PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
NEW/REPLACEMENT NARRATIVE
Management Science for Health's project Strengthening Pharmaceuticals Systems (MSH/SPS) will
enhance access to ART for adults in Namibia through the following activities:
1.Provide dispensing equipment to 15 health centers and clinics.
Success in the Ministry of Health and Social Services (MoHSS) ART programs since 2002 had resulted in
55,000 patients on ART in 35 facilities. However, the number of patients now overburdens care providers,
compromising quality of care. In FY 2009 COP the MSH/SPS project will build on FY 2008 COP efforts on
activity ID 3769.08 to work closely with MoHSS to continue to scale-up ART services and to ensure that
decentralization is adequately supported. MSH/SPS will continue to strengthen storage and inventory and
dispensing practices to support the scale up of referral and outreach programs in 15 Integrated
Management of Adult and Adolescent Infection (IMAI) sites across Namibia. MSH/SPS will provide
dispensing and related equipment to enhance efficient delivery of pharmaceutical services to the increasing
numbers of patients in order to reduce waiting time and enhance adherence. This activity will support
services at the static ART sites which have increased from 35 in FY 2007 COP, to 50 in FY 2008 COP and
are projected to reach 65 in FY 2009 COP.
2. Provide basic pharmaceutical management training.
This is a follow on to activity ID 3769.08. To support MoHSS IMAI and decentralization strategies and in an
effort to provide necessary capacity for task-shifting, MSH/SPS will use the basic pharmaceutical
management curriculum developed in FY08 to provide training to 30 non-professional pharmacy staff and
nurses. Overall, the objective is to shift basic pharmaceutical duties to other workers in these new facilities.
MSH/SPS will work closely with regional and district pharmacists on this activity to ensure sustainability.
Also in FY08 MSH/SPS expanded the contents of the HIV/AIDS pharmaceutical management training
materials to topics on rational use of TB medicines, good prescription practices, prevention with positives,
and palliative care medicines. In FY 2009 COP MSH/SPS will provide trainings to 120 HCWs on these key
topics. To facilitate sustainability, MSH/SPS will collaborate with NHTC to ensure that the trainings are
subsequently taken up by the continuous training program of the institution.
3. Provide support through Potentia for selected positions.
In FY 2009 COP MSH/SPS will continue to provide funding through Potentia for ongoing salaries of
seconded staffs and recruitment of other critical positions as identified by the MoHSS. This is a follow on to
FY 2008 COP activity ID 3769.08. A total of 15 old and new staffs including pharmacists and other
pharmaceutical staffs will be funded with FY 2009 COP funds.
4. Strengthen regional pharmacists' routine monitoring and supervision activities. Since FY 2007 COP
MSH/SPS has worked with MoHSS to provide support to regional pharmacists to enhance the supportive
supervisory activities, this is a follow on to FY 2008 COP activity ID 3769.08. In FY 2009 COP MSH/SPS
will continue to strengthen routine monitoring and supervision of district hospitals, health centers and clinics
by regional pharmacists to enhance delivery of pharmaceutical services through supportive supervisory
activities by providing technical assistance and support for the conduct of 30 supportive supervisory visits
and activities
5. Improve access to palliative care medicines.
Following on FY 2008 COP activities and as a continuation of activity ID 17259.08 SPS in FY 2009 COP will
work with MoHSS to ensure sustainable availability and rational use of morphine and other palliative care
medicines for PLWHA. MSH/SPS will provide support to home based care organizations and volunteers in 5
regions to ensure that the increased availability of morphine in the facilities is adequately utilized and
monitored when indicated by home based care providers in the communities.
6. Provide technical assistance to the essential medicines selection system.
In FY 2009 COP MSH/SPS will provide technical assistance and support for the strengthening of the
essential medicines management system. The purpose of this support is to ensure that a sustainable,
efficient, rigorous and transparent essential medicines selection system is established in the country.
MSH/SPS will provide support to MoHSS for the revision, updating and publication of the next edition of the
Namibia essential medicines list (Nemlist).
7. Support Therapeutics Committees (TC) to improve rational use and mitigate antimicrobial resistance
(AMR).
This is an expansion of FY 2008 COP activity ID 3769.08 to improve quality, reduce antimicrobial resistance
and secure durability of current ART regimens. Since 2005 the RPM Plus followed by the MSH/SPS
program, have been supporting Therapeutic Committees (TCs) to address issues related to rational use of
medicines in health facilities. Irrational use of medicines has many consequences. In addition to wastage of
resources, it is a health risk to the public especially due to an increased incidence of Adverse Drug
Reactions (ADRs) and is a major underlying factor for the development and spread of antimicrobial
resistance. In Namibia, TCs have been identified as the appropriate vehicles for addressing the problem of
irrational use of medicines at the facilities. However, most of the TCs in the country have either been
functioning sub-optimally or not at all and MSH/SPS has been providing TA to MoHSS to reactivate and
support these committees. In FY 2009 COP, a key component of this activity will include support for the
establishment of a system for both internal and external monitoring and evaluation of the functionality of
TCs, using indicators developed in FY 2008 COP. For TCs identified to be functioning sub-optimally,
interventions will be developed and implemented to strengthen them. TCs will also be assisted in applying
both quantitative and qualitative methods of investigating medicine use, especially ARVs and TB medicines,
and ABC/VEN analyses and the DDD methodology. MSH/SPS will implement interventions to address any
medicine use problems identified.
8. Implement evidence-based strategies for HIV Drug Resistance surveillance activities.
The widespread and inappropriate use of antimicrobial agents in health care facilities has resulted in the
emergence of Antimicrobial Resistance (AMR) bacteria. Individual and public health consequences are
Activity Narrative: enormous in terms of increased morbidity and mortality, prolonged periods of infectiousness with increased
risk of transmission of the resistant pathogen to others, and increased direct and indirect costs. With
increasing number of patients on ART in Namibia, HIV Drug Resistance (HIV DR) posses an urgent and
imperative risk to the delivery of ART. In FY 2009 COP, MSH/SPS will provide TA which incorporates WHO
strategies/protocols to develop a system to identify the challenges and implement evidence-based
strategies for HIV DR surveillance activities throughout the country. MSH/SPS will provide technical
assistance for AMR capacity building. MSH/SPS will provide training for 30 prescribers and dispensers in
AMR. MSH/SPS will also provide support for developing and updating ART and antimicrobial guidelines,
and policies to improve compliance with guidelines. MSH/SPS will continue to work with WHO Namibia and
WHO Geneva to ensure a system of on-going monitoring of HIVDR Early Warning Indicator (EWI).
9. Support implementation of infection control strategies.
Since FY08 MSH/SPS has collaborated with the University Research Company (URC) and the MoHSS
Quality Assurance unit to strengthen national and facility level Infection Control (IC) activities and improve
awareness and behavior for good IC practices. The spread of infectious diseases in hospitals amongst
patients and staff is a serious problem worldwide. These hospital-acquired infections (nosocomial
infections) cause serious risk to immunocompromised individuals including HIV/AIDS patients and
contribute to morbidity and mortality in hospitals and health care facilities and increase costs significantly.
There is clear evidence that IC programs are effective in decreasing the rates of infection, morbidity, and
mortality, as well as in decreasing costs associated with managing infections. The entire health care
community is responsible for developing and following procedures to prevent infections, and the TC bears
much of the responsibility. The development of drug and antiseptic resistant microbes is a critical risk to not
only PLWHA but to the entire delivery of health care. In FY 2009 COP MSH/SPS will expand on FY 2008
COP activity ID 3769.08 by implementing 3 components of this activity; 1) by ensuring MoHSS staff at
regional and facility level avail IC commodities in all the 34 hospitals in Namibia, 2) MSH/SPS through
working and strengthening Therapeutic Committees (TCs) will ensure that in all the 13 regions implement
and monitor infection control practices, and 3) simple strategies for prevention of nosocomial infections.
These activities will leverage and complement URC principal focus on safe injection practices and
contribute to efforts in improving infection control in Namibia.
10. Conduct PHEs approved in COP08.
In FY 2008 COP MSH/SPS received approval to conduct 2 PHEs: 1) evaluation of adherence to treatment
guidelines and 2) Drug Utilization Review (DUR). In FY 2009 COP MSH/SPS will continue to implement
activities as proposed in the PHE. This is a follow on to FY 2008 COP activity ID 3769.08
11. Implementation of adherence interventions in adults.
This is a continuation of FY 2008 COP activity ID 3769.08. Poor ART adherence is recognized as a major
contributing factor to the development of AMR leading to therapeutic failure. In FY 2009 COP MSH/SPS will
expand earlier efforts at piloting adherence intervention activities to a nationwide scale-up. MSH/SPS work
with partners to implement strategies to improve adherence in 35 ART facilities nationwide.
12. Improve Private Public Partnerships and the quality of ART services in the private sector.
This is a continuation of FY 2008 COP activity ID 3769.08 In FY 2009 COP MSH/SPS will continue to
collaborate with partners to implement interventions to lower cost and access and quality of ART services in
the private sector. MSH/SPS will improve private sector practitioners' compliance to National ART
guidelines by 5% and reduce cost of provision of ARVs to 25% of private patients by 10%.
13. Strengthen environmental compliance towards safe disposal on pharmaceutical wastes.
Improper disposal of expired medicines is a major problem that occurs in many countries including Namibia.
The risks associated with improper disposal of expired medicines include the environmental pollution or
contamination which is potentially harmful to the health of the community and the fact that these medicines
can potentially be diverted for reuse or resale posing a major health threat. In FY 2009 COP MSH/SPS in
collaboration with URC will build on FY 2008 COP activities in environment compliance. MSH/SPS will
provide support to MoHSS and other stakeholders to provide policies and standard procedures for
managing pharmaceutical waste.
New/Continuing Activity: Continuing Activity
Continuing Activity: 17358
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
17358 3769.08 U.S. Agency for Management 7650 7650.08 Strengthening $2,733,364
International Sciences for Pharmaceutical
Development Health Systems GHN-A
-00-07-00002-00
7136 3769.07 U.S. Agency for Management 4315 1149.07 Rational $3,090,198
Development Health Management,
Plus
3769 3769.06 U.S. Agency for Management 3062 1149.06 Rational $1,644,495
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $550,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.09:
enhance access to ART for pediatrics in Namibia through the following activities:
1. Provide technical assistance for increased access and availability of better pediatric formulations of
ARVs.
Numerous challenges have confronted efforts at scaling up pediatric ART. There is a lack of adequate
pediatric formulations including lack of pediatric fixed dose combination products. In FY 2009 COP
MSH/SPS will provide technical assistance to MoHSS to improve the availability of adequate pediatric
formulations. MSH/SPS will conduct a review of the level of satisfaction with the current formulations and
make recommendations on how to improve availability of better formulations for children and care givers.
Findings from the review will be published and used to advocate for increasing access to pediatric
formulations.
2. Support interventions to improve compliance to treatment guidelines.
The treatment of HIV positive children is often challenging due to the nature of HIV in children and the lack
of pediatricians and specialists with expertise in pediatric ART. In Namibia guidelines exist for the
management of pediatric ART however there are anecdotal reports that the level of compliance to the
guidelines are low. For instance, children qualifying for cotrimoxazole prophylaxis therapy (CPT) and
Isoniazid prophylaxis therapy (IPT) are often not provided these life-saving medicines. In FY 2009 COP
MSH/SPS will collaborate with therapeutics committees to implement interventions that are aimed at
improving compliance to pediatric guidelines. MSH/SPS will support the implementation of those
interventions in 10 high volume ART facilities.
3. Implement adherence interventions in children.
Ensuring adherence to ART in pediatrics is often complicated by several factors including the lack of
adequate tools for monitoring pediatric adherence and the administration of doses to children by older
caregivers and other relatives who do not fully understand how medicines should be taken and the need to
adhere to prescription. In FY 2009 COP MSH/SPS will develop IEC materials to educate low literacy care
givers for pediatric patients on how to administer ART and monitor adverse events on children on ART.
MSH/SPS will also provide trainings to 120 care givers and members of the community on adherence, side
effect recognition, and other self management strategies to improve outcome to treatment for pediatric
patients. These trainings will be conducted across all the regions in Namibia. The ART adherence PHEs
activity referenced under HTXS will also ensure the study of children as an important subgroup during the
survey and the implementation of interventions.
4. Accelerate Pediatric ART roll-out.
During the FY 2009 COP, MSH/SPS will continue to support the decentralization of ART service delivery.
This activity will increase access to ART for adults and children. Other approaches to increase access to
pediatric ART will include:
- Support the integrated development of pediatric HIV care and treatment services with adult ART and
PMTCT services (e.g.: service co-location) to support family health interventions and approaches.
- Support the development of models of care that enable follow-up and management of HIV-infected
children started on ART to ensure optimal adherence and reduced morbidity and mortality.
5. Strengthen national capacity in the delivery of pediatric ART.
MSH/SPS will provide support for the pediatric HIV team within the National HIV Program to ensure that
evidence based technical decisions are planned and implemented in the delivery of pharmaceutical care to
pediatrics. At the same time, MSH/SPS will provide support to national programs to expedite needed
updates in plans, policies, guidelines and training materials in relation to pharmaceutical service delivery.
Through the strengthening support supervision activities at the regional and district level MSH/SPS will work
with national programs to strengthen district/regional health teams to monitor and supervise pediatric
program service roll-out. MSH/SPS will support national programs in ensuring that special considerations
for pediatric ARVs (new regimens, formulations -including pediatric fixed dose combinations, storage and
different combinations, and age-specific dosing) are adequately supported and monitored. This will include
improved inventory management systems for pediatric ARVs and monitoring of rational use of ARVs.
MSH/SPS will support the monitoring systems for pediatric ARVs, CTX, OI drugs and pain medications
(including opioids) at the facility level and support rational use activities.
6. Human Capacity Development.
In FY 2009 COP, MSH/SPS will continue to support the National Health Training Center (NHTC), University
of Namibia (UNAM) and other ongoing training activities in the management of pediatric HIV patients on
ART.
7. Program Monitoring.
The expansion of Pediatric HIV services will require the parallel development of capacity for program
monitoring and evaluation. MSH/SPS will support PEPFAR national teams and partners to develop, collect,
report and monitor pediatric HIV indicators by age categories (Infancy <2 years, childhood 2-5 years, and
children and adolescents from 6-14 years).
