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: 2007 2008 2009
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS
In FY 2009 COP SCMS will continue their main activities and, in addition, provide support to the HBC
logistics system designed in FY 2008 COP. SCMS will monitor this system performance as well as develop
a Logistic Management Information System (LMIS) capable of reporting logistics data and an Inventory
Control System to ensure maintenance of appropriate quantities of HBC kits at all levels of the system.
Standard Operating Procedures (SOP) will be developed that provide guidelines for inventory management,
quantification, reporting and ordering, monitoring and supervision. Trainings will be conducted to enable the
end users of the system to adhere to the system principles and SOPs, conduct annual quantification for
HBC and procurement planning, and support monitoring and supervision of HBC kits utilization. In FY 2009
COP, in liaison with DOD/I-TECH, SCMS will procure 100 HBC kits for 522 patients on ART under the
DOD/I-TECH support. USG, through SCMS, will also support the replenishment and distribution of an
estimated 8600 HBC kits (Public Sector GFATM procured-6500; PEPFAR funded-2000; DOD/ITECH-100).
Please review narrative from COP08:
This activity has two components: support for the Home Based Care(HBC) Kit logistics systems and
procurement and replenishment of HBC kits for PEPFAR funded faith based organizations (FBOs), NGOs
and community-based organizations (CBOs). The main focus is to continue to provide support to the
Primary Health Care Directorate of the Ministry of Health and Social Services (MoHSS-PHC) to ensure that
HBC Kits are in sufficient supply, and moving through a supply chain that ensures that the kits are available
in the right quantities, at the right places, at the right time. HBC Kit contents include both consumable and
non-consumable supplies to provide basic nursing and personal hygiene care, wound care, gloves to
ensure universal precautions, multi micronutrient tablets and Step I analgesics (panadol) for chronic and
terminally ill people living with HIV/AIDS (PLWHA) who are visited at home by community and home-based
care (CHBC) providers. It is anticipated that supportive and clinical supervision of providers will be
strengthened as the supply chain of HBC kit improves (related to HBHC PACT and MoHSS)
In COP 2007, the Supply Chain Management System (SCMS) supported the MOHSS-PHC Directorate by
conducting an assessment of the distribution and logistics information management system for HBC kits in
Namibia, whose public sector HBC Kits are funded by the Global Fund. SCMS also provided support to
facilitate the distribution of about 6,500 HBC kits to partners across the country, leveraging the Global Fund
funding.
In COP 2008, SCMS will continue support to the MOHSS-PHC with technical assistance for procurement
and distribution of HBC Kits. SCMS will also support the development of reporting and monitoring systems
for this commodity and strengthened logistics training of the MOHSS PHC Directorate with the goal
improving the MoHSS supply chain management for HBC Kits. SCMS will also work with the MOHSS-PHC
Directorate to create a system of HBC kit replenishment for consumable portions of the kit (gloves,
bandages, panadol, multi micronutrient tablest, etc) which is currently non-existent. Proposed activities will
ensure that there is an uninterrupted supply of HBC kits to support the scale-up of palliative care services
within home-based care settings in Namibia. HBC Kits are procured mainly with funding from the Global
Fund. SCMS in COP2008 will leverage this funding and provide support for the distribution of an estimated
8,000 HBC Kits throughout Namibia.
Additionally, the USG through SCMS, will also support the replenishment and distribution of 1,500 kits for
PEPFAR-funded FBOs and NGOs in collaboration with PACT subgrantees. This includes technical
assistance and support for development of reporting and monitoring systems for HBC Kits by PACT
grantees and a system of HBC kit replenishment for consumable items such as gloves for universal
precautions, bandages for wound care, etc. The goal of this activity is to develop an uninterrupted supply of
HBC kit consumables for USG-supported home-based care sites.
To ensure long-term sustainability of interventions, SCMS will assist in improving national capacity through
training and skills transfer to MoHSS-PHC staff, and will ensure that the interventions are consistent with
the vision and capacity of the MoHSS-PHC. This component will provide support to one MoHSS division,
and training for about 10 personnel.
The main emphasis area for the activity is logistics with commodity procurement, local organization capacity
building, and training as minor emphasis areas. The target population is mainly policy makers and other
MoHSS staff.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16185
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16185 7967.08 U.S. Agency for Partnership for 7373 4420.08 SCMS $466,500
International Supply Chain
Development Management
7967 7967.07 U.S. Agency for Partnership for 4420 4420.07 SCMS $285,159
Emphasis Areas
Military Populations
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $57,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.08:
NEW/REPLACEMENT NARRATIVE
In addition to the adult HBC component, SCMS will be extending its support to the Ministry of Health and
Social Services-Primary Health Care directorate to ensure adequate and appropriate pediatric HBC kit
supplies at all levels of the system to match the scaling up of pediatric HIV/AIDS programs. In FY 2008
COP, SCMS assisted in determining additional pediatric formulations to include into the already existing
HBC kit. The pediatric contents to be included are Oral Rehydration Salts (ORS), pediatric paracetamol
suspension and Ready-to-Use Therapeutic Food (RUTF). In FY 2009 COP, SCMS will provide technical
assistance to enable forecasting and quantification of pediatric formulations to be included in the HBC kits.
A replenishment system will also be put in place to ensure an uninterrupted supply of these pediatrics
formulations.
