technical advisor (TA) to help develop and implement standard operating procedures to
ensure quality services related to diagnostic DNA PCR, CD4, HIV incidence testing, and resistance testing.
During FY05, the diagnostic algorithm for pediatric diagnosis using PCR was developed and the use of
dried blood spots (DBS) was field-tested. During FY06, in collaboration with the Ministry of Health and
Social Services (MOHSS) PMTCT program, the diagnostic DNA PCR was introduced for symptomatic
infants and HIV-exposed infants at six weeks of age. The TA played a focal role in ensuring that
technicians at the central and peripheral NIP labs were trained in PCR, new equipment was purchased, and
health workers were trained in the collection of dried blood spots.
The TA will continue to work with the International Laboratory Branch Consortium to coordinate ongoing
information sharing between NIP and other laboratories. These continuous quality improvement activities
will focus on laboratory management, logistics, strategic planning, and technical training, with a particular
emphasis on TB diagnostics. During FY07, the Association of Public Health Laboratories collaborated with
NIP to follow up the management training with strategic planning efforts. In COP09, the TA will continue to
work with the NIP and the MOHSS to improve turnaround times between specimen collection and receipt of
test results by expanding placement of NIP's Meditech lab information system in all ART sites and
decentralizing testing to peripheral areas through expanded use of point of care equipment. The TA will
also continue to provide assistance to NIP for program reporting.
Estimated amount of funding that is planned for Human Capacity Development $272,320
Table 3.3.16:
This activity has four main components, three of which are continuing: (1) support local costs for data
triangulation activity; (2) office support for SI-related ePMS/HIS and CDC; (3) three technical advisors, and
(4) prison HIV prevalence survey (new):
1. Local data triangulation funds: These funds will contribute to the data triangulation exercises by
supporting local costs to host the stakeholders' workshops, bringing in the regional data analysts and
officers to participate and learn, and to fund local staff travel for data analysis training. (This activity is
further described in the I-TECH HVSI narrative).
2. ePMS/HIS and CDC SI support:
This component relates to the USG-supported SI technical advisors and includes: data and monitoring and
evaluation (M&E) personnel supported through Potentia; equipment and communications supported through
the Ministry of Health and Social Services (MOHSS); training supported through I-TECH; and support to the
TB and ART information systems.
- Technical support for software applications: Namibia has adopted or developed information systems for
both ART and TB that are separate from the routine Health Information System. These systems are patient
-based (with one record per patient per encounter) and hence are more complex than the aggregate
systems maintained for routine program information. This activity will support technical assistance to help
maintain these systems in the form of training on the software, technical and supportive supervision to
newly rolled-out sites, database management, consultants for updating and reprogramming the software
based on feedback, and protocol revisions (e.g. new changes to ART guidelines).
-Regional Support Visits: SI personnel will visit the field periodically to support and supervise activities with
an emphasis on capacity building. USG will support visits by the response monitoring and evaluation
(RM&E) Unit to visit all regions and districts during FY 2009.
-Software support and training: This is to ensure that all CDC staff members that need to use an appropriate
statistical package (SPSS, SAS, STATA, etc) have updated licenses and training to be able to use the
software to enhance the programs on which they work.
3. Support for three technical advisors (M& E, HMIS, SI): The three SI Technical Advisors to the MOHSS
are an integral part of the USG SI program. The MOHSS M&E unit responsible for all monitoring and
evaluation is currently undergoing reorganization. In response to any resulting changes, CDC will refine the
duties of the three TA positions accordingly.
The first position is a Monitoring and Evaluation Technical Advisor position seconded to the MOHSS RM&E
subdivision. The subdivision had requested an epidemiologist to advise on program evaluation,
surveillance activities, research, and operations research. The second position is a Health Information
Systems Technical Advisor seconded to the MOHSS to advise on and help manage all health information
systems for PEPFAR-supported health sector programs (ART, PMTCT, VCT, pharmacy, and lab). The third
position is a Strategic Information/M&E Advisor that sits within the MOHSS and CDC and advises on routine
program monitoring, program evaluation, data capture and tool development, data triangulation, HIVQual,
costing, PEFPAR-related SI, and other special SI projects.
In the past these positions have been funded through a contract with Comforce, but by FY2009COP they
will be funded as Personal Service Contractors (PSC) in line with current CDC strategic planning.
4) Prison HIV prevalence survey:
The HIV/AIDS Program in the Government of Namibia's Department of Prison Services, Ministry of Safety
and Security has asked CDC Namibia to provide technical assistance in conducting an HIV prevalence
study in the national prison system. Although voluntary HIV counseling and testing is currently offered to
the incarcerated population and prison staff, there is varied delivery and uptake of these services. At
present, the rate of HIV infection among prisoners is unknown. Prisoners likely represent a population in
Namibia with an increased vulnerability to HIV infection, and therefore assessing the current impact of
HIV/AIDS in prisons could help to improve the health of infected inmates by increasing linkages to medical
and social services. In addition, an assessment of potential routes of HIV transmission in prisons will help
to inform the development of prison HIV/AIDS programs and serve as an advocacy tool for HIV/AIDS-
related prison policy. The survey will be conducted in six Namibian prisons, and will include HIV testing as
well as assessment of risk behaviors.
Continuing Activity: 16242
16242 3859.08 HHS/Centers for US Centers for 7390 1157.08 $345,012
7359 3859.07 HHS/Centers for US Centers for 4389 1157.07 $946,951
3859 3859.06 HHS/Centers for US Centers for 3128 1157.06 $337,567
Estimated amount of funding that is planned for Human Capacity Development $350,000
Estimated amount of funding that is planned for Public Health Evaluation $0
Table 3.3.17:
In 2009, funding will be reprogrammed from the CDC mechanism in HVMS to pay approximately $493,605
in ICASS costs to State.
This activity consists of one component: ICASS charges for the CDC Office in Namibia.
(1) ICASS. This activity further supports the International Cooperative Administrative Support Services
(ICASS) provided through the US Embassy by the Department of State. The CDC office is relatively small
and has traditionally been heavily staffed by persons in technical positions to support the MOHSS and other
partners to provide HIV prevention, care and treatment services. As a result, the CDC office has not had
the capacity to perform many of the traditional ICASS responsibilities, including travel and procurement, and
opted to subscribe for most of the services available through ICASS. When possible and cost effective, the
CDC office has and will continue to take on more of these duties in-house.
Costs here are based on an approximation that CDC's ICASS costs will increase by at least 66%. By
COP09, the following positions and one new position (Technical Advisor for Infection Control and
Communicable Disease Surveillance) will have been converted from non personnel services contracts (non-
PSC) to personnel services contracts (PSC) and will be factored into ICASS charges:
Contracted personnel include technical advisors who specialize in:
a. Health Information Systems
b. PMTCT
c. Counseling and Testing
d. Monitoring and Evaluation
e. Strategic Information
f. Laboratory Services
g. Clinical Quality Assurance
This conversion from non-PSCs to PSCs is necessary for two primary reasons: (1) to reflect the inherently
governmental functions of these positions, and (2) to rectify the double taxation of these positions by both
the US and Namibian governments. The double taxation results from the lack of a ratified bilateral
agreement between the two countries that covers non-PSC positions. While reducing taxation costs, this
conversion will result in increased ICASS costs. An individual agency's ICASS charges are based on a
complex formula of number of employees, their family sizes, workload counts, as well as the ICASS
charges borne out by other US government agencies at post. For that reason, only an estimation of CDC's
eventual 2009 ICASS charges are possible at this time.
Table 3.3.19:
This activity is comprised of three components: (1) salaries and personnel costs for CDC staff in Namibia.
These positions include administrative support staff as well as technical staff working in three or more
program areas, (2) operating expenses for the CDC office, and (3) ICASS costs.
Funding for this activity is divided and the remainder has been reflected in a separate entry for CDC HVMS
(base).
(1) CDC Staff. Since 2002, the CDC staff in Namibia has been located in the Directorate of Special
Programs (TB, HIV/AIDS, and malaria), Ministry of Health and Social Services. CDC direct hire personnel
a. Country Director,
b. Deputy Director of Operations,
c. Deputy Director of Programs,
d. Prevention Advisor,
e. Public Health Evaluation Advisor, and
f. Health Communications Specialist.
This activity relates directly to all CDC activities and to all USG activities as part of the PEPFAR team in
Namibia. In 2002, CDC's Global AIDS Program began its collaboration with Namibia by opening an office in
the MOHSS DSP to provide technical assistance in PMTCT, VCT, TB/HIV, surveillance, and ART/care
services.
The Country Director's efforts are primarily spent assisting the DSP Director and Deputy Director with
capacity building, including the development of national technical policies and guidelines, strategic planning
for the rollout of new services, work plans for the Directorate, and field guidance and support. To date, the
DSP has been supported to develop:
• ART, PMTCT, and TB/HIV guidelines and a national rollout plan for these services;
• Guidelines for the selection of community counselors to provide CT in the clinical setting;
• Rapid HIV testing policies;
• HMIS for PMTCT and ART;
• HIV sentinel surveillance procedures;
• Procedures for providing support visits to all ART sites; and
• Guidelines on delivery of outreach services.
The Deputy Director of Programs position is currently vacant and unlikely to be filled before early 2009.
Upon their arrival in Namibia, the incumbent will continue to spend most of his or her time working with the
Ministry of Health and Social Services (MOHSS) Directorate of Special Programmes (DSP) and the
Directorate of Primary Health Care (PHC) to establish and rollout guidelines and policies and to provide field
support.
The emphasis during FY09 will include training providers on the newly updated ART, PMTCT and STI
guidelines; expanding and evaluating prevention efforts; ongoing rollout of ART services to clinics and
health centers; strengthening the ARV regimen for PMTCT; integration of TB and HIV services; developing
surveillance systems; strengthening task shifting and IMAI; improving palliative care and pediatric treatment;
introducing an incidence assay into HIV sentinel surveillance; continuing to assist with DSP's response to
drug-resistant TB; carrying out ongoing surveillance for drug-resistant HIV and TB; accelerating the rollout
of rapid HIV testing and the community counselors program; implementation of mobile services; and further
coordination of efforts and resources with the Global Fund and other donor organizations.
While primarily assisting the MOHSS with technical assistance, both the director and deputy director
provide some technical assistance related to policy development and capacity building to local
organizations, including Development Aid People to People, the Namibia Institute of Pathology, and the
Blood Transfusion Service of Namibia (NAMBTS).
In addition to direct hire staff, the CDC/Namibia office is further comprised of contracted personnel serving
as technical advisors who are specialists in:
a. Health Information Systems,
b. PMTCT,
c. Counseling and Testing,
d. Monitoring and Evaluation,
e. Strategic Information,
f. Laboratory Services, and
g. Clinical Quality Assurance.
By COP09, these positions and one new position (Technical Advisor for Infection Control and
PSC) to personnel services contracts (PSC). This conversion is necessary for two primary reasons: (1) to
reflect the inherently governmental functions of these positions, and (2) to rectify the double taxation of
these positions by both the US and Namibian governments. The double taxation results from the lack of a
ratified bilateral agreement between the two countries that covers non-PSC positions. While reducing
taxation costs, this conversion will result in increased ICASS costs.
COP09 will also continue to support one Association of Schools of Public Health (ASPH) fellow providing
support in strategic information or management and administration. Locally employed staff (LES) positions
include two nurse HIV field coordinators who head up the CDC/Oshakati office, one TB laboratory
specialist, and one palliative care coordinator. Other LES positions include an office manager, a financial
analyst, two systems administrators, an administrative assistant, three drivers, two driver/administrators
(Windhoek and Oshakati offices), and a receptionist. The salaries and benefits of technical and
Activity Narrative: programmatic staff are assigned to the appropriate program area within the Emergency Plan categories, but
their management and support costs are included under this activity. The Country Director spends
approximately 40% of his time on assisting the MOHSS with policy and capacity-building, but all costs for
this position are included in this activity. The Deputy Director of Operations, the Health Communications
Specialist, the Infection Control/Surveillance Advisor, and the ASPH fellow are 100% assigned to
management and staffing.
(2) Operating expenses. Being located in the Ministry of Health and Social Services, the CDC office
provides direct logistical and material support to the MOHSS' daily programmatic operations and to
prevention, care and treatment sites in the regions. Operations costs outside of human resources include
information technology and digital videoconferencing facilities; telecommunications; photocopying and
materials production; printing of guidelines, reports, training curricula, and HMIS records; office
consumables; utilities; office maintenance and equipment; security; staff training; field, conference, and
meeting travel; and other daily operations costs.
As of COP08, a major accomplishment has been to program 90% of CDC-managed funds to partners.
Seventy-three percent (73%) of CDC-managed funds go to Namibian partners. From this office, the deputy
director of operations, office manager/financial analyst, and ASPH fellows liaise with the Program and
Grants Office at CDC-Atlanta and provide direct financial management support to counterparts in these
Namibian organizations receiving direct USG funding under Cooperative Agreements. These organizations
include the Ministry of Health and Social Services, Namibia Institute of Pathology, Potentia Namibia
Recruitment Consultancy, and Development Aid People to People. In addition to the US Embassy
procurement and financial management staff, the deputy director of operations also works closely with the
Ministry of Works and MOHSS' Directorate of Public Policy and Human Capacity Development on
renovations at ART/PMTCT sites that are contracted under the Regional Procurement and Services Office
(RPSO) in Frankfurt.
This activity leverages resources with the Global Fund, the UN Family, and GTZ which provide technical
advisors to increase capacity of the Directorates of Special Progammes and Primary Health Care, as well
as Regional and Constituency AIDS Coordination Committees (RACOCs and CACOCs).
All but three of the CDC positions in Namibia are based in the Directorate of Special Programs (TB,
HIV/AIDS, and Malaria), Ministry of Health and Social Services (MOHSS) in Windhoek, the centrally located
capital. Three additional staff members are deployed to the CDC office located on the grounds of the
MOHSS' Oshakati State Hospital located in the large northern city of Oshakati. By the end of FY08, the two
CDC/Namibia offices will consist of six CDC direct hires, eight contractors in technical roles, two locally
employed staff (LES) in technical roles, and eight LES in administrative support positions.
(3) ICASS. This activity further supports the International Cooperative Administrative Support Services
Continuing Activity: 18908
18908 18908.08 HHS/Centers for US Centers for 7390 1157.08 $1,072,282