Health-related Wraparound Programs
* TB
Estimated amount of funding that is planned for Human Capacity Development $40,000
Table 3.3.11:
This activity under Management Science for Health's project Strengthening Pharmaceutical Systems
(MSH/SPS) has four components: 1) technical support to ensure compliance with IPT and CTX guidelines
for TB patients; 2) technical support to ensure rational use and safety of TB medicines; 3) expanded training
in TB pharmaceutical management and enhanced support to M&E systems; and 4) enhanced infection
control activities.
1) Compliance with IPT and CTX guidelines. Evidence has shown that IPT and CTX play critical roles in
primary and secondary prophylaxis of opportunistic infections in HIV positive patients. The use of IPT in
people living with HIV significantly reduces reactivation of latent TB, and the use of CTX has been shown to
be beneficial in primary and secondary prevention of Pneumocystis carinii pneumonia and Pneumocystis
jirovecii pneumonia.
To improve uptake of these proven interventions, MSH/SPS-supported sites that are successfully providing
ART will provide increased access to IPT and CTX and ensure adequate monitoring systems to enable
ongoing evaluation of access to these medicines. This activity will be implemented in collaboration with the
Tuberculosis Control Assistance Program (TBCAP), DSP M&E, the HIVQUAL project and the Therapeutics
Committees (TC) from selected facilities to build capacity and sustainability and ensure compliance with the
treatment guidelines.
2) Ensure rational use and safety of TB medicines. Concerns have been raised about the side effects of
some TB medicines. In FY08 MSH/SPS collaborated with TBCAP to introduce pharmacovigilance activities
within the public health programs, using the TB program as a pathfinder. During the FY 2009 COP,
MSH/SPS will continue its collaboration with TBCAP to monitor and document side effects of TB medicines,
in particular the second line TB medicines. MSH/SPS will consolidate the lessons learned and provide
continued support to health workers in sustaining the patient-initiated adverse event reporting system.
MSH/SPS will also collaborate with the Therapeutics Information and Pharmacovigilance Center (TIPC) to
expand the trainings provided in FY08 to community based organizations (CBOs). These CBOs practice
Directly Observed Short-Course Treatments and have also been trained to monitor side effects and adverse
drug reactions to TB medicines in the three regions of Erongo, Caprivi and Karas. These trainings will now
be provided to other CBOs in Namibia.
3) Expand training in TB pharmaceutical management and increase support for M&E systems. During the
FY 2009 COP, implementing in close collaboration with I-TECH, MSH/SPS will continue supporting
professional health training activities containing components of HIV/AIDS and TB pharmaceutical
management. MSH/SPS will advocate for the inclusion of topics on the rational use of TB medicines, good
prescription practices, prevention with positives, and palliative care medicines into relevant curricula in the
National Health Training Center and the University of Namibia.
MSH/SPS will also support strengthening of the HIV patient monitoring system, using the Antiretroviral
Dispensing Tool, and enhance linkages with other monitoring systems to support intensified TB case-finding
among PLWH. MSH/SPS will also strengthen referrals to other HIV care/support activities and TB
treatment. MSH/SPS will support the use of the data for program planning, resource allocation, and
program improvement. Data use will be supported to enhance both the TB program and the HIV program.
4. Strengthen Therapeutics Committees (TCs) to implement infection control strategies in support of
national TB programme, TBCAP and Quality Assurance department of the MoHSS. MSH/SPS will work
through the TCs to train health workers in the use of an integrated approach to TB infection control,
including minimizing the risk of TB infection to both patients and health care workers. Lessons learned from
implementing strategies will be documented and shared widely among health workers through the Namibia
Medicines Watch and other forums to encourage a positive behavioral change to infection control.
Continuing Activity: 19401
19401 19401.08 U.S. Agency for Management 7650 7650.08 Strengthening $250,000
Estimated amount of funding that is planned for Human Capacity Development $30,000
Table 3.3.12:
NEW/REPLACEMENT ACTIVITY
This activity under Management Science for Health's Strengthening Pharmaceutical Systems project
(MSH/SPS) has two components: 1) implementation of the ART Commodity Tracking System at treatment
facilities; and 2) support for data quality, program monitoring and the Pharmacy Management Information
System (PMIS).
1) The ART Commodity Tracking System: The strategic information activities described below will facilitate
improved procurement and distribution of ART commodities nationwide. This activity is related to USG
technical advisors supported through CTS Global (7233) and strategic information personnel supported
through Potentia (7338).
ART commodities tracking has been an on-going activity since COP 06. In line with the decentralization of
ART services, strengthening pharmaceutical management, patient management and reporting at all
identified sites is essential. MSH/SPS will continue to support health facilities using the ART Dispensing
Tool (ADT), thereby ensuring that all sites providing full ART services and ART outreach services enhance
their work with timely information for decision making.
MSH/SPS will also rollout the ADT to 15 new treatment facilities with the highest volume of patients and
train and refresh 40 pharmacy and nursing staffs that use the ADT in new and existing facilities that are
already using the ADT. To promote the rational use and planning of ART services, MSH/SPS will obtain
data on the number of patients, by category, receiving treatment at facilities and also encourage the use of
the ADT tool for periodic reviews of the use of ARVs and OI medicines.
In conjunction with the Ministry of Health and Social Services' (MoHSS) Directorate of Special Programs as
well as the Pharmaceutical Services Division, MSH/SPS will also identify critical information gaps in the
delivery of ART in Namibia which can be adequately filled by the ADT, and amend the ADT accordingly.
MSH/SPS will enhance reporting systems from the ADT National Level Data Base by incorporating
additional reports and queries as required by the MoHSS. Data on ARV consumption from this database will
be used by the SCMS-proposed Central Data Repository to enhance national level quantification of ARVs
MSH/SPS will also continue to support the Information Systems Administrator at the MoHSS
Pharmaceutical Services Division to ensure that the ADT and other electronic tools are adequately
supported and maintained. (This position is part of the HTXS support through Potentia.)
The ADT will also be updated to enable reporting on PMTCT activities in the country; once this system is
implemented, up to 60% of PMTCT patients will be reported on and adequately covered. Linkages between
the ADT and other systems such as the Health Information System (HIS) and the Electronic Patient
Management System (ePMS) used in the MoHSS, will also be strengthened.
Finally, data from MSH/SPS' ART Commodity Tracking System (ACTS) will be utilized by SCMS to ensure
timely quantification for the central medical stores.
2) Support for data quality, program monitoring and the Pharmacy Management Information System
(PMIS).
The PMIS was launched in July 2007 and subsequently implemented in all 13 regions of Namibia.
Information from the system is used both at local facility and national levels for monitoring and evaluating
pharmaceutical system performance for planning purposes and to guide decision-making. .In FY 2009 COP,
MSH/SPS will continue to support the implementation of the system, especially in strengthening data quality
and collection and aspects of reporting. In addition, MSH/SPS will provide technical assistance for utilizing
the PMIS to monitor the quality of pharmaceutical care and services, including ART services, at treatment
facilities. Using the information gathered from the PMIS, MSH/SPS will provide technical assistance in
identifying weaknesses and designing interventions to improve quality of treatment and care services at all
levels of the healthcare system.
MSH/SPS will also provide technical assistance to the MoHSS for the roll-out and implementation of some
of the PMIS indicators at the Primary Health Care level, especially for monitoring pharmaceutical care and
services following the decentralization of ART services and palliative care to this level. MSH/SPS will further
provide technical assistance for the incorporation of some key PMIS indicators into the HIS and the National
Essential Indicator Framework.
In addition, MSH/SPS will provide technical assistance to the MoHSS & the PMIS taskforce for the planned
review of both system implementation and system indicators, incorporating feedback from the users and
making revisions as necessary.
MSH/SPS will also support a series of activities to improve data quality including: improving timeliness,
completeness, accuracy and quality of data collected and reported; conducting data quality audit activities in
selected facilities; and providing training on data quality to all regional pharmacists from the 13 regions.
MSH/SPS will also provide support for data synthesis and triangulation of HIV treatment data and link this
information with other care indicators, e.g. palliative care, IPT, CPT, and CB DOTS.
MSH/SPS will continue providing technical assistance to the MoHSS-convened Monitoring and Evaluation
Committee by submitting reports on specific pharmaceutical indicators, as requested.
Continuing Activity: 17037
17037 17037.08 U.S. Agency for Management 7650 7650.08 Strengthening $180,600
Estimated amount of funding that is planned for Human Capacity Development $50,000
Program Budget Code: 18 - OHSS Health Systems Strengthening
Total Planned Funding for Program Budget Code: $8,642,507
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Despite tremendous obstacles, including one of the highest rates of HIV in the world, severe shortages of health care providers,
and sparse populations across vast distances, Namibia has excelled at rolling out HIV programs, ranking among PEPFAR
countries first for ART coverage and second for PMTCT coverage. Emerging as a newly independent nation liberated from
apartheid only in 1990, the Government of the Republic of Namibia (GRN) should be commended for its ongoing commitment to
bringing HIV prevention, care and treatment services to its residents.
The Partnership Compact Concept Paper between the US Government (USG) and the GRN recognizes the GRN's success to
date in delivering recurrent services. The Concept Paper commits the USG to focusing more on agreed-upon priority areas,
including prevention, systems strengthening, and human capacity development. Some of the most pressing systems
strengthening needs include:
• Pre- and in-service training for Namibians in HIV and HIV-related fields;
• Public health leadership training for current managers and supervisors to include personnel management, fiscal management,
and using data for decision making;
• Integrated and comprehensive health information systems (to include clinical, laboratory and pharmacy systems) that are
networked between central and peripheral levels;
• Infection control for both patients and health care workers, especially in view of increasing numbers of MDR and XDR
tuberculosis cases in Namibia;
• Enhancements to health facilities to better serve the burgeoning number of individuals in need of services;
• Decentralization of services via outreach and task-shifting to reach rural communities;
• Strategic planning to guide sustainability and the possible integration of HIV care and treatment services within primary health
care; and
• Improved linkages between facility- and community-based programs.
Only recently classified as a lower-middle income country, Namibia fares better, in general, than its Sub-Saharan peers in its
health status indicators, such as maternal and child mortality, bringing services closer to orphans and vulnerable children and the
increased number of people accessing antiretroviral services. One notable exception is the Namibian population's life expectancy,
which at 47 years due to the HIV/AIDS epidemic, is lower than the averages of Sub-Saharan African countries (48 years) and that
of lower-middle income countries (67 years). However, Namibia reveals worse health status and health systems indicators than
its income group peers. Moreover, its unique geography and population structure further call for broad support to the health
system, in order to ensure equity, efficiency, and quality in the scale-up of services to mitigate the HIV/AIDS epidemic.
The Ministry of Health and Social Services (MOHSS) clearly recognizes the importance of coordination with and communication
between the large number of donors and stakeholders supporting HIV/AIDS and other health programming in Namibia.
Strengthening the Namibian health system is crucial for maximizing the impact and reach of leveraged resources from the
MOHSS, PEPFAR, the Global Fund, and other donors. By leveraging limited resources to strengthen the Namibian health system
to support HIV services, other programs, such as primary health care and other communicable disease programs, such as TB and
STI, are also strengthened. Furthermore, USG officials continue to collaborate with the MOHSS and other ministries on a daily
basis to develop and implement HIV-related efforts. This close collaboration increases expertise and ensures country ownership
and the sustainability of programs beyond PEPFAR.
In COP09, the USG will continue to support health systems strengthening as a platform to foster and strengthen new and existing
collaboration and coordination among donors, the government actors involved in HIV/AIDS programs, public and private sectors,
and civil society, in order to maximize results. Through its cross-cutting health system strengthening portfolio, USG will work
under the leadership of the GRN/MOHSS to support the sustainable transfer of technical capacity to the GRN and to local
institutions.
USG programs will continue to be guided by the GRN's National HIV/AIDS Policy and Third Medium Term Plan (MTP III) to
reduce the incidence of HIV infections to below epidemic threshold (1%). USG will support country leadership of HIV/AIDS
programming and contribute to:
• Reducing new infections of HIV, STI, and TB through evidence-based prevention programming;
• Continuing to increase access to cost-effective, and high quality treatment, care, and support services for all people living with or
affected by HIV/AIDS, with a particular emphasis on outreach-based services in COP09;
• Strengthening and expanding the capacity for local, culturally sensitive responses to mitigate socio-economic impacts of
HIV/AIDS;
• Strengthening of an enabling environment so that people infected and affected with HIV/AIDS access equal rights in a culture of
acceptance, openness, and compassion; and,
• Developing strategic plans for integrated and coordinated program management to keep pace with increasing ownership of HIV
programs and increasing numbers of Namibians needing HIV prevention, care, and treatment services.
The USG aims to achieve maximum improvements in the overall health status of Namibians through improving service delivery for
primary health care, alleviating the human resource crisis, facilitating the use of data for participatory decision-making, continuing
to strengthen pharmaceutical management, and strengthening the leadership and governance capacity of health sector
stakeholders. The USG will seek to leverage HIV/AIDS programming to maximize the positive effects of these interventions into
other health areas. All health systems strengthening activities will be guided by a focus on achieving and monitoring results, both
in the scale-up of HIV/AIDS programs and the overall improved health of the population.
Strengthening the capacity of Namibian government institutions: Following the recent Health Systems Review, which highlighted
the system's strengths and weaknesses, the PEPFAR program will continue to support the capacity development of the GRN and
parastatal institutions such as the Namibia Institute of Pathology (NIP) to plan, manage, and implement HIV programs and, in
NIP's case, to establish a true national public health laboratory.
With COP09, PEPFAR will continue to support the capacity development of the MOHSS' Directorate of Special Programs, which
oversees the national HIV/AIDS response. One fundamental strategy in capacity development that will continue to strengthen
capacity is PEPFAR's continued support for technical advisors who work on a daily basis with MOHSS and other ministry
counterparts to strengthen PMTCT, care and treatment, TB/HIV integration, capacity building, counseling and testing, laboratory
services, clinical quality assurance, monitoring and evaluation, strategic information, health information systems, and OVCs.
These TAs will continue to provide day-to-day guidance and assistance to increase the capabilities of their counterparts.
PEPFAR will further assist the MOHSS in addressing Namibia's human resource challenges through recruitment, placement, and
pre- and in-service training of health professionals across a wide range of specialties, including community counselors. These
community counselors are a cadre of laypersons who provide CT and other supportive services within the clinical setting. The
GRN is currently in the process of adding a position for "public health worker" to its staff establishment which will serve as a
platform for absorbing CCs and, equally important, will provide an entry-level position for persons who can be groomed to take on
increasingly responsible positions within the public sector.
More details on Namibia's health workforce development can be found in the HCD narrative. PEPFAR will also continue to assist
the MOHSS in improving the quality of their evidence-based decision making through improved tracking of financial resources for
health through National Health Accounts and HIV/AIDS sub-accounts. PEPFAR will also continue to support the Central Medical
Stores, the MOHSS' well-established procurement system, to respond to increasing decentralization of services to the peripheral
level and to strengthen medicine safety and logistics program. Overall, PEPFAR will assist its counterparts in the Namibian
government in both policy development and implementation, as well as in monitoring and evaluation of programs.
Strengthening local partner organizations: PEPFAR will continue to strengthen local non-governmental organizations (NGOs),
faith-based organizations (FBOs), community-based organizations (CBOs) and Regional and Constituency AIDS Coordinating
Committees (RACOCs and CACOCs) supporting the delivery of HIV/AIDS services, as well as umbrella organizations, particularly
in financial and human resource management and accountability, local leadership, and policy and strategic development. During
COP 09 PEPFAR will continue to assist Namibian organizations to transition to direct funding. These organizations will continue
to receive follow-on organizational development support in order to ensure their long-term sustainability.
Furthermore, through participatory assessments, PEPFAR will continue to work with local partner organizations to strengthen
strategic planning and evidence-based decision-making. PEPFAR will also support the development of criteria for local partner
graduation in order to promote a holistic approach to strengthening organizations. Lastly, PEPFAR will continue to support the
expansion of academic training institutions, such as the Polytechnic of Namibia (PoN) and the University of Namibia (UNAM), to
provide more training options for future health professionals, by supporting their staff and their organizational development (please
see HCD narrative for more details).
Long term training: In addition to providing long term bursaries (scholarships) in country or in other countries, PEPFAR will provide
long-term training opportunities for at least two young Namibian students through the Fulbright Scholarship Program to obtain
their Masters in Public Health at US universities. Cross-border projects and twinning programs will also be promoted where
feasible between Namibia and other southern African countries in order to promote south-south collaboration and the sharing of
best principles in addressing HIV/AIDS.
Support for construction, renovation and decentralization: The lack of suitable physical infrastructure in many of Namibia's health
facilities, particularly in rural areas, poses a great challenge to service delivery for HIV/AIDS, TB, and primary health care. In
COP09, PEPFAR will respond to this challenge by providing targeted assistance in the area of infrastructure. This will include
procurement of updated equipment and supplies, renovation and refurbishment of HIV and TB clinical facilities, support for
outreach teams to include mobile units, and development of policies for maintenance of health facilities, including a report on the
current state of the facilities unit.
PEPFAR support to the Namibian health workforce and human capacity development, as well as to the health information system,
can be found in the HCD and SI program area narratives, respectively.
Table 3.3.18:
This continuing activity has five components: (1) improving governance in medicine regulation; (2)
strengthening the regulatory framework to ensure safety and effectiveness medicines; (3) strengthening
TIPC and adverse events data collection, analysis and use for regulatory and policy decisions; (4) providing
technical assistance for the implementation of the NPMP; and (5) strengthening sustainable human
resource capacity for the delivery of pharmaceutical services.
1. Improving governance in medicine regulation. This is an expansion of FY08 activity ID 17259.08 to
expand SPS efforts in providing support to build capacity and strengthen medicines regulation systems that
will enable the Namibia Medicine Regulatory Council (NMRC) to achieve and sustain a strengthened
regulatory system that assures safety, quality, and effectiveness of medicines used in Namibia. SPS will
achieve this by applying an integrated approach to medicines regulation through supporting the NMRC
secretariat's, registration, inspection and quality surveillance, and therapeutics information and
Pharmacovigilance center (TIPC) activities. The integrated approach to strengthening medicines regulation
with focus on ARVs will improve local capacity and lead to sustained awareness, improved stewardship in
safeguarding public health, containment of safety scares and guarantee public trust in the safety of program
medicines. There are two components of this activity; with FY09 funds SPS will provide support to NMRC
and PC&I towards the implementation of systems and standards established in FY08 to ensure
transparency and good governance in medicine regulation in Namibia. Also SPS will continue on FY08
activities to improve in-country quality assurance. MSH/SPS will work with the MoHSS to ensure that the
Quality Surveillance laboratory is accredited by WHO and work with SCMS to strengthen routine quality
testing of all HIV medicines used in facilities in Namibia. SPS will provide training to 30 (13 regional
pharmacists, 7 principal pharmacists from 7 regions, 7 customs / Ministry of trade officials and 3 MoHSS
headquarters staff responsible for inspection) persons on medicines inspection. Experiences gained in
FY08 in the implementation of the Minilab technology at selected ports of entry will be scaled up. SPS will
also provide other infrastructure support to improve inspection activities. SPS will continued support for the
NMRC website and domain and other strategies to ensure free access to medicine regulation information to
the public. This activity will enhance transparency and good governance in medicine regulation in Namibia.
2. Strengthening the regulatory framework to ensure safety and effectiveness medicines. This activity is to
strengthen the regulatory framework to ensure safety and effectiveness of ARVs, TB and OI medicines.
This is an expansion of FY08 activity ID 17259.08. In FY09 SPS will expand efforts at monitoring real-life
experiences with the use of ARVs, TB, and OI medicines including other new essential medicines. SPS will
improve in-country capacity for post marketing surveillance activities by providing trainings to 30 (1 technical
staff from each of the 13 regional/health facility TCs, 10 member of the Essential Medicines committee, and
7 Policy Control and Inspection subdivision of the MoHSS) and health care workers on
pharmacoepidemiology methods, comparative effectiveness reviews, and other methods for monitoring the
real-life safety and effectiveness of new essential medicines. In FY08 SPS developed a pharmacovigilance
model to introduce patient-initiated adverse event reporting. In FY09 SPS will utilize experiences from FY08
to expand the potential of patient-initiated reporting. SPS will collaborate with DSP/TBCAP to train CBOs
that support DOTS, home based care and treatment programs in monitoring side effects and adverse drug
reactions to ARVs and TB medicines in all the 13 regions of Namibia. Data collected will be useful in
defining and quantifying the incidence and prevalence of adverse drug events related to TB medicines.
Results from these analyses will inform guidelines changes and regulatory decisions. Also in FY09 SPS will
set up 3 sentinel sites to implement an active surveillance activity to monitor the safety of 2nd line ARVs.
3. Strengthening TIPC and adverse events data collection, analysis and use for regulatory and policy
decisions. This is an expansion of FY08 activity ID 17259.08 to provide ongoing support to for optimal
functioning of the TIPC. In FY08 SPS provided support to TIPC for subscriptions for software, database,
journals, infrastructure and the development of IEC materials. In FY09 SPS will continue to provide support
to ensure continued functioning of the center. SPS will also provide other support towards the
implementation of other TIPC activities including training 120 health care workers on ADR reporting,
publication of the Namibia Medicines Watch, and other activities to improve medicine safety monitoring in
Namibia.
4. Providing technical assistance for the implementation of the NPMP. In FY06 and FY07 RPM Plus
conducted a consultancy that reviewed the National Medicines Policy (NMP). In FY08 SPS collaborated
with MoHSS to conduct workshops on the implementation of the National Pharmaceutical Master Plan,
NPMP. This is an expansion of FY08 activity ID 17259.08 to support MoHSS with the implementation of key
aspects of the NPMP that will facilitate the delivery of ART services. For instance SPS will collaborate with
MoHSS towards the finalization of the development of the national formulary initiated in FY08.
5. Strengthening sustainable human resource capacity for the delivery of pharmaceutical services.
Unavailability of sufficient, adequately trained and skilled manpower continues to be a challenge in the
provision of quality pharmaceutical care services required to support the expansion and scale-up of ART
services in Namibia. This is an expansion of FY08 activity ID 17259.08 and focuses on human capacity
development. The aim is to improve local capacity at all levels for sustainable pharmaceutical management
expertise. This will be achieved in a number of ways:
(a.) SPS will collaborate with the NHTC, Namibia Polytechnic, UNAM, Interim Health Professions Council
(IHPC), Pharmaceutical Society of Namibia (PSN), MoHSS and other stakeholders to develop a strategy for
increased enrollment and training of pharmacist's assistants and other middle level pharmacy officers. SPS
support will strengthen IHPC and PSN continuing professional development (CPD) programs to ensure that
pharmacy officers are adequately trained on provision of pharmaceutical services. SPS will collaborate with
UNAM, NHTC and stakeholders to ensure sustainable leadership and management training programs and
promote the incorporation of continuous quality improvement skills (like MTP-Monitoring Training and
Planning) into pre-service training for health providers.
(b.) SPS will support the UNAM pharmacotherapy program for nurses and newly developed pharmacy
program to incorporate HIV/AIDS pharmaceutical management modules. SPS will provide support towards
the functioning of the local chapter of the International Network for improving Rational Use of Drugs,
Activity Narrative: INRUD.
(c.) SPS will collaborate with MoHSS to review the pharmaceutical staff establishment at the central level to
meet the current scope of pharmaceutical services.
Continuing Activity: 17259
17259 17259.08 U.S. Agency for Management 7650 7650.08 Strengthening $700,462
Estimated amount of funding that is planned for Human Capacity Development $65,000