In FY 2009 COP, SCMS will continue support for the HBC logistics system implementation which will
provide the basis for HBC commodity flow for both adult and pediatric products and monitor system
performance. FY 2009 COP activities include development of a Logistic Management Information System
(LMIS) capable of reporting logistics data and an Inventory Control System (ICS) to ensure maintenance of
appropriate pediatrics contents and quantities in HBC kits at all levels of the system and Standard
Operating Procedure (SOP) development that provide guidelines for inventory management, quantification,
reporting and ordering, monitoring and supervision. SCMS will also conducting training to enable the end
users of the system to adhere to the system principles and SOPs and conduct annual quantification for
pediatrics HBC and procurement planning. FY 2009 COP will support SCMS to monitor and supervise HBC
kits utilization and conduct a quantification for Cotrimoxazole(CTX), Ready To Use Therapeutic Food
(RUTF) and OI medicines for pediatrics.
Estimated amount of funding that is planned for Human Capacity Development $12,000
Table 3.3.10:
This is an ongoing activity from COP07. The main focus of this activity is to maintain a comprehensive
supply chain management system to support counseling and testing activities. This includes support to 18
USG supported sites [16 IntraHealth and 2 Catholic AIDS Action] as well as support to the 4 fixed Namibian
Ministry of Defense sites. Program successes in COP07 and COP08 include setting up a direct delivery
system for rapid test kits and supplies to supported sites, implementation of inventory control and logistics
management information systems in supported sites, installation of an automated data capture and
database system for VCT logistics data, and the procurement and distribution of required rapid test kits and
related commodities. Continued training and supportive supervision activities were carried out to ensure
optimal operations.
In COP08, SCMS continued the upgrading of storage facilities in CT sites as well as provided additional
storage facilities to accommodate the scale up of CT activities of the VCT partner. This activity will continue
in COP09 with new sites that are being added to existing ones. Training shall be provided to all CT sites,
both existing and new, including outreach and mobile clinics in inventory management of CT commodities.
This will be in addition to refresher courses that will be provided periodically to existing and new personnel
of CT sites in Logistics Management Information Systems (LMIS) and Inventory Control Systems (ICS).
New sites shall also be trained in the automated LMIS as the software is rolled out. These trainings shall be
followed up with supportive supervisory visits and on-the-job trainings as may be indicated.
In COP09, SCMS will continue to procure all the rapid test kits and related supplies according to regulations
and will deliver the supplies directly to the USG supported sites. SCMS commodity deliveries will facilitate
the achievement of VCT partners targets as follows: IntraHealth/CAPACITY Project, 105,964 clients to be
tested in sixteen (16) fixed sites and an equivalent number of mobile/outreach outlets; I-TECH/DOD
supported MOD/NDF MAPP, 4,000 clients at four one provider initiated sites and four mobile/outreach sites;
CAA, 14,400 clients at the two sites. A total number of 128,717 tests plus quality control (3.5%) for the
parallel algorithm of Detremine and Unigold will be procured.
Continuing with the roll-out of the logistics system automation that was implemented in COP08, SCMS will
provide ten (8) additional computers; software, hardware and related accessories to new and also existing
sites managed by IntraHealth, CAA and ITECH, and provide training to personnel in the automated LMIS
and inventory control system. SCMS will provide scanners and accessories to outreach and mobile VCT
sites that will be added to scale up CT activities. Training will be provided on inventory management and
tools. SCMS will support the set up and operation of new and outreach /mobile VCT sites with equipment
and accessories such as battery powered cool boxes to ensure that heat-sensitive commodities' qualities
are preserved throughout the outreach period. SCMS will also support store upgrades and renovation and
overall training in inventory and logistics management.
Continuing Activity: 16186
16186 7448.08 U.S. Agency for Partnership for 7373 4420.08 SCMS $648,500
7448 7448.07 U.S. Agency for Partnership for 4420 4420.07 SCMS $410,136
Estimated amount of funding that is planned for Human Capacity Development $90,000
Table 3.3.14:
To ensure long-term sustainability of the work of the Namibia Institute of Pathology (NIP), the Partnership
for Supply Chain Management (SCMS) will assist in improving national capacity. This will be done through
assessments, systems development and supporting policy development, trainings and skills transfer to NIP
staff, and the creation of systems and policies that are consistent with the vision and capacity of the NIP.
The SCMS project will place emphasis on developing the capacity of personnel at the national and local
levels to implement an efficient supply chain management system for laboratory supplies. The other focus
of this activity is to support NIP to ensure that laboratory reagents and supplies are being provided in
sufficient supply and moving through a supply chain system that will support the scale-up of the ART
program. The NIP is a parastatal organization mandated to provide laboratory services in Namibia; it
operates 36 laboratories across the country.
In COP08, SCMS facilitated the design of a Laboratory Logistics Management System for NIP through a
consultative process. SCMS also provided support to redesign the layout of the central warehouse of the
NIP and assisted in reorganizing the contents, thus freeing up about 30% of the space without adding
additional infrastructure. With COP09 funding, support provided to NIP will ensure that Laboratory Logistics
Management System is operated optimally. For this task, SCMS will continue to support the position of a
Laboratory Logistics Advisor placed at NIP. SCMS will consultatively develop Standard Operating
Procedures (SOPs), a quality manual, Job Aids and train staff on the system.
In COP08, SCMS provided support to do a preliminary review of the materials management module of
Meditech® and the initial gaps in the inventory control parameters were noted. A further in depth gaps
analysis was made. With COP09 funding, support will continue through formal training of staff at both the
central and facility levels, a focus on the gaps found in the analysis and work to increase the knowledge
pool at NIP. On the job training and supportive supervision strategies will be carried out periodically to
ensure that the system operates optimally and necessary adjustments to the inventory control parameters
are made. Support will also be provided for the maintenance of the systems for laboratory equipment
management and tracking developed in COP08.
With COP08 funding, support was provided for the review and development of Disposal Policies to govern
disposal of obsolete and non-functional equipment and supplies. With COP09 funding, support will be
provided for implementation of the SOPs and Job Aids and also physically removing and destroying
accumulated equipment in the various NIP warehouses and stores. Continued support will be given to
improve and make safe the storage facilities for flammable and corrosive reagents.
SCMS will continue to focus on waste management (disposal of infectious medical waste) by supporting
NIP and/or MoHSS in facilitating development and putting in place relevant SOPs and guidelines,
maintenance contracts and relevant training of operators.
In COP09 SCMS will continue to work with the NIP in pursuing ISO certification for the central stores
through supporting the strengthening of systems and procedures for re-accreditation of the central
laboratory, followed by the regional laboratories.
In COP09 SCMS will continue to provide support to strengthen NIP's procurement management systems.
Continued support will also be provided to support standardization, forecasting and quantification of
reagents, supplies and equipment.
In COP09, SCMS will also support tertiary institutions to introduce laboratory logistics in their curriculum for
training of laboratory technicians.
These activities will ensure that the supply of laboratory supplies remains uninterrupted to support the scale
-up of ART services in Namibia.
Continuing Activity: 16188
16188 7451.08 U.S. Agency for Partnership for 7373 4420.08 SCMS $450,000
7451 7451.07 U.S. Agency for Partnership for 4420 4420.07 SCMS $389,404
Estimated amount of funding that is planned for Human Capacity Development $225,000
Program Budget Code: 17 - HVSI Strategic Information
Total Planned Funding for Program Budget Code: $5,868,234
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
November 7, 2008
HVSI COP 09 Program Area Summary
The US Government (USG) supports Namibian strategic information (SI) initiatives related to HIV/AIDS within the framework of
Namibia's multi-sectoral Integrated Action Plan (IAP) to monitor and evaluate the national response to HIV/AIDS. The IAP
outlines SI priorities, including monitoring and evaluation (M&E), health management information systems (HMIS), surveys and
surveillance, and public health evaluations (PHE). The IAP is based on Namibia's National M&E Plan, which is designed to track
progress toward the 3rd Medium-Term National HIV/AIDS Strategic Plan (2004-2010). Harmonization of USG SI activities with
Namibian frameworks and priorities will ensure national ownership, maximum impact, and sustainability.
Namibia's ability to implement the IAP is limited by inadequate human resources, insufficient expertise in SI disciplines, weak
information systems, and the absence of a functioning, internationally recognized institutional review board (IRB). USG activities
in FY 2009 COP will strengthen Namibian SI capacity through: (1) highly skilled technical advisors; (2) human resources for data
entry and management; (3) information technology hardware and software; (4) support in certifying three national IRBs: and (5)
other capacity building activities in SI. These activities include support for M&E training and technical assistance in Namibia via
implementing partners, scholarships for M&E workshops and short courses at internationally recognized institutions in the region.
The USG SI team is also working with host-country counterparts to prioritize and address SI gaps by building capacity in the
integrated use of existing data sources and by promoting key surveys to identify population characteristics related to HIV and TB
transmission and prevention. The objective of supporting these gaps is to provide information that will facilitate the design of
prevention, care and treatment activities, while building local capacity in SI skills. USG representatives sit on the national M&E
committee to ensure coordination of USG SI support with that of government ministries, civil society, and other development
partners.
A priority of the USG SI team is to support and improve the national health information systems (HIS) that provide critical data on
HIV/AIDS and TB indicators. Since FY 2002, the USG has supported the development of paper-based and electronic information
systems that allow calculation of these critical HIV and TB indicators. Since FY2005 COP, the USG has also supported an HIS
technical advisor who assists the HIS and M&E subdivisions in the Ministry of Health and Social Services (MOHSS).
Since the FY 2007 COP, the USG has supported: (1) review and revision of the ART clinic-based patient monitoring system
(based on the WHO ART card), which included development and roll-out of a locally engineered, computerized system
(Filemaker) to capture and report on critical indicators; (2) roll-out and enhancement of the ART pharmacy management
information system (PMIS) and commodity tracking system; (3) design and roll-out of the electronic TB information management
system; and (4) design and roll-out of a revised routine HIS that captures key epidemiological outcomes (on HIV/AIDS, TB,
mortality, PMTCT, and VCT).
The USG will also continue to support the national OVC database in FY 2009 COP through technical assistance (via an
implementing partner) to the Ministry of Gender Equality and Child Welfare. In addition, the USG will provide technical assistance
via an implementing partner to the Ministry of Education's management information system.
Continuing from the FY 2008 COP, the SI team will also support the information technology component of the HIVQUAL program
to facilitate HIV quality-of-care evaluation at the facility level. HIVQUAL relies on a computer-based tool to summarize selected
indicators bi-annually, and the SI team will support maintenance and use of that tool in coordination with HIVQual international.
In FY 2009 COP, the USG Department of Defense (DoD) will continue working closely with the Government of Namibia's Ministry
of Defence/Namibia Defence Force (MOD/NDF) to build capacity in SI, including the ability to gather and analyze service delivery
and survey data, and to analyze the data to improve the quality of care and treatment programs to strategically plan in response to
evolving needs, programmatic innovations, and new technologies. DoD will also support the MOD/NDF in building a Health
Management Information System for the roll out of their VCT, laboratory facilities and ART services. Continuing from FY 2008
COP activities will be support to the MOD/NDF in compiling the prevalence survey report and disseminating it to relevant
authorities. In addition, the USG is supporting short and medium training in M&E for MOD M&E officers as well assisting the MOD
in establishing its M&E system.
As noted above, support for M&E systems is another USG priority. A USG technical advisor for M&E has been seconded to the
MOHSS M&E Sub-Division since FY 2006 COP and this advisor led USG support for the first national M&E plan, which was
launched in late that same year.
During FY 2007 COP, this M&E plan was translated into the Namibia IAP using a 13-component framework developed by a
consortium that included the USG, UNAIDS, the World Bank, and other international HIV M&E stakeholders. In FY 2009 COP the
USG will support continued refinement and implementation of the IAP.
Since the FY 2007 COP, the USG has supported 13 regional level M&E officers (one per region), who are using various data
sources to lead SI activities in each region. In FY 2009 COP the USG will continue to support national and regional
implementation of the IAP, with the 13 regional M&E officers playing a pivotal role in data collection, program monitoring, and
basic analysis.
Capacity building is a central tenet of the IAP, and the USG supported the development of a Namibian M&E curriculum in FY 2008
COP, and in FY 2009 COP will continue support for the delivery of this curriculum to appropriate personnel in government and
partner institutions. USG FY 2009 COP activities will also support the development of key M&E products (annual HIV/AIDS
report, UNGASS report, quarterly bulletins) through contributions made by various members of the SI team.
The USG also supports surveys and surveillance systems to: inform the design of prevention, care, and treatment programs;
provide inputs for epidemiological projections, and monitor progress toward prevention, care, and treatment goals. In FY 2009
COP, this support will include implementation of the bi-annual sentinel HIV survey and possible incidence testing on banked
samples from the 2006 and 2008 sentinel surveys, if deemed appropriate. To establish HIV infection levels in the Namibian
military, the USG will continue to support a prevalence study that began in FY 2008 COP. The USG will also continue to support:
the implementation of the first ever AIDS Indicator Survey (AIS) with HIV biomarker to evaluate HIV prevalence in the general
population; a health facility survey to assess the availability and quality of HIV/AIDS services; and, a behavioral and prevalence
survey of prisoners. As has been planned since FY 2005 COP, the USG will also support a survey of TB cases to assess the
extent of drug-resistant TB and drug-resistant HIV throughout Namibia. Implementation of a smaller, less in-depth version of this
survey took place in 2007 after much delay due to inadequate laboratory capacity, but this challenge has now been overcome.
The drug resistance survey implemented with FY 2009 COP funds in 2010 is expected to be comprehensive in nature and to be
adequately supported by USG technical advisors to the MOHSS.
Continuing from FY 2006 COP, the USG will support training on the use of the EPP/Spectrum software packages to support HIV-
related projections. Using these and other tools, the USG assists in modeling the projected need for clinical, laboratory, and
pharmaceutical services through 2014. The USG will continue to support policy decisions by refining projections based on newly
available programmatic and survey data and by disseminating computerized policy tools such as EPP Spectrum to policy makers
and program planners.
Continuing from FY 2008 COP, the USG Namibia team will build programmatic M&E capacity in community-based, faith-based
and non-governmental organizations through training and support visits. As in FY 2007 COP and FY 2008 COP, when the USG
Namibia team worked extensively on determining minimum standards of quality for OVC services, the SI team and USG partners
will continue emphasizing minimum standards of services to all areas supported by PEFPAR in prevention, care and treatment.
Data quality issues will also be addressed through adapting the PEPFAR/Global Fund data quality tool to the local context and
working with partners to increase the reliability of their data. Training and supportive supervision will be provided by USG staff
and implementing partners to ensure that data quality activities are underway and personnel are properly trained.
Formative evaluations for improving health communication programs and targeted program evaluations as well as operations
research will be supported through NGO implementing partners. Such activities include: (1) a KAP survey among MARPs; (2) an
outcome evaluation of an integrated income generating and care program; (3) a KAP survey among teachers; and (4) VCT
mystery-client evaluations.
In FY 2009 COP, the USG will also support PHEs across the various program areas. Continuing PHEs include: (1) an ART
adherence survey; (2) an assessment of infant feeding practices; (3) an evaluation of a comprehensive prevention intervention for
HIV care and treatment settings; (4) a quasi-experimental study on changing gender norms that support HIV risk behaviors among
men in Namibia; (5) an evaluation of the Windows of Hope life skills prevention program; and (6) an evaluation of compliance to
guidelines on treatment and prescription for HIV/AIDS. At the time of the FY 2009 COP submission, Team Namibia was awaiting
final word from the PHE review committee regarding the PHEs newly proposed for FY 2009 COP.
Members of the current USG SI team include the SI advisors for CDC and USAID, the HIV/AIDS project coordinator for DOD, the
M&E technical advisor for CDC, the HIS technical advisor (CDC), and, new to FY 2009 COP, an SI program assistant at USAID.
SI team members communicate daily to support SI activities and meet regularly (at least monthly).
Table 3.3.17:
(1) In collaboration with MoHSS-DSP and other stakeholders, SCMS will review a systems and options
analysis of available tools (ADT, Meditech, Inventory control system for VCT, HBC kits, filemaker); on the
tools currently in use in country. To further enrich the options analysis, SCMS will support a visit(s) to other
countries to learn best practices, and recommend options on the way forward in use of tools or
synchronization of available tools (US$7,855)
(2) In COP09, SCMS will continue TA to the Logistics Management Information System (LMIS) capable of
monitoring national pipelines of ARVs, Test Kits, Laboratory Supplies and other HIV/AIDS related
commodities, and also provide TA and support to the HIV/AIDS logistics management unit (HLMU) activities
of the MoHSS for the collection and management of HIV/AIDS-related logistics information in support of the
LMIS.
(3) In collaboration with MoHSS-DSP and in-country partners, SCMS will participate in the development and
implementation of a Central Data Depository (CDR) for HIV/AIDS commodity related data, that will enable
the capture, storage, aggregation, processing, transmission and online presentation/reporting for all
HIV/AIDS related commodity data capable of managing service statistics, essential logistics data and other
related data for ARVs, RTKs, HBC kits, Laboratory reagents and supplies and other HIV/AIDS related
commodities. The CDR will receive data from diverse sources to be managed in one solution; these primary
source systems include, MSH/SPS ADT/NDB; NIP's Meditech; IntraHealth ICS and HBC supply logistics
systems. System requirements, technical design, implementation approach, and supporting material will be
defined and documented as appropriate. The developed and implemented CDR for all HIV/AIDS related
commodity data will enable efficient managing of the national HIV/AIDS program. SCMS will also support IT
specialist services for the implementation and operations of the CDR and needing primary sources systems
(US$21,755).
(4) SCMS will continue to provide staff to MoHSS Pharmaceutical Services Division for the position of ART
Logistics Pharmacist seconded to the MoHSS handling ART data, LMIS and HLMU activities (US$42,000).
(5) Monitoring and Evaluation: Support the development & implementation of an M&E system to ensure the
generation and utilization of quality information to support HIV/AIDS supply chain management activities
(US$8,390). This system will extract key supply-chain information from existing information systems.
Continuing Activity: 16189
16189 7452.08 U.S. Agency for Partnership for 7373 4420.08 SCMS $84,700
7452 7452.07 U.S. Agency for Partnership for 4420 4420.07 SCMS $319,483
Estimated amount of funding that is planned for Human Capacity Development $42,000
In FY2008, SCMS recruited and seconded one tender/procurement pharmacist and one pharmacy assistant
to the MoHSS to support procurement activities within the Central Medical Stores (CMS), these positions
will continue to be supported under COP09.
SCMS will continue to review the extent of implementation and continued suitability and applicability of
Standard Operating Procedures (SOPs) for CMS, propose and implement changes and provide training as
required in line with the continuous changes to the system.
In COP09, SCMS will continue to support implementation of the recommendations of the Short Term
Technical Assistance (STTAs) conducted in COP07 and COP08, including the review of the transport and
fleet management systems of HIV/AIDS medicines and related commodities, evaluation of poor suppliers
performance of CMS, and other technical assistance reviews for supply chain management systems and
procedures.
The fourth component of this activity is amended as follows: SCMS will provide support to the Procurement
and Tenders Section of the CMS to undertake procurement of ARVs, rapid test kits and HIV/AIDS related
medicines and commodities using funds provided by USG, GFATM and the Government of Namibia, to
ensure compliance with the requirements of the USG FARs and AIDAR, GFATM and GRN regulatory
conditions.
Continued support will be provided for the positions of Quality Surveillance Lab (QSL) manager and Quality
Analyst. In addition, SCMS will provide support to strengthen the analytical capacity and skills of staff of the
QSL through specific capacity building activities to be developed and implemented for the QSL in
collaboration with the SCMS Quality Assurance partner NorthWest University, based in South Africa, to
ensure that quality assurance systems in place in the country guarantee the procurement and acceptance
of ARVs and other HIV/AID commodities meeting the required quality standards.
SCMS will support 30 individuals and provide funding for training for these 30 in stores management and
procurement, distribution of HIV/AIDS commodities to about 55,000 patients on treatment, and leveraging
resources provided by the GRN and GFATM.
COP 08 ACTIVITY NARRATIVE
This continuing activity is an expansion from FY07 and relates to other activities in this area, including
MSH/RPM+ (7650), to ARV service activities, including those of Potentia (7374), the Ministry in Health and
Social Services (MoHSS) (7365), and Intrahealth (7361) and to PMTCT activities including those of MOHSS
(7365) and IntraHealth (7361).
This activity has four components and aims to strengthen the capacity of the MoHSS to procure, store and
distribute ARVs and related commodities, while assuring the right quality and also that the supply chain
management services are provided in a cost effective and timely fashion.
The first component is to provide continued technical assistance and support to the Central and Regional
Medical Stores of Namibia for the continued development and implementation of modern logistics practices
and technologies. In FY2007 USG through SCMS provided support to the MoHSS to continue the work
initiated by MSH/RPM Plus to strengthen supply chain management systems and procedures of the Central
and Regional Medical Stores of Namibia to enable it to efficiently carry out it's responsibility for procurement
and distribution of MoHSS, USG and GFATM funded HIV/AIDS related commodities. In FY2007, support
was provided to develop proposals for the reorganization of the distribution systems of the MoHSS, through
integrating the Regional and Central Medical Stores into one functional unit. A proposal for reorganization
was submitted to the MoHSS and USG, and funding will be provided under COP FY2008 to implement the
recommendations. Specifically, in FY2008, support will be provided to support the set up and operation of
the proposed Medical Stores Division within the Directorate of Tertiary HealthCare and Clinical Support
Services. This assistance will also include the integration of the inventory control management systems,
Syspro™ databases, of the Central Medical Stores (CMS) and the two Regional Medical Stores (RMS) into
a single database and begin the implementation of warehouse Management System (WMS) modules in the
3 warehouses and ensure proper integration of the functions of the medical store system. To facilitate the
effective implementation of the WMS, and to address the problem of space availability for ARVs and related
commodities, USG will support targeted renovations of the CMS and the two RMS; the provision of
warehouse, storage and handling equipment, including racks, pallets, shelving as may be required so as to
ensure optimum utilization of the storage space available and provide appropriate and adequate storage for
ARVs and related commodities. Comprehensive SOPs and Job Aids for the management of workflow
processes of the integrated Medical Stores System will be developed and training provided for all staff of
the CMS and RMSs. Previously, USG supported the review of the procurement policies and procedures of
the MoHSS and provided training in the revised procedures. In FY2008, support will be provided for the
development and implementation of a comprehensive computerized procurement management system,
including, tender management, contract documentation and supplier performance monitoring systems. This
will ensure that procurement and vendor management is carried out optimally, thus assuring the continued
availability of quality products. To further assure the security of ARVs in particular and other related
commodities, USG will support the installation of access control systems in the ART warehouses of the
central and regional medical stores. To promote retention of staff, and also to build capacity locally, support
will be continued to provide training for senior management and staff of the CMS and RMS to ensure that
modern logistics practices are always adhered to.
The second component of this activity will be to continue support for strengthening quality assurance
systems for HIV/AIDS related commodities to ensure that the quality of ARVs and other HIV/AIDS related
commodities are assured throughout the supply chain. Specifically, technical assistance and support will be
Activity Narrative: provided for; 1) Procurement of selected equipment for the QSL to enhance the testing capacities of the
laboratory; and 2) Provision of training to personnel of the QSL to ensure that they are up to date with
regulations and new techniques to ensure sustainability and support capacity development in the principles
of quality assurance in supply chain management; 3) Continued support for the position of QSL Manager
seconded to the MoHSS.
The third component of this activity is to provide support to strengthen quantification, supply planning and
inventory management the medical store system to facilitate coordinated forecasting, quantification, and
procurement planning for MoHSS, USG and GFATM funded HIV/AIDS related commodities. In FY2008,
support will be provided to recruit and second to the MoHSS HIV/AIDS Logistics Management Unit (HLMU),
an ART Logistics Officer to support quantification, supply planning and inventory management for ARVs,
RTKs, medicines for opportunistic infections (OI) and other HIV/AIDS related commodities. The HLMU will
also be supported to develop and implement a system for collection and management of logistics
information to support quantification and supply planning for ARVs, RTKs and other HIV/AIDS related
commodities, and develop quarterly updates of quantification and supply plans for HIV/AIDS commodities
which will contribute to ensuring an uninterrupted supply of HIV/AIDS related commodities. All seconded
personnel will be recruited through a local HR firm at MoHSS levels to ensure that thy can be absorbed by
the MoHSS. Training will be provided to ensure that competencies in the use of SCMS selected tools such
as Quantimed®, PipeLine®, ProQ®, etc are enhanced and institutionalized in the MoHSS, to develop local
capacity for inventory management, forecasting and supply planning.
The main focus of the fourth component of this activity is to procure ARVs to treat HIV/AIDS in Namibia, and
to ensure sufficient supply and availability of quality ARVs to Namibians at treatment sites. These ARVs will
be procured in accordance with the Government of the Republic of Namibia's (GRN) national ART program
protocols, and USG rules and regulations. Procurement of ARVs will be done through a dual mechanism. 1)
The GRN will be provided funds under the CDC cooperative agreement with the GRN to procure ARVs, and
2) Procurement through the SCMS to leverage the benefits of the SCMS approach to procurement which is
based on aggregated purchasing on behalf of HIV/AIDS care and treatment programs. By creating a
consolidated international procurement mechanism, SCMS leverages economies of scale, provides the best
value and increases efficiency. SCMS will procure about US$1,000,000 of ARVs as part of the USG
contribution of ARVs to the GRN. These ARV drugs will go directly to the Central Medical Store and will be
accessed by all public sector ART programs. The USG contribution is estimated to cover approximately a
third of the national ARV procurement needs, which target ~55,000 patients on treatment by the end of the
program year 2008. The procurement process is closely linked with the development of a rigorous logistics
management information system and the use of software to monitor stock levels on a monthly basis. SCMS
will continue to make full use of its Regional Distribution Center (RDC) in South Africa and/or Botswana to
allow for speedy shipping of products on a more frequent basis which will diminish the storage capacity
needs of CMS.
This activity will provide support to 3 medical stores, 1 Quality Control Laboratory and also provide training
support for about 30 individuals in stores management and 6 individuals in procurement, and provide
support for the procurement and distribution of ARVs to about ~55,000 individuals on treatment, leveraging
Continuing Activity: 16187
16187 7449.08 U.S. Agency for Partnership for 7373 4420.08 SCMS $2,777,688
7449 7449.07 U.S. Agency for Partnership for 4420 4420.07 SCMS $2,497,291
Program Budget Code: 19 - HVMS Management and Staffing
Total Planned Funding for Program Budget Code: $8,976,610
In FY08 the Namibia PEPFAR Team continued to make progress toward an interagency team approach. This year's COP
planning retreat, the second ever held in Namibia, was widely attended by not only the USG team, but by all implementing
partners, including more than 20 representatives from six Namibian government ministries, and over 40 representatives of
indigenous and international implementing partners. In addition, representatives of the greater donor community operating in
Namibia attended this year's retreat, resulting in a combined participation of more than 110 individuals who contributed to
identification of national gaps in service, and then prioritized program activities required to close the identified service gaps.
The PEPFAR team in Namibia progressed in its efforts to address the Staffing for Results (SFR) and other management and
staffing exercises prescribed for development of the FY 2009 Country Operational Plan (COP 09). In acknowledging the
requirements of SFR implementation and the specific activities required for the COP, Team Namibia again attempted to look
strategically across all participating agencies and to reach consensus on the relative and unique strengths and weaknesses of
each agency. The team utilized the work done at the retreat, supplemented by interagency technical team input, to identify current
and prospective partners required to fill service gaps. The COP09 SFR exercise was constrained in its scope because of late and
inaccurate guidance on important areas impacting staffing levels and budgets. Additionally, because of the continuing transition
of the USAID Mission to an all-PEPFAR Mission, coupled with an unusually high level of management rotation and vacant
positions, the SFR process required substantial preparation and challenging work. There is much remaining to be done on SFR,
and over time, following on the COP09 and FY 2008 Annual Performance Results (APR08) exercises, that work will move
forward. Our SFR vision commits us to identifying and achieving the optimal mix of technical and administrative personnel
deployed in interagency teams and assigned to the most appropriate managing agency to assure continued success of the
Emergency Plan in Namibia. Responsibility for managing the SFR process was left with the country agency head committee, with
the Coordinator's office mediating SFR committee meetings, but a lack of interagency analysis of management and staffing made
it difficult to complete the SFR exercise. We continue to see SFR as a flexible, country internal tool for determining our ideal
staffing levels and structures.
The following were identified as agency-specific core strengths:
HHS/CDC: The Centers for Disease Control (CDC) has a strong partnership with MOHSS and the Namibia Institute of Pathology
in promulgating critical technical standards and guidelines, technical direction of partnerships for essential routine data collection
and disease surveillance, identifying and piloting cutting-edge approaches to clinical and prevention opportunities such as
Prevention with Positives and TB/HIV integration, as well as strategic information gathering, analyses and dissemination across
multiple program areas. In light of the continuing, substantial shortage of skilled health personnel, CDC also emphasizes short-
and long-term HR provision and planning, and assists with growth of Namibia human capacity through support of in- and pre-
service training, including development of a graduate program for an MPH that will have concentrations in general public health
policy and financial management, nutrition and strategic information, offered to up to a minimum of fifty students annually. New
activities associated with National Testing Day, Male and Female Leadership Conferences on HIV/AIDS, all first-time activities,
were highlights of CDC's roster of involvement in 2008. All of these strengths will continue to be emphasized during COP 09, and
will be complemented by the full PEPFAR team that was also involved in these activities during 2008.
Peace Corps: Peace Corps was the first USG agency in Namibia following this country's independence in 1990. Approximately
120 volunteers, most of whom are teachers, work at the grass-roots level throughout Namibia. PCVs have provided assistance to
PEPFAR through Regional AIDS Committees for Education (RACE) which promote awareness of HIV/AIDS, prevention and risk-
reduction in schools. In COP09, PC will focus on prevention initiatives, complementing the other USG agencies working in
Namibia and taking advantage of the ability of volunteers to reach distant or isolated locations and populations that other agencies
have difficulty reaching.
USAID: Unique aspects of the US Agency for International Development (USAID) include an ability to manage very large projects
supporting the interagency response, piloting and then rapidly taking to scale and assuring quality of complex clinical and
community interventions; flexible and responsive hiring mechanisms; and historic and successful management of HIV and health
social marketing, behavior change communications, community-based, and mitigation programs. USAID also has long-standing,
positive relationships with key host government and civil society counterparts and development partners, and wrap-around
funding from other streams such as TB. Public-Private Partnerships were notably enhanced during the last year, and will continue
to be supported in COP09.
DOD: The US Department of Defense (DOD) has been active in HIV/AIDS in Namibia initially through the Humanitarian
Assistance Program, and subsequently through its model Military Action and Prevention Program (MAPP) that has already
reached more than 10,000 members of the military (more than half of all members of the military), with expectations of reaching
an additional 2,000-3,000 through the doubling of military CT centers from two to four during FY 2008. The DOD's partnership
with the MOD is invaluable as Militaries are notoriously protective of their information and service provision. Establishing a
comprehensive HIV/AIDS program in the MOD with direct support from the USG, including expansion and integration of
counseling and testing with treatment services on bases, has been a great accomplishment of Namibia's PEPFAR program.
State: Commencing in 2007 with a full-time EP Coordinator, the US Department of State (State) is responsible for the overall
coordination of PEPFAR program development and implementation throughout Namibia. In addition, State supports a newly-
developed position for managing a grants portfolio within the Public Affairs Office of the Embassy, a portfolio managed by award-
winning PAO and agencies to highlight and coordinate PEPFAR efforts in Namibia. State also supports the Ambassadorial
portfolio of small grants for HIV/AIDS projects. Although approved in COP 08, the position of strategic Information Liaison/Deputy
Coordinator is currently being prepared for recruitment and continuation with COP 09 support.
In the process of preparing for COP08 and for SFR within that process, Interagency Technical Teams (ITTs), operating with fewer
members than in COP 08 due to staff shortages, and larger Technical Advisory Committees that are inclusive of key partners and
technical experts beyond the USG team, were critically examined for effectiveness, burden on available staff, overlap and
harmonization with simlar GRN or GF working groups, and capacity to promote integrated planning across agencies and technical
areas. As a result, teams were consolidated and further strengthened for development of the 2009 COP, which was led again this
year by the ITTs, each of which was led by 2 co-chairs rather than by a single chair as was the case for COP08. The nineteen
PEPFAR programmatic budget areas were primarily planned for in the Namibia COP09 by the following six interagency technical
teams:
* Prevention (HVAB, HVOP, HBML, HMIN, IDUP, and CIRC)
* Adult and Pediatric Care and Treatment (PMTCT, HTXS, PDTX, HVTB, HBHC and PDCS)
* Orphans and Vulnerable Children (HKID)
* Counseling and Testing (HVCT)
* Strategic Information (HVSI)
* Other Health Policy and Systems Strengthening and Lab Infrastructure (HLAB, OHSS, cross-cutting issues, HCD and training)
In the course of all of the above, historic and current agency staffing was critically examined. No redundancies were found and
critical gaps were identified and responded to in the Program Planning and Oversight Functional Staff Chart as well as the
individual agency management chart and consolidated database that constitute SFR supporting documents. Planned staff
additions are consistent with agency core strengths summarized above. CDC, DOD, State, PC and USAID personnel have
participated in technical reviews for new hires to be managed by the other agencies. It was anticipated that as the SFR process in
Namibia progressed, new, cross-agency selection panels for new hires would have been developed, but such did not happen. We
remain optimistic that such will become the case in future COP planning, with at least a sharing between agencies of position
descriptions and recruitment plans, thereby affirming dedication to interagency collaboration. Full details on status of staffing as
requested in the COP Guidance are in a separate supporting document, the Namibia Program Planning Functional Staffing Chart.
Team Namibia has, through efforts aimed at ITT development and functioning, strategically allocated additional time and
resources to more effective management of our overall response to COP development and management needs. While we are
slightly above the recommended 7 % ceiling for these vital M&S functions because of the continuing transition of the USAID
Mission to an all-PEPFAR Mission, the interagency collaboration that continued into its second year will hopefully strengthen and
serve the team well going forward.
It is anticipated that upon approval of Team Namibia's Partnership Compact Concept Paper, COP 09 will support the development
of the Compact which will focus on three primary pillars: Human Capacity Development, Prevention and Workplace Programs.
There will be an intensely-focused effort on these three issues, with hoped-for investment up front during the second phase of
PEPFAR. Implementation of the Compact will lead to Namibia assumption of an increasingly greater portion of PEPFAR
activities.
In response to a State action cable received in late October, subject: INTERAGENCY COORDINATION BEST PRACTICES AND
LESSONS LEARNED THROUGH PEPFAR AND PMI PHASE I, the following best practices are noted:
* Establishment of Interagency Technical Teams (ITT) developed with representation of all USG agencies, co-chaired by two
people, each from a different agency. The ITTs have responsibility for determining program service gaps and developing
recommendations for filling the gaps. Their activities revolve around prevention, care, treatment, and cross-cutting activities within
the three large categories.
* Annual off-site retreats that initiate the COP development process. USG team members attend the first 2-3 days, and then are
joined by representatives of all implementing partners, government, and donors, including the Global Fund. Broad ownership of
gap identification processes and prioritized actions to fill the gaps lead to common understanding among all USG team members
of PEPFAR goals and objectives for the coming year.
* The importance of consistent support of the Coordinator's roles and responsibilities by the Ambassador and DCM cannot be
overstated. In the absence of such support the convening, organizing and facilitating authority of the Coordinator could be
undermined by some agencies and individuals.
* Establishment of a committee comprised of ITT co-chairs is a potentially very constructive action, allowing co-chairs to come
together to discuss among themselves common issues, insights, frustrations, and management challenges. Ideally, this
committee would meet without the presence of agency heads, but with a representative of the Coordinator's office present.
* PEPFAR HQ support for an externally facilitated, objective SFR exercise that looks at all positions of all agencies with a
discipline, authority, and expertise strong enough to reinforce the activity.
Table 3.3.19:
