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
PUBLIC HEALTH EVALUATION FOR PALLIATIVE CARE IN NAMIBIA (PHE tracking # = NA.09.0252)
A review of palliative care provision in sub-Saharan Africa in 2005 found a wealth of experience but a lack
of evidence, and that a priority for the field should be a focused evaluation focus to: (1) capture lessons
learned, (2) prove the effectiveness of facilities, and (3) move forward on expansion of quality palliative care
with maximum coverage (Harding & Higginson 2005). This lack of evidence, and lack of documented
lessons learned, hampers informed priority setting and decision making on the part of national and
subnational programs, and of local service providers.
Although palliative care improves some outcomes for those living with HIV disease (Harding et al 2005), the
evidence base is largely absent in Africa. A survey of end-of-life HIV care providers in Africa has identified
the reasons for this absence of evidence. African practitioners reported the need for the skills and tools to
evaluate and audit palliative care (Harding et al 2003).
With funding from PEPFAR, two public health evaluations (PHE) of palliative care in Kenya and Uganda
were commenced in 2007 and both are set to be completed by the end of 2008. The evaluation design
consists of an observational longitudinal evaluation of existing care, and focuses on the outcomes of
palliative care. An additional cost analysis component will also compare outcomes with their associated
costs.
The African Palliative Care Association (APCA) is proposing that a similar public health evaluation be
undertaken in Namibia. This evaluation will follow on from the rapid situational analysis of palliative care that
was undertaken by the MoHSS in conjunction with APCA in 2008, and the results of this situational
analysis will also be taken into account when finalising the protocol for the Namibia public health evaluation.
The findings from this public health evaluation are intended to inform practical guidelines for scaling up
palliative care provision in Namibia and making mid-course corrections for the programme.
The specific aims of this Palliative Care PHE are as follows:
• To evaluate how program components and costs are related to health outcomes
• To disseminate "lessons learned", best practices and to provide recommendations for scale-up and mid-
course corrections identified from the evaluation
PHEs are undertaken in order to understand rapidly the effectiveness of programs of interest to countries,
so that mid-course corrections and adjustments can be appropriately applied based on the study's findings.
We envisage that the multiple data sources could be used to guide future care by providing information on
the following:
- detailed description of the processes and outputs of care provided cross-sectionally and over time by
home based care providers providing palliative care, including methods of working, assessment systems,
drugs provided, methods of detection and management of opportunistic infections, symptoms and
psychological problems, nutrition, primary prevention, family care, measurement methods and continuity,
follow-up and defaulting rates;
- detailed description of the outcomes and impacts of care achieved over time by palliative care service
providers, including change in symptoms and symptom relief, change in quality of life, health status and
psychological needs, and family support;
- linkage of input and components of care, cost, process, outcome and impact data to determine which
models of care provide optimal outcomes for whom and in what circumstances;
- suggestions to guide the optimal future investment in palliative care, utilising integration of outcome and
qualitative data to examine associations between components of care and patient clinical and non-clinical
outcomes;
- The purpose of capturing costs associated with different care models and their outcomes is to estimate,
compare and evaluate their strategic value within the overall study. Costs are a critical component of any
PHE because they inform resource-allocation decisions during the initiation, scale-up, and maturation of
sites providing palliative care.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Human Capacity Development
Public Health Evaluation
Estimated amount of funding that is planned for Public Health Evaluation $173,094
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.08:
NEW/REPLACEMENT NARRATIVE
The African Palliative Care Association (APCA) is dedicated to applying lessons learned from other African
countries to scale-up cost-effective, culturally-appropriate palliative care for Namibian persons living with
HIV/AIDS (PLWHA) and their families. This continuation from FY 2007 AND 2008 COP relates to other
Basic Care services: USAID, MOHSS, I-TECH and PACT grantee links.
Palliative care technical expertise in Namibia is increasing and has expanded beyond the cancer center to
doctors, nurses and community volunteers through palliative care training provided in COP 2006 and COP
2007. The development and expansion of palliative care has been limited by the lack of expertise to support
not only provision of palliative care but efforts to advance programs. In COP 2006 and 2007, the USG and
its partners, including the Ministry of Health and Human Services (MoHSS) received technical assistance
from APCA and its members. This included support for the Catholic AIDS Action (CAA) community and
home-based care (CHBC) program to pilot a program to integrate key palliative care strategies and training
into their efforts within Anamulenge & Rehebooth. Sensitization of the MoHSS, other key stakeholders and
USG care and treatment partners about the palliative approach to HIV/AIDS care and effective bi-directional
referrals has also been carried out. Initial work has begun in conjunction with I-TECH to review the
Namibian adaptation of the IMAI palliative care module, along with I-TECHS HIV/AIDS modules for the
University of Namibia School of Nursing. Integration of palliative care into pre-service curricula is key and
APCA will work alongside training schools to introduce palliative care and integrate into their curriculum.
The long-term education strategy for palliative care in Namibia is to build in-country expertise that can be
used in trainings and for supervision and mentorship, thus APCA plans to support selected healthcare
workers to pursue specialist training in palliative care. Mobilization for Namibian leadership in palliative care
training, service delivery and policy development has been key through the initial development of a National
Task Force for Palliative Care and the later establishment of a Namibian Palliative Care Association.
While significant program accomplishments are underway, continued technical support is needed to build
on program successes, address existing gaps and develop dedicated in-country expertise. In FY 2009
COP, APCA will support the MoHSS, USG partners and other stakeholders to roll out HIV-related palliative
care services, including continued support for the national Integrated Management of Adult Illnesses (IMAI)
palliative care program and the development and piloting of a national palliative care training program for in-
service training, training of trainers (ToT) and supportive supervision. In 2009, the IMAI palliative care
module will be completed and implementation will begin in selected health centers and clinics. APCA will
support the MoHSS and ITECH with implementation through ongoing review of training materials and
essential drug lists, and technical assistance with the current policy environment for ensuring availability
and accessibility of essential palliative care drugs. While initial work during COP 2007 resulted in palliative
care being included in the national policy on HIV/AIDS, APCA will advocate and support the MoHSS in the
development of further palliative care policies and guidelines; the development and implementation of
standards of care; monitoring and evaluation of palliative care and movement towards the development of a
national palliative care policy that allows nurses to prescribe narcotics and other symptom-relieving
medications. Technical assistance will follow for nurse training and the possible integration of this topic into
the University of Namibia's Advanced Nursing Diploma. Building on successes to date of APCAs Regional
Drug Availability Workshops in Entebbe (2006) and Accra (2007), APCA works with the National Palliative
Care Task Force to ensure Namibian follow-through on the work plan that was developed by Namibian
stakeholders at the drug availability meeting in Windhoek in February 2008.
During COP 2007 APCA supported the National Palliative Care Task Force and the MoHSS to develop a
detailed plan for palliative care leadership and integration at policy, service delivery and education/training
levels. This was informed through a study tour for key MoHSS and NGO personnel to share lessons learned
and best practices across Africa. In FY 2009 COP APCA will support the development of a functional
national palliative care association out of the task force, with clear terms of reference, strategic plan and
work plan. APCA will also support key personnel from Namibia to attend their regional palliative care
conference to be held in Namibia in September 2010.
The CAA/APCA pilot program to integrate palliative care into select sites in the CAA home-based care
program was completed in COP 2007 and lessons learned along with implementation challenges are being
disseminated. In FY 2009 COP, this program will be expanded to additional sites selected in partnership
with the MoHSS and CAA. APCA will train a further 20 health care professionals to receive ToT in palliative
care and also directly train up to 180 community volunteers. APCA will also provide refresher training and
on-going support and mentorship for persons previously trained. APCA will ensure gender-sensitive
approaches, including equitable training and support of male and female health care workers with the goal
of equitable access to HIV/AIDS services for PLWHA and their families throughout USG-supported
programs. APCA will also build upon its programs in other countries looking at men as caregivers for
PLWHA and will integrate the lessons learned into its program in Namibia.
The USG supports a tremendous range of palliative care activities in Namibia. Some palliative care is
provided by partners and sub-partners under the "palliative care" program areas; other palliative care is
provided by partners in other program areas, such as prevention, counseling and testing, and HIV
treatment. Care-related activities extend from clinical interventions focused on the patient (e.g. infection
prophylaxis and pain management) to psychological, spiritual and social care interventions for the patient
and the patient's family. More information is needed on the range, levels and quality of activities being
supported. In FY 2006/2007 APCA conducted a palliative care public health evaluation (PHE) in Kenya and
Uganda. During COP 2008, lessons learned from this PHE were disseminated and applied to the Namibian
context. APCA will conduct a similar PHE in Namibia and a separate PHE in COP 09 form has been
submitted. The results will build upon the situational analysis undertaken with the MoHSS in FY 2007/8 and
will help develop: 1) an inventory of palliative care activities in Namibia; 2) a practical framework for
categorizing these activities including the levels of palliative care provided; 3) a set of process indicators
that can be used to evaluate the quantity, quality and levels of palliative care provided; 4) a model that
estimates the demand for and supply of palliative care by select palliative care partners in a specified
geographic area including an appraisal on implementation of elements of the preventive care package, and
Activity Narrative: strategies that support treatment adherence and management of symptoms and pain. The results will be
used to inform program planning by the Namibian Government, expand palliative care service delivery in
underserved areas, and identify priorities for monitoring and evaluation. The results will also help APCA
support the MoHSS to develop a framework for palliative care monitoring and evaluation for Namibia and
APCA will provide technical assistance in developing tools for ongoing monitoring and evaluation of
palliative care. This activity will be undertaken in consultation with the MoHSS.
APCA will also undertake an assessment of priorities and preferences in end-of-life care in Namibia. This
will be part of a larger multi-country assessment that APCA is undertaking across the region to identify
priorities and preferences for end-of-life care. To date it has been assumed that individuals would prefer to
die at home, yet they are often rushed into the clinic at the last minute. This assessment will seek to
ascertain priorities and will help to shape the overall policy development for palliative care and training
within Namibia and the region.
Throughout FY 2009 COP the work of APCA in Namibia will be coordinated by an in-country project
coordinator with the support of an administrator and technical support and supervision from the Southern
Africa Regional Office under the direction of the Southern Africa Regional Coordinator. Oversight of the
program will remain with the APCA head office and other APCA staff will provide technical assistance as
required.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16183
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16183 4797.08 U.S. Agency for Pact, Inc. 7372 3475.08 South Africa- $471,669
International Regional
Development Associate Award
8043 4797.07 U.S. Agency for Pact, Inc. 4672 3475.07 South Africa- $293,373
4797 4797.06 U.S. Agency for Pact, Inc. 3475 3475.06 South Africa- $203,051
Estimated amount of funding that is planned for Human Capacity Development $206,669
Estimated amount of funding that is planned for Public Health Evaluation $0
HIV/AIDS (PLWHA) and their families. This continuation from FY 2007 and 2008 COP relates to other Basic
Care services: USAID, MOHSS, I-TECH and PACT grantee links.
Palliative care technical expertise in Namibia is increasing and has expanded beyond the cancer centre to
2007. The development and expansion of palliative has been limited by the lack of expertise to support not
only provision of palliative care but efforts to advance programs. In COP 2006/2007, the USG and its
partners, including the Ministry of Health and Human Services (MoHSS) received technical assistance from
APCA and its members. This included support for the Catholic AIDS Action (CAA) community and home-
based care (CHBC) program to pilot a program to integrate key palliative care strategies and training into
their efforts within Anamulenge & Rehebooth. Sensitization of the MoHSS, other key stakeholders and USG
care and treatment partners about the palliative approach to HIV/AIDS care and effective bi-directional
University of Namibia School of Nursing. Mobilization for Namibian leadership in palliative care training,
service delivery and policy development has been key through the initial development of a National Task
Force for Palliative Care and the later establishment of a Namibian Palliative Care Association.
on program successes, address existing gaps, including that of pediatric palliative care, and develop
dedicated in-country expertise. In FY 2009 COP, APCA will support the MoHSS, USG partners and other
stakeholders in the development and piloting of a national palliative care training program for in-service
training, training of trainers (ToT) and supportive supervision, which includes pediatric palliative care. In
2008, this palliative care module will be completed and implementation will begin in selected health centers
and clinics. APCA will support the MoHSS and ITECH with implementation through ongoing review of
training materials and essential drug lists, and technical assistance with the current policy environment for
ensuring availability and accessibility of essential palliative care drugs for both adults and children. While
initial work during FY 2006 resulted in palliative care being included in the national policy on HIV/AIDS,
APCA will advocate and support the MoHSS in the development of further palliative care policies and
guidelines which include those for children; the development and implementation of standards of care;
monitoring and evaluation of palliative care provision for adults and children and movement towards the
development of a national palliative care policy that allows nurses to prescribe narcotics and other symptom
-relieving medications.
During FY 2007 COP, APCA supported the National Palliative Care Task Force and the MoHSS to develop
a detailed plan for palliative care leadership and integration at policy, service delivery and education/training
and best practices across Africa. In FY 2008 COP APCA will support the development of a functional
work plan which includes an emphasis on pediatric palliative care. APCA will also be running a pediatric
palliative care track at their conference in 2010 and will support key personnel from Namibia to take part in
this.
It is anticipated that the Namibian palliative care PHE will highlight some of the needs of children requiring
palliative care. Thus the results will be used to inform program planning by the Namibian Government,
expand palliative care service delivery for children, and identify priorities for monitoring and evaluation. The
results will also help APCA support the MoHSS to develop a framework for palliative care monitoring and
evaluation for Namibia and APCA will provide technical assistance in the developing tools for ongoing
monitoring and evaluation of palliative care such as the APCA African Pediatric Palliative Outcome Scale.
This activity will be undertaken in consultation with the MoHSS.
Throughout FY 2009 COP, the work of APCA in Namibia will be coordinated by an in-country project
coordinator with the support of an administrator, and technical support and supervision from the Southern
Africa Regional Office under the direction of the Southern Africa Regional Coordinator. Overall oversight of
the program will remain with APCA head office and other APCA staff will provide technical assistance as
Estimated amount of funding that is planned for Human Capacity Development $67,000
Table 3.3.10:
