Communication for Change (C-Change) is a continuing Implementing Mechanism from FY09. In 2007, Namibia requested assistance from C-Change to strengthen social and behavior change communication (SBCC) for HIV/AIDS, particularly related to the prevention of sexual transmission of HIV. Country level implementation began in mid-July 2008.

1. C-Change provides SBCC strengthening from national to local levels, focusing on the prevention of HIV sexual transmission through three objectives, reflecting its breadth across technical areas: 1) strengthening the SBCC capacity of PEPFAR-funded partners, 2) strengthening the SBCC capacity of national HIV/AIDS programs, and 3) increasing the number of individuals trained in SBCC for HIV and AIDS.

C-Change assists PEPFAR partners to develop programs based on evidence, focus on changing behaviors related to the drivers of the epidemic, and strengthen approaches to ensure quality program design, implementation and M&E. On the national level, C-Change is helping to define essential packages of services, develop mass media and interpersonal communication materials for partner use, and implement behavioral M&E to monitor results. C-Change is also increasing the number of PEPFAR partners and public, private and civil society partners who are trained in SBCC.

First-year achievements included: rapid assessment of partner programs against SBCC against standards of quality; in-depth baseline assessments of prevention programs; development of SBCC strategies focusing on the drivers of the epidemic; improved service delivery structures and behavioral M&E; TOT of partner staff in SBCC and behavioral M&E; assistance during baseline data collection and analysis; identification/development of interpersonal communication (IPC) materials related to the drivers; TOT of partner staff in the use of the new materials; and assistance during training of field staff and volunteers. By the end of the period, 20 PEPFAR partners and their prevention programs had received strengthening support in SBCC.

2. The mechanism is in line with USG commitments of the Partnership Framework (PF) in terms of the PF prevention objectives. C-Change will continue to provide support to achieving these objectives through social and behavior change communication strengthening from national to local levels focusing on the key drivers including MC and MCP, youth, adults, MARPS and other vulnerable groups; through civil society, private sector and ministry programs in workplaces, communities, and in clinical settings.

3. Geographic coverage is nationwide. C-Change works directly with partners in every region to improve programs and provide SBCC TA and training.

4. C-Change works with GRN Ministries at the national level to assist in the development of national plans and strategies. For example, under the second objective C-Change has provided assistance to the National Prevention Technical Advisory Committee to develop the National Strategic Plan for HIV and AIDS and the National Strategy for the Prevention of Sexual Transmission of HIV. C-Change has also assisted in the development of national SBCC strategies for MCP, male circumcision, testing and counseling, alcohol and HIV; and development of mass media and IPC materials related to the drivers for partner use in national campaigns. C-Change also worked to strengthen the Ministry of Education's (MOE) regional workplace program through training in SBCC theory, SBCC strategy development, and use of new interpersonal communications (IPC) materials.

5. The cross-cutting nature of SBCC is the reason C-Change works with so many PEPFAR partners and government agencies. C-Change has also worked on gender in collaboration with USG and GRN partners.

6. C-Change will continue to work closely with PEPFAR partners and others to leverage funding and maximize cost-efficiency. Strengthening of PEPFAR partner programs is provided in coordination with other PEPFAR partners funded directly or indirectly. Strengthening of national HIV and AIDS structures and programs is provided in coordination with USAID, CDC and cooperating partners such as UNICEF, UNAIDS and GTZ.

7. C-Change is monitoring SBCC strengthening of PEPFAR partners and ensuring data quality by maintaining detailed lists of individuals trained and organizations strengthened. Outcomes of program strengthening are measured against a set of quality SBCC standards. SBCC strengthening of national level programs is tracked in periodic reports. National surveys tracking key indicators related to the drivers of the epidemic will continue to be the most important measures of national behavior change

This is a continuing activity from FY09.

Communication for Change (C-Change) will provide cross-cutting strengthening in social and behavior change communication (SBCC) in sexual prevention -abstinence/be faithful (AB) through the following three objectives: 1) strengthening the SBCC capacity of PEPFAR partners, 2) strengthening the SBCC capacity of national HIV and AIDS programs, and 3) increasing the number of individuals trained in SBCC for HIV and AIDS. C-Change capacity building activities will be jointly funded from HVAB and HVOP budget codes to ensure a comprehensive approach and results monitored to prevent double counting.

1. Under the first objective, C-Change will provide support to PACT and IntraHealth partners working in community/workplace/clinical settings. PACT partners include: Change of Life Styles, the Rhenish AIDS Program, Sam Nujoma Multipurpose Center, Catholic AIDS Action, Namibian Association of Community Based Natural Resource Management Support Organizations HIV and AIDS Program, the Chamber of Mines, and Caprivi Hope for Life. IntraHealth partners include 6 hospitals, 7 VCT programs and LifeLine/ChildLine. C-Change Namibia will also support partners who are directly funded by PEPFAR including the Social Marketing Association (SMA), Hope Humana Development AID People to People (DAPP), NawaLife Trust and the Peace Corps.

C-Change will strengthen up to 20 partners through a blended approach involving participatory assessments of SBCC capacities against standards in planning and design, program implementation and M&E, development of SBCC strategies, updating/developing curricula and interpersonal communication (IPC) materials, training of trainer of staff in SBCC theory and methods, technical assistance to partners during training of field staff and volunteers, supportive supervision of field staff and volunteers during field implementation, and training in behavioral M&E and collection of baseline/follow-on data to measure results. This approach to strengthening SBCC prevention among youth, for example, has resulted in programs that are focused on behavioral outcomes, with multi-level/multi-channel interventions, updated materials and behavioral baseline data.

C-Change will strengthen SBCC for HIV prevention, moving partner efforts towards a combined approach addressing key drivers among youth and adults such as multiple or concurrent partners, transactional/cross-generational sex, social norms that underlie these behaviors, and provision of and/or referral to biomedical and structural interventions. IPC will be coordinated with mass media as part of national campaigns. Programs will include those in high prevalence geographical areas such as the northern region, land and water borders and transit corridors.

C-Change will encourage testing of innovative community-based models for behavior change that include all standards of quality SBCC programming and the delivery of integrated packages of prevention services in highest risk areas. Targeted provision of integrated services by civil society has been shown to be less costly and have greater results than more vertical approaches, particularly when coordinated with the public sector from the outset.

2. Under the second objective, C-Change will work closely with USG and cooperating partners to strengthen health systems at the national level. Support may include assistance to the Prevention TAC to determine an integrated package of prevention services for youth and adults and develop supporting materials for partner use, in planning and budgeting of prevention support among cooperating partners, monitoring the response, determining national-level behavioral M&E, and support to mainstreaming

among line ministries.

3. Under the third objective, C-Change will train up to 100 partner staff in SBCC. Those directly trained will include staff from PEPFAR partners and GRN ministries. All capacity building inputs will be in the form of training-of-trainers. Each organization's trained technical staff will train their field staff and volunteers with assistance from C-Change.

The program will continue to coordinate closely with special initiatives such as gender, alcohol, prevention with positives, and male circumcision (Activities 12342.08, 17057.08, 4737.08. 16762.08). Emphasis will be on changing male norms and increasing male involvement in prevention, reducing violence, sexual coercion, and transactional and cross-generational sex. It will also, in conjunction with the PEPFAR/SI team, ensure adaptation and integration of results and recommendations from program evaluations, PHE, the BSS+ and KAP studies into SBCC programs.

Supportive Supervision/QA Activities: C-Change will ensure the quality of partner programs through assessments to ensure that programs meet all standards of SBCC programming and through supportive supervision of field staff and volunteers during field implementation.

Contribution to Sustainability: The sustainability of program efforts will be enhanced through strengthening of partner capacities, training of trainers, and cascade training of field staff and volunteers, and through strengthening of SBCC in national level plans, strategies and programs.

This is a continuing activity from FY09.

Communication for Change (C-Change) will provide cross-cutting strengthening in social and behavior change communication (SBCC) in sexual prevention - other prevention -- through the following three objectives: 1) strengthening the SBCC capacity of PEPFAR partners, 2) strengthening the SBCC capacity of national HIV and AIDS programs, and 3) increasing the number of individuals trained in SBCC for HIV and AIDS. C-Change capacity building activities will be jointly funded from HVAB and HVOP budget codes to ensure a comprehensive approach and results monitored to prevent double counting.

1. Under the first objective, C-Change will provide support to PACT and Intrahealth partners working in

community/workplace/clinical settings. PACT partners include: Change of Life Styles, the Rhenish AIDS Program, Sam Nujoma Multipurpose Center, Catholic AIDS Action, Namibian Association of Community Based Natural Resource Management Support Organizations HIV and AIDS Program, the Chamber of Mines, and Caprivi Hope for Life. IntraHealth partners include 6 hospitals, 7 VCT programs and LifeLine/ChildLine. C-Change Namibia will also support partners who are directly funded by PEPFAR including the Social Marketing Association (SMA), Hope Humana Development AID People to People (DAPP), NawaLife Trust and the Peace Corps.

C-Change will strengthen up to 20 partners through a blended approach involving participatory assessments of SBCC capacities against standards in planning and design, program implementation and M&E, development of SBCC strategies, updating/developing curricula and interpersonal communication (IPC) materials, training of trainer of staff in SBCC theory and methods, technical assistance to partners during training of field staff and volunteers, supportive supervision of field staff and volunteers during field implementation, and training in behavioral M&E and collection of baseline/follow-on data to measure results. This approach to strengthening SBCC prevention among youth, for example, has resulted in programs that are focused on behavioral outcomes, with multi-level/multi-channel interventions, updated materials and behavioral baseline data.

C-Change will strengthen SBCC for HIV prevention, moving partner efforts towards a combined approach addressing key drivers among youth and adults such as multiple or concurrent partners, transactional/cross-generational sex, social norms that underlie these behaviors, and provision of and/or referral to biomedical and structural interventions. IPC will be coordinated with mass media as part of national campaigns. Programs will include those in high prevalence geographical areas such as the northern region, land and water borders and transit corridors.

C-Change will encourage testing of innovative community-based models for behavior change that include all standards of quality SBCC programming and the delivery of integrated packages of prevention services in highest risk areas. Targeted provision of integrated services by civil society has been shown to be less costly and have greater results than more vertical approaches, particularly when coordinated with the public sector from the outset.

2. Under the second objective, C-Change will work closely with USG and cooperating partners to strengthen health systems at the national level. Support may include assistance to the Prevention TAC to determine an integrated package of prevention services for youth and adults and develop supporting materials for partner use, in planning and budgeting of prevention support among cooperating partners, monitoring the response, determining national-level behavioral M&E, and support to mainstreaming among line ministries.

3. Under the third objective, C-Change will train up to 100 partner staff in SBCC. Those directly trained will include staff from PEPFAR partners and GRN ministries. All capacity building inputs will be in the form of training-of-trainers. Each organization's trained technical staff will train their field staff and volunteers with assistance from C-Change.

The program will continue to coordinate closely with special initiatives such as gender, alcohol, prevention with positives, and male circumcision (Activities 12342.08, 17057.08, 4737.08. 16762.08). Emphasis will be on changing male norms and increasing male involvement in prevention, reducing violence, sexual coercion, and transactional and cross-generational sex. It will also, in conjunction with the PEPFAR/SI team, ensure adaptation and integration of results and recommendations from program evaluations, PHE, the BSS+ and KAP studies into SBCC programs.

Supportive Supervision/QA Activities: C-Change will ensure the quality of partner programs through assessments to ensure that programs meet all standards of SBCC programming and through supportive supervision of field staff and volunteers during field implementation.

Contribution to Sustainability: The sustainability of program efforts will be enhanced through strengthening of partner capacities, training of trainers and cascade training of field staff and volunteers, and through strengthening of SBCC in national level plans, strategies and programs.