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.
NEW/REPLACEMENT NARRATIVE
CARE OF THE CARERS/STIGMA REDUCTION
Stigma and discrimination can affect negatively the interactions of healthcare workers with HIV infected
clients or those perceived to be positive. Poorly informed staff in healthcare settings may perceive HIV
infected patients to be the biggest threat to their safety at work. Their attitudes can frighten those patients
and limit access to and utilization of HIV-related services. Sometimes health workers may go as far as
withholding health services from those believed or known to be HIV positive; or they may create segregated
area for them thus violating their fundamental human rights. As HIV-related prevention, care, and treatment
services are scaling up in Namibia, access to these life saving services will be greatly influenced by the
degree to which health facilities welcome and respect the rights of HIV-positive clients. Studies reveal that
stigma and discrimination in health facilities have numerous causes: lack of knowledge regarding the modes
and risk of HIV transmission; judgmental attitudes, and assumptions about the sexual lives of people living
with HIV; fears of becoming infected. Anonymous discussions conducted with MOHSS staff by URC have
revealed numerous concerns that need immediate attention. For example, many healthcare workers with
sharps injuries fail to report their injuries as well as get HIV tested. By refusing to be tested to learn about
their HIV status they put themselves in the awkward position of not receiving the appropriate care and
support they deserve. If infected they put their lives and those of their clients at risk. "To reduce stigma and
discrimination in health care settings, we need to address health care workers' fear about getting infected
on the job, and their need to protect themselves through standards precautions. They have to be trained to
come to terms with their fears and anxieties about their own sexuality and mortality, their prejudices" People
working in the healthcare settings have no more information than members of the general population.
Unless exposed to special training and/or information sharing they are unable to display the right positive
attitudes. URC is working with MOHSS to develop strategies to improve knowledge regarding HIV/AIDS
among healthcare workers., The collaborative approach is being used to apply the behavior change
strategy in HIV/AIDS that empower professional and non-professional health workers to make informed
decisions regarding their sexual life, to disclose the information regarding work accidents in relation with
infectious needles and sharps injuries, and to carry out non-discriminatory behaviors regarding patients
infected or believed to be infected with HIV/AIDS.
In FY08 URC trained more than 1,000 healthcare workers and 16 trainers in ABC. URC has also worked to
leverage other resources (Tulow Oil and Rotary international) for supporting programs for healthcare
workers. This program will continue in FY09 and FY10. The program will continue to have three key
elements: (1) Identification of training needs through a pre-test questionnaire which addresses the
knowledge/attitudes/practices regarding HIV/AIDS and ABC; (2) training target groups; (3) monitoring the
effects of health worker training on using post-test results of the training through post-testing the survey
tools to measure changes in knowledge/attitudes/practices regarding HIV/AIDS. As part of capacity building,
and to ensure sustainability of the intervention, URC will continue to apply a two fold strategy approach:
advocacy and TA for development and submission of proposals for funding to private organizations by
MoHSS regional staff, and, training of MoHSS staff member, mostly supervisors (Control Registered Nurse,
Infection Control Nurse for example) as master trainers. The care of the carers/stigma reduction program
will be led by a BCC specialist with background in nursing and public health, and a social worker who has
expertise on how to unlock the inhibitions and open the floodgates of anger, sadness, and confusion, and
create the right atmosphere for sharing of feelings and worries. The BCC Specialist will conduct ABC and
counseling sessions alone in the beginning, then in collaboration with MoHSS trained facilitators, and finally
she will progressively hand over the training responsibility to MoHSS staff. These sessions will improve the
(PEP) uptake among workers with sharps injuries, help HCWs cope with the stress associated with HIV
activities in their work environment and will prevent burn out syndrome. With their new level of knowledge
and understanding of the epidemic, the trainees will drive the necessary changes in their facility, thus
creating a welcoming environment for people living with HIV. URC will provide also technical support to
MoHSS staff who wants to organize and maintain a better set up to alleviate pressure during working hours
including recreational and information sharing area. The psychologist will be asked to train workplace
program counselors as a mean of ensuring program viability. The target group will be all people working in
the Health system including: support staff, management, laboratory staff, etc. The trainer will be required to
adapt the curriculum for participants with various level of literacy. It is expected that by the end of FY10, 480
healthcare workers will receive direct training in ABC; that 2,000 MoHSS health workers will be exposed to
ABC messages through the trainers; that 50% (1,250) of those trained and exposed will express confidence
to seek medical help and disclose the information to their superior if they get needle prick or sharp injuries,
and 75% (1,875) healthcare workers will report positive change of behavior vis a vis patients infected with
HIV/AIDS, ABC knowledge of 100% of those exposed will be improved, 100% of the trainees will offer good
quality dissemination sessions, 50% of the regions will attract funding from potential donors to implementing
relevant activities. Furthermore the program will be extended to cover all the 13 regions.
Transition process To enable the MoHSS to take over the technical and managerial functions of the Care of
the Carers project, URC will focus its efforts on capacity building. Interventions will address human
resources and systems. Three main vehicles to achieve success of the transition: leadership, integration,
and decentralization will be supported.
Transition plan: URC acknowledges that many discussions sessions have taken place with the MoHSS
regarding stigmatization against HIV+ patients and personnel, staff support needs to avoid burnout
syndrome, coverage/extension strategy to allow all regions to take advantage of the program, financial
support for certain workplace aspects not taken in charge by URC/USAID support, transfer of this program
to the MoHSS, and its sustainability. URC will prepare an MOU outlining the transition plan within the next
60 days. The plan will include the components to be implemented. It will also include a time frame for
taking over of each component.
Human resources empowerment: URC will transfer knowledge and skills to the MOHSS staff for designing
and implementing care of the carers program.
Systems building: support systems will be developed/strengthen. These include: planning, logistic,
Activity Narrative: supervision, data management, financial, and fundraising.
Leadership: The central, regional, and district managerial level staff will be encouraged to provide guidance,
general supervision, and continuous support to the program. To provide identical direction, vision, mission
statement, general objective, and strategic directions need to be developed. URC will help MOHSS to
develop appropriate managerial structure/unit at all levels. Assistance will be provided to recruit and train
appropriate staff for the program. Advocacy for proper staffing/multiple tasking will be recommended. URC
will advocate for inclusion of the program budget in the overall MoHSS annual budget.
Integration: URC will advocate for progressive integration of the program to other components of the
healthcare system. A sense of ownership will be nurtured to ensure that they become part of staff culture,
and be understood as supports to a continuum of quality of care. Their cross cutting characteristics will be
emphasized to facilitate their adoption by all services.
Decentralization will be a key element of the overall transition. Each administrative level should be
autonomous. They will be empowered to play their role interdependently. At facility level a board-to-ward
approach will be adopted. The flow of information should go from bottom to top with feedback from top to
bottom. The collaborative approach will be promoted to create a powerful network for sustainability.
Contingency plan: Past experiences with the MoHSS in taking over some managerial functions of a
program have demonstrated that unanticipated constraints may delay the process. Constraints: a) only 50%
of regions are estimated to have financial support through fundraising by end of FY10, b) no link at central
level yet have been established, and subcommittees exist only in 2 regions (Karas and Hardap), top
management involvement only in one (Karas), no national guidelines and definite implementation and
sustainability strategy. Ultimately a contingency plan will be developed to mitigate the negative effects in
case the handing over can not be conducted according to the schedule.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16232
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16232 7461.08 U.S. Agency for University 7387 4662.08 $116,441
International Research
Development Corporation, LLC
7461 7461.07 U.S. Agency for University 4662 4662.07 $110,896
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $45,158
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.03:
URC SAFE INJECTION, INFECTION PREVENTION AND CONTROL
Under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Namibian Ministry of Health and
Social Services (MoHSS) with technical assistance from URC is implementing several policy and
programmatic interventions to improve medical injection safety and waste management practices in the
country. A rapid assessment was conducted in June 2004 to guide the development of safe injection
interventions. The assessment looked at quality of services, demand for and provision of injections,
compliance of providers with safe injection practices, and other aspects related to injections. The baseline
assessment showed a number of quality gaps: over-prescription of medical injections, improper injection
and waste disposal procedures, among others. To change healthcare provider practices, the Medical
Injection Safety Program is using the collaborative improvement approach. Four major strategies are being
used: a) behavioral change communication, b) compliance with infection prevention and control practices, c)
commodity and logistic, d) waste management. Performance at provider and facility level is reviewed on a
regular basis. For the past 4 Years, URC worked closely with the MOHSS and other partners to promote
safe injection and waste management practices. Program interventions have produced dramatic results.
The project succeeded in creating an enabling environment with the development of and distribution of
guidelines and policies related to Injection safety. From less than 60% the availability of Standard Treatment
Guidelines (STG) and (PEP) Guidelines rose to 100%. Over 5,000 staff members have been trained in
Injection Safety. More than 15000 community members have been exposed to Safe Injection Messages.
Practices on preparation and administration of injections have improved. Sharp injuries have decreased
significantly. Awareness creation about risk of Hepatitis B resulted in expanded vaccination of Health Care
Workers. To manage needles and sharp waste, URC purchased and distributed more than 300,000 safety
boxes. In FY09 URC will continue consolidation of this program. The focuses will be: (a) reduction of
medical injections prescriptions; (b) reduction of demand for injections; (c) improvement of medical waste
management at health facilities; (d) strengthening of the procurement and logistics system; (e)
reinforcement of an enabling environment with emphasis on cost - effective and environmentally friendly
strategy; (f) reinforcement of the supervisory system; (g) strengthening of the monitoring and evaluation
system; and (h) increase program sustainability.
It is expected that by the end of FY10 (a) the entire health sector will comply with best practices in Injection
Safety, Waste Management, and environmentally friendly regulations and standards; systems will ensure
that all healthcare workers are trained before placement in clinics as well as receive periodic refresher
updates on injection safety and infection control with special emphasis on mastery of phlebotomy
procedures; 62 MoHSS facilitators will be certified as capable to conduct feedback sessions; MoHSS will
take over all aspects of the feedback function. All efforts will be made to use MoHSS accommodations to
decrease costs associated with these activities; (100%) public sector facilities and 50% private facilities will
be in compliance with injection safety and waste management guidelines; 10 out of 13 region will be able to
manage their data including reports production; all safety boxes and PPE/PPC will be procured by the
MoHSS through local production with a positive effect on cost reduction in comparison with the logistic
associated with imported materials; a plan to improve medical waste disposal using incinerators will be
developed and its implementation started; 10 staff in 5 regions will be trained for incinerator maintenance to
allow smooth and continuous functioning of the system and to prevent frequent breakdowns and
replacement of very expensive parts; 80 community volunteers will be trained; 40,000 community members
will be exposed to injection safety and waste management messages.
INFECTION PREVENTION AND CONTROL
URC, in order to improve patients and provider safety will assist MOHSS to develop and institutionalize
strategies for improving Infection Prevention and Control (IPC) in community and clinical settings. This
intervention aims at improving clinical processes that reduce the risk of nosocomial infections among
workers, patients and care givers. Approach "Board to Ward" IPC implementation through four major
strategies: 1) empowerment of MoHSS Nursing Managers to lead and champion IPC activities at every level
2) creation of an enabling environment: through development of methods, procedures, policies, and
standards as well as IPC structure at national, regional, and district level (3) promotion of best practices with
emphasis on aseptic techniques. (4) continuous quality improvement through performance management
and creation of two ways sharing of information for decision-making. For the past two years, URC, in
collaboration with the MoHSS, has trained more than 100 HCWs in IPC. These trainees have raised
awareness among their peers regarding IPC best practices. IPC committees are being organized in most of
the regions. Universal precautions are being supported. But these changes remain small scale and have not
yet gathered the critical mass to produce drastic and lasting changes. The percentage of trained workers in
IPC is only 0.014%. By the end of FY10 it will be 4.2% including the number that will be trained in FY09. To
ensure sustainability of the intervention, in FY10 URC will assist the MoHSS to develop and implement IPC
systems. The most important ones will be: a) training system: through development of IPC training program
with emphasis on adapted pre - service curricula and skilled trainers. The training strategy will cascade as
follows: (1) training of healthcare providers, (2) training of trainers, (3) training of peers by trainers, (4)
evaluation of trainers through evaluation of trainee performance in work settings. b) monitoring and
evaluation system: with appropriate tools to collect, analyze data, and produce relevant reports c)
reinforcement of the existing logistic system: logistic issues regarding appropriate equipment and
commodities necessary to support a high quality IPC program will be addressed by the MOHSS
management at all level. An IPC pilot intervention will be developed which focuses on decreasing hospital
acquired infection (HAI). Clinical questions regarding effectiveness of simple interventions in preventing
specific diseases will be at the center of this pilot project. Among the infection to be averted a special
emphasis will be put on tuberculosis. The intervention will be piloted in 5 selected regions and two main
health facilities (HF) by selected region. Two audits of the selected (HF) will be conducted at 6 months
interval: the first one to establish baseline data, the second to evaluate progress of the interventions.
Baseline data will be collected in laboratories through customized data collection tools for comparison at
regular interval during implementation. Necessary readjustments will be made. The proven best practices
will be scaled up to other regions and other (HF). It is expected that by the end of FY10, 13 HCWs will be
trained as trainers, 100 will receive basic training in IPC (20 through training of trainers, 80 trained by the
trainers), IPC systems will be functional in 5 pilot regions, and HAI will decrease by 20% of the baseline in
Activity Narrative: the selected (HF).
Transition process: URC will build MoHSS capacity to enable the MoHSS to take over the technical and
managerial responsibility of the project. Interventions will address human resource and systems. Three
main vehicles to achieve success of the transition: leadership, integration, and decentralization will be
supported.
Transition plan: URC plans to finalize an MOU in the next two months to outline the transition of roles and
responsibilities that URC is currently leading to MOHSS. This plan will include the components to be
implemented and a time frame for taking over by MOHSS.
Human resources empowerment: knowledge and skills will be transferred.
Systems building: support systems will be developed/strengthen. They include: planning, logistic,
supervision, data management, financial, and fundraising.
Leadership: The central, regional, and district managerial level will be encouraged to provide guidance,
statement, general objective, and strategic directions need to be developed. Appropriate managerial
structure/unit need to be created at all levels. Focal persons need to be appointed, empowered, and be held
accountable for success of the program. Advocacy for proper staffing/multiple tasking will be recommended.
URC will advocate for inclusion of the program budget in the MoHSS annual budget.
Integration: URC will advocate for progressive integration of Injection safety and Waste Management to
other components of the healthcare system. A sense of ownership will be nurtured to ensure that they
become part of routine prevention and supports to a continuum of quality of care. Their cross cutting
characteristics will be emphasized to facilitate their adoption by all services.
autonomous. They should be empowered to play their role interdependently. At facility level a board-to-ward
approach will be adopted. The flow of information will be designed to go from bottom to top with feedback
from top to bottom. The collaborative approach will create a powerful network for sustainability.
Contingency plan: Past experience in the case of safety boxes procurement have demonstrated that
unanticipated constraints have delayed the process. Serious constraints may hamper a short term
transition: a) very limited managerial staff at central level (1 technical staff in Quality Assurance unit), b)
inexistence of appointed counterparts in the regions; c) insufficient community support (780 facilitators
trained end of FY10; the ideal number is 2000; 1 for 1000 community members), d) no evidence of sufficient
financial and technical support to bring all incinerators up to standard); e) IPC strategy implemented only in
38% of the country (5/13 regions; f) HAI decreased by only 20%; g) small percentage of staff establishment
4.2% (300/7000) trained in IPC. These considerations will lead ultimately to the development of a
contingency plan to mitigate the negative effects in case the handing over can not be conducted according
to schedule.
Continuing Activity: 16231
16231 3774.08 U.S. Agency for University 7386 1317.08 $1,529,031
7139 3774.07 U.S. Agency for University 4317 1317.07 $78,425
3774 3774.06 U.S. Agency for University 3064 1317.06 $1,529,031
Estimated amount of funding that is planned for Human Capacity Development $176,268
Program Budget Code: 06 - IDUP Biomedical Prevention: Injecting and non-Injecting Drug Use
Total Planned Funding for Program Budget Code: $0
Program Budget Code: 07 - CIRC Biomedical Prevention: Male Circumcision
Total Planned Funding for Program Budget Code: $915,060
Table 3.3.07:
