NEW/REPLACEMENT NARRATIVE

The FY 2009 COP Tuberculosis Control Assistance Program (TBCAP) builds on COP 08 and also

leverages $1.2 million in USAID Child Survival and Health TB funds. PEPFAR funding is used to support

collaborative TB/HIV activities, while USAID CSH funding continues to focus on strengthening the

foundation of TB prevention and control, in particular the continued roll out of community based DOTS to

Oshana, Oshikoto, Karas and Erongo regions.

The activities in the FY 2009 COP have been planned in close coordination and collaboration with other

USG partners, the Government of Namibia and the Global Fund.

USG partners participating in TBCAP are: CDC - strengthening NIP in quality assured sputum-smear,

culture and drug sensitivity testing, drug resistance surveillance, and counseling & testing; TB Infection

Control: I-TECH -training health workers on TB/HIV, MDR-TB, and developing a TB/HIV training for

community field promoters and supervisors: MSH/SPS - rational drugs management, regulation of new

additional second line drugs, monitoring of side-effects, prescription audits, public health evaluation;

Capacity Project - training, VCT, community-based DOTS; Development Aid from People to People

(DAPP): home based care; PACT - home based care; and the Global Fund - training health workers on

TB/HIV IEC, C&T for HIV in TB patients; training home-based-care workers on TB/HIV.

Coordination of these activities at all levels is still a major challenge for the Ministry of Health and Social

Services (MOHSS) National AIDS Control Program (NACOP) and National TB Control Program (NTCP),

exacerbated by a persistent shortage of human resources, including a lack of capacity in monitoring and

evaluation. FY 2009 COP funding will thus be used for the strengthening of coordination, management,

technical assistance, and development of technical policies.

A priority for TBCAP is thus strengthening leadership and management of the NTCP in all aspects of TB

control (in particular CB-DOTS, MDR-TB, TB-Infection Control, TB/HIV). To this end, COP 2009 will

enhance and expand communication and deliberations among program officers and staff through the

TBCAP-supported review meetings and TBHIV Committees at all levels. TBCAP will also support annual

TB/HIV meetings using the MSH Management and Organizational Sustainability Tool (MOST) model, a tool

(which was initiated in July 2007 for TB/HIV in Namibia.

The FY 2009 COP TB CAP program will concentrate on the following areas:

Coordination at all levels. TBCAP will strengthen coordination through the establishment and facilitation of

TB/HIV Coordinating Committee meetings at all levels on a quarterly basis, which should enable all

stakeholders in TB/HIV - both from a clinical and community perspective - to review progress and

challenges and develop remedial actions. Once yearly a TB/HIV MOST workshop will be organized at the

national level and in each region to ensure that planning and evaluation go hand-in-hand, and that activities

supported from all different funding streams are coordinated and well targeted.

Clinical management of patients dually treated for TB and AIDS (ART, CPT) will be reviewed at the health

facility level in clinical meetings through USG partners supporting TB treatment, HAART and HIV/AIDS

care. This review will be linked to clinical supervision supported by TB CAP, TB management in general,

and MDR-TB in particular. This activity will be sustained because it will be integrated into existing facility-

based Therapeutic Committees.

- TB/HIV IEC materials. This is a continuation from COP2008, but with co-funding from GFATM, will now

focus on re-printing and translating IEC materials into additional tribal languages for TB patients, PLWHA,

and the community. A new component is the development of short videos, leaflets, etc., aimed at raising

awareness of the rise in TB/HIV and how to take appropriate actions. The MOHSS will sustain these

activities once its recurrent budget for TB control is increased.

-TB Infection Control: This is a continuing activity but will be expanded to all hospitals and busy health

centers through: training existing Infection Control Officers on the prevention of TB nosocomial infection

using the new Namibian infection control guidelines; and site visits to conduct infection control assessments

and to supervise and monitor their implementation and monitoring and evaluation efforts. .

This will be done in close collaboration with anticipated continued support from CDC through visits by IC

specialists. Once existing infection control officers are trained in TB-IC and health facility infection control

plans are developed and implemented, MOHSS will sustain their enforcement.

Funding will also be set aside for purchasing N95 respirators. TB CAP has already worked with the NTCP

to make N95 masks available as part of the regular Central Medical Stores commodity and some

emergency protective clothing will also be procured. . TB-IC will thus become fully integrated in the national

IC policy and technical guidelines.

- MDR- TB Register. A new component of this activity is supporting the adjustment of an existing electronic

MDR-TB Register (developed by Stop-TB Partnership) for Namibia, in order to improve monitoring and

evaluation of MDR-TB management. Linkages to NIP data on drug resistant strains diagnosed in NIP will

also be pursued. This will be sustained by incorporating the TB information system into the existing MOHSS

HIS.

- Management of drug resistant TB: TB CAP will continue supporting programmatic management of drug

resistant TB through trainings; support supervisions and will fund quarterly clinical case review meetings.

These meetings will also strengthen surveillance of drug resistant TB.

-TBCAP will continue support for IPT through continued training of health workers who man ART clinics

using the TB/HIV module in the NTCP trainings; this activity is carried out in collaboration with I-TECH.

Support supervision for TB will also focus on ensuring smooth referral systems between TB clinics and ART

Activity Narrative: clinics and will also be rendered to ART, PMTC and VCT to ensure intensified case finding among PLWA.

Community NGOs working in HBC will continue to be invited for quarterly meetings to ensure they support

TB patients and also screen PLWA for TB as part of intensified case finding.

- Staff support. One medical doctor and one nurse will continue to be supported (as under COP2008) in the

TB ward in Katutura hospital to provide on-the-job and formal training of medical doctors and nurses on

MDR-TB management. These staff will also supervise the other seven MDR-TB admission centers and

conduct clinical audits, supporting M&E for MDR-TB.

- CB-DOTS coverage will be expanded within regions already supported by TBCAP. TBCAP will also

provide technical assistance to home based care NGOs such as DAPP to ensure that they include TB/HIV

collaborative issues into their activities;

- Increase TBCAP management capacity: FY 2009 COP funds will continue supporting a KNCV

Tuberculosis Foundation office in Windhoek. The office will comprise three resident medical officers, one of

which will be the project coordinator, who will provide hands-on technical assistance for implementation of

both USG and Global Fund work plans. They will be assisted by a financial controller and bookkeeper and

driver;

- Improve access to TB care: TBCAP will continue working with the Namibian government and other

partners to improve access to quality tuberculosis (TB) care for those infected with HIV & TB. All partners

will continue supporting one common goal as stipulated in TB Medium Term Plan I: to reduce tuberculosis

morbidity and mortality until TB is no longer a public health problem. Considerable progress has been made

in the past two years showing that funding and technical assistance from TBCAP is having an impact , also

allowing parallel efforts supported by Global Fund and WHO (Global Drug Facility) to bear fruit. The

continued rise in HIV testing among TB patients has been made possible through the continued support,

supervision and training in the new guidelines that incorporate TB/HIV activities. Given that almost 60% of

TB patients are HIV infected, TBCAP will strengthen prevention among positives through strengthening

health education messages in health facilities providing TB care.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16210

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16210 4436.08 U.S. Agency for Royal Netherlands 7379 3073.08 Tuberculosis $1,102,324

International Tuberculosis Control

Development Association Assistance

Program

8040 4436.07 U.S. Agency for Royal Netherlands 4411 3073.07 Tuberculosis $1,048,466

International Tuberculosis Control

Development Association Assistance

Program

4436 4436.06 U.S. Agency for Royal Netherlands 3073 3073.06 $118,000

International Tuberculosis

Development Association

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $340,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12: