Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012

Details for Mechanism ID: 11572
Country/Region: Namibia
Year: 2010
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Implementing Agency
Funding Agency: HHS/CDC
Total Funding: $3,866,918

SUBSTAINTIALLY CHANGED FROM LAST YEAR The CDC Global AIDS Program (GAP) provides technical assistance and direct funding to partners working in the national HIV/AIDS response in Namibia. CDC's main partner is the Ministry of Health and Social Services (MOHSS), which hosts CDC's offices through a co-location agreement. CDC technical advisors and administrators provide direct support to MOHSS to strengthen public health infrastructure and build human resource capacity. CDC support for MOHSS includes technical input through evaluations, assessments and surveys, supportive supervision and mentoring, human resource capacity building, and collaboration on joint initiatives such as the Partnership Framework (PF).

In COP10, continuing technical emphasis will be placed on:

• Training for providers on revised ART, PMTCT and STI guidelines. • Expanding and evaluating prevention efforts • Supporting the decentralization of ART services. • Integrating TB and HIV services. • Surveillance systems • Evaluating the impact of task-shifting. • Expanding access to palliative care and pediatric treatment. • Assisting with the response to drug-resistance (TB and HIV) • Supporting rapid HIV testing by community counselors and through mobile services. • Building the evidence base to support expanded HCT and care and treatment services in Namibian prisons. • Coordinating resources with the Global Fund, the government of Namibia (GRN) and other donors.

CDC also provides technical and financial assistance to local partners, including, Development Aid People to People (DAPP), the Namibia Institute of Pathology (NIP), and the Blood Transfusion Service of Namibia (NAMBTS). In COP09, 86% of CDC-managed funds were allocated to partners, of whom 79% were local Namibian entities. The balance of CDC's budget supported CDC technical advisors and office operations.

Links to the Partnership Framework

In Namibia, unlike many other PEPFAR-supported countries in sub-Saharan Africa, a majority of the PEPFAR budget provides direct support to the GRN and other local entities. Given these considerable local investments, CDC is already deeply engaged in strengthening GRN capacity and ownership, especially in the areas of human resources, and the financing and operation of national healthcare systems. In COP10, PEPFAR will emphasize the GRN's capacity to plan, oversee, manage and, eventually, finance a growing share of the commitments made in the four priority areas identified by the PF: Prevention; Treatment, Care and Support; Impact Mitigation; and Coordination and Management.

Coverage and Target population

CDC supports activities with a national scope. In COP10 and beyond, CDC will increasingly promote multi-sectoral coordination and integration to mainstream the impact of PEPFAR's HIV/AIDS investments.

Health Systems Strengthening

In 2008, an MOHSS review identified two areas of structural weakness within the GRN healthcare system: Unequal access to health facilities and human resources.

In COP10, CDC technical assistance will emphasize training and other capacity building for all cadres of health workers. CDC will also support expanded access to services. Special emphasis will be placed on supporting administrative systems to manage Human Resources for Health.

Cross-Cutting Programs and Key Issues This activity's main cross cutting area is Human Resources for Health. This program will contribute to PEPFAR's broader effort to build human resource capacity by improving the capacity of MOHSS to recruit, manage and retain staff. CDC's support for pre- and in-service service training will also build a sustainable pool of Namibian healthcare workers in nursing, medicine, pharmacy, counseling, and laboratory sciences.

Cost Efficiencies Over Time

CDC's technical assistance to the MOHSS and other partners supports the development of sustainable engagement and, where relevant, transition plans. These plans are evidence-based. Special emphasis will be given to cost-efficient strategies, including task-shifting and the recruitment and deployment of locally-trained community lay healthcare workers. In COP10, CDC will continue support for on-going GRN costing activities, and conduct programmatic assessments to determine the costs and impact of

community-based strategies. These assessments will be linked to the bi-annual PEPFAR reporting calendar, and respond to reporting requirements embedded in the cooperative agreement mechanisms used to manage PEPFAR funds. CDC will also continue support for long-term strategic planning, including the National Strategic Framework and associated costing exercises. Key areas for CDC support in this area include: 1) Actual and projected costs; 2) non-financial resources needed to meet program goals (e.g., human resources, equipment); 3) resource mobilization strategies, and; 4) options to institutionalize the activity within a particular sector (e.g., GRN, NGO community, for-profit).

Over time, CDC is committed to working with MOHSS to identify activities that may be absorbed completely by the GRN, that require continuing technical assistance from the USG, and that could be terminated.

Monitoring and Evaluation Plans

The CDC works with MOHSS and other development partners to strengthen, integrate, and align M&E plans, indicators and systems. All of CDC's program indicators have been aligned with NSF and PEPFAR targets. Bi-annual reports identify progress and describe any necessary changes based on available evidence.

Funding for Care: Adult Care and Support (HBHC): $75,000

NEW/CONTINUING ACTIVITY WITH SUBSTANTIAL CHANGES This is a continuing activity from COP09. It includes one component: 1) partial salary support for a CDC technical advisor for palliative care. This position will work with a team of other CDC technical advisors embedded with the Ministry of Health and Social Services (MOHSS) Directorate for Special Programmes (DSP). Palliative care is a multidisciplinary approach that improves the quality of life for children and their families through prevention of, and relief from pain, as well as through treatment of other symptoms of disease and provision of psychosocial and spiritual support. The funds from this activity cover 75% of salary and personnel-related costs for a Palliative Care Technical Advisor. The remaining funds are reflected in the PDCS program area. In COP10, this position will be a Locally Employed Staff (LES). The technical advisor will provide specific technical assistance to the MOSS in the following areas: 1. Quality assurance for adult and pediatric HIV care services. This support will also cover QA activities related to the national Integrated Management of Adult Illness (IMAI) and Integrated Management of Childhood Illness (IMCI) programs. 2. Mentoring and program support for the MOHSS Coordinator for Palliative Care and Opportunistic Services in the DSP. This assistance will emphasize leadership capacity building. 3. Serve as a liaison to the MOHSS Case Management Unit, CDC's HIVQUAL Coordinator, I-TECH's training and mentorship programs, the IMAI site nurses and district ART doctors. 4. Collaborate with the MOHSS Family Health Division, to promote integration of nutrition, family planning and other community and home-based health programs with HIV services and HIV palliative care. These priorities include, cotrimoxizole prophylaxis for HIV-exposed children; support for the 3 I's of TB prevention (infection control, isoniazid preventive therapy, and intensified case finding); integrated HIV counseling and testing; safe motherhood and child survival cross-cutting activities (e.g., infant feeding counseling for HIV-positive mothers); referrals to other health programs (e.g., immunizations);

combination prevention messaging, and; condom promotion. 5. Coordinate procurement and supply chain management issues with MOHSS ART sites, Central Medical Stores, and SCMS. 6. Support for opportunistic infection management, routine clinical monitoring, and systematic pain and symptom management. Supportive Supervision: The palliative care technical advisor will complement other direct technical assistance offered by other members of the CDC technical advisory team (prevention, PMTCT, HIVQUAL, laboratory, health communications). Supportive supervision will be provided through site visits and in conjunction with training courses offered by other partners. The palliative care TA will also collaborate with the African Palliative Care Association (APCA) and a USAID Regional Technical Advisor for HIV/AIDS Palliative Care. Sustainability: Support for the CDC palliative care advisor is in line with PEPFAR's vision of constructive, government-to-government engagement through technical assistance. Through other technical areas (Health Systems Strengthening), CDC will continue to support the MOHSS to build additional human resource capacity within the MOHSS civil service. This support will emphasize the creation of HR structures to absorb a wide range of healthcare personnel, including community-based prevention counselors and nurses with integrated training in HIV/AIDS, IMAI and IMIC. Direct technical assistance in this area will also contribute to the development of a national palliative care policy as well as palliative care ask-shifting activities within the MOHSS. Lastly, through supportive supervision visits, closer partnerships with districts and communities will allow increased opportunities to leverage HIV/AIDS investments to benefit other community health objectives, e.g., safe water and malaria prevention.

Funding for Treatment: Adult Treatment (HTXS): $444,073

NEW/CONTINUING ACTIVITY WITH SUBSTANTIAL CHANGES This is a continuing activity from COP09. It includes two components: (1) personnel-related costs for CDC's HIVQUAL Technical Advisor, (2) a portion of the costs of HIVQUAL program administration. Funding for this activity is reflected 85% in Adult Treatment (HTXS) and 15% in Pediatric treatment (PDTX)

1. Personnel-related costs for CDC's HIVQUAL Technical Advisor: Since FY 2007 COP, PEPFAR has funded a technical advisor to assist the Ministry of Health and Social Services (MOHSS) with rollout of the HIVQUAL program The HIVQUAL Technical Advisor provides high-quality technical assistance to PEPFAR country team, MOHSS, technical workgroups, and implementing partners to ensure that the

portfolio of program activities contributes to the national HIV/AIDS strategic goals and targets. The HIVQUAL TA assists MOHSS with continuous quality improvement of HIV care and treatment services through leadership of the HIVQUAL initiative as well as through training and monitoring of personnel at participating clinical sites.

2. HIVQUAL program administration. COP10 funds will be used to support general administration of the HIVQUAL program, as well as in-country travel for quality improvement (QI) coaching and training costs related to rolling out the HIVQUAL program in treatment and care settings. The sharing of best practices is necessary to learn from the experiences of others and promote quality improvement. The national coordinators of HIVQUAL participate in QI conferences to learn from others and share experiences. Supportive supervision The HIVQUAL coordinator along with MOHSS staff make frequent support supervision visits to participating clinics throughout Namibia. During these visits the HIVQUAL team assesses the following: 1) quality management programs at the participating clinics; 2) performance measurement of selected core indicators. The HIVQUAL coordinator also provides ongoing QI coaching at participating sites and promotes consumer engagement in HIV care. The HIVQUAL team has regular conference calls with the US-based team and develops and disseminates QI related IEC materials including the HIVQUAL International Newsletter. An assessment tool is used to measure the capacity of the quality management program at each facility. Aggregate facility-specific data provides population-level performance data that indicate priorities for national quality improvement activities and campaigns. Publication and dissemination of these data will be done under the auspices of the MOHSS. An important emphasis of this approach is to develop the skills of providers for collecting and using performance data within their own organizations to improve their systems of care. The HIVQUAL technical advisor will complement other direct technical assistance offered by other members of the CDC technical advisory team (prevention, PMTCT, HIVQUAL, laboratory, health communications. Sustainability COP10 HIVQUAL activities will be conducted under the leadership of the MOHSS Directorate of Special Programs (DSP) in close collaboration with the CDC HIVQUAL Technical Advisor. The HIVQUAL program will support capacity building for QI for all public health facilities providing HIV care and treatment. This approach is in sync with the new PEPFAR vision for sustainability and will ensure integration of the quality improvement program at all levels of management and HIV service delivery. In addition, by building capacity at the national and local levels for quality improvement and use of strategic information by providers for program improvement, the activity will strongly contribute to overall health systems strengthening. Support for the CDC HIVQUAL technical advisor is in line with PEPFAR's vision of constructive, government-to-government engagement through technical assistance.

Funding for Prevention: HIV Testing and Counseling (HVCT): $297,500

NEW/REPLACEMENT NARRATIVE WITH SUBSTANTIAL CHANGES

This is a continuing activity from COP09. It includes one component: 1) salary and related personnel

costs for CDC's Counseling and Testing Technical Advisor. Since 2005, PEPFAR has funded a technical

advisor to assist the Ministry of Health and Social Services' (MOHSS) National Counseling and Testing

Coordinator via a non personal services contract. In COP 2009, this position was converted to a personal

services contract (PSC).

The CT Advisor will continue to play a key role in the deployment of community counselors to public

health facilities, outreach teams, and correctional facilities. In COP10, the Advisor will continue to support

CT related policy development and changes that facilitate the implementation of HCT activities in

Namibia. As part of maintaining quality while expanding coverage, the Advisor will support the HCT

program's quality assurance activities for both rapid HIV testing and counseling. With shifting of HCT

tasks from the laboratory personnel to community counselors (CC), the Advisor will work with the

MOHSS to ensure that CC provide high quality, and cost effective, services.

The Advisor will provide technical assistance to the head of the Counseling and Testing Unit within

MOHSS' Directorate of Special Programmes (DSP) to promote provider-initiated testing and counseling

(PITC) in clinical settings. The Advisor will also guide the national program in the continued

implementation of national CT guidelines and will support the regions and districts in the implementation

and monitoring of programs. This work will be done in line with the implementation of a new national

Decentralization plan. The Advisor will also continue to support the unit with the continued scale up and

supervision of rapid HIV testing as well as counseling and testing sites in health facilities, correctional

facilities, and new outreach activities.

Supportive Supervision: The advisor will continue to play a key role in the training and mentoring of CCs

for CT services and to support strategies described in the Partnership Framework Implementation Plan to

link HCT with other programmatic areas, including PMTCT, AB, condoms/other prevention, TB/HIV, and

care and treatment services. Within ART sites, CCs provide adherence and couples counseling, among

other responsibilities. The advisor will be intimately involved with other CDC technical advisors in the

MOHSS' continuing implementation of the prevention with positives initiative at the national level. The

Advisor will continue to serve as a co-chair and member of the HCT national technical working group and

a co-chair of the National HIV Testing Day (NTD) steering committee. The advisor will continue to play a

key role in NTD planning and implementation, as well as similar testing events coordinated with World

AIDS Day.

Sustainability: In COP10, the Advisor will continue to build the capacity of the CT program through

mentorships and technical assistance aimed at transferring skills to MOHSS counterparts. In addition to

technical guidance on HCT, the Advisor will also support the development of administrative capacity,

leadership, and country-ownership within the MOHSS. Specific emphasis will be placed on

strengthening the MOHSS's ability to plan, manage and finance national mobilization and advocacy

events, such as the National Testing Day.

Funding for Care: Pediatric Care and Support (PDCS): $25,000

NEW/CONTINUING ACTIVITY WITH SUBSTANTIAL CHANGES This is a continuing activity from COP09. It includes one component: 1) partial salary support for a CDC technical advisor for palliative care. This position will work with a team of other CDC technical advisors embedded with the Ministry of Health and Social Services (MOHSS) Directorate for Special Programmes (DSP). Palliative care is a multidisciplinary approach that improves the quality of life for children and their families through prevention of, and relief from pain, as well as through treatment of other symptoms of disease and provision of psychosocial and spiritual support. The funds from this activity cover 25% of salary and personnel-related costs for a Palliative Care Technical Advisor. The remaining funds are reflected in the Adult Care and Support (HBHC) program area. In COP10, this position will be converted from a contractor to a Locally Employed Staff (LES). The technical advisor will provide specific technical assistance to the MOSS in the following areas: 1. Quality assurance for adult and pediatric HIV care services. This support will also cover QA activities related to the national Integrated Management of Adult Illness (IMAI) and Integrated Management of Childhood Illness (IMCI) programs. 2. Mentoring and program support for the MOHSS Coordinator for Palliative Care and Opportunistic Services in the DSP. This assistance will emphasize leadership capacity building. 3. Serve as a liaison to the MOHSS Case Management Unit, CDC's HIVQUAL Coordinator, I-TECH's training and mentorship programs, the IMAI site nurses and district ART doctors. 4. Collaborate with the MOHSS Family Health Division, to promote integration of nutrition, family planning and other community and home-based health programs with HIV services and HIV palliative care. These priorities include, cotrimoxizole prophylaxis for HIV-exposed children; support for the 3 I's of TB prevention (infection control, isoniazid preventive therapy, and intensified case finding); integrated HIV counseling and testing; safe motherhood and child survival cross-cutting activities (e.g., infant feeding counseling for HIV-positive mothers); referrals to other health programs (e.g., immunizations); combination prevention messaging, and; condom promotion. 5. Coordinate procurement and supply chain management issues with MOHSS ART sites, Central Medical Stores, and SCMS. 6. Support for opportunistic infection management, routine clinical monitoring, and systematic pain and

symptom management. Supportive Supervision: The palliative care technical advisor will complement other direct technical assistance offered by other members of the CDC technical advisory team (prevention, PMTCT, HIVQUAL, laboratory, health communications). Supportive supervision will be provided through site visits and in conjunction with training courses offered by other partners. The palliative care TA will also collaborate with the African Palliative Care Association (APCA) and a USAID Regional Technical Advisor for HIV/AIDS Palliative Care. Sustainability: Support for the CDC palliative care advisor is in line with PEPFAR's vision of constructive, government-to-government engagement through technical assistance. Through other technical areas (Health Systems Strengthening), CDC will continue to support the MOHSS to build additional human resource capacity within the MOHSS civil service. This support will emphasize the creation of HR structures to absorb a wide range of healthcare personnel, including community-based prevention counselors and nurses with integrated training in HIV/AIDS, IMAI and IMIC. Direct technical assistance in this area will also contribute to the development of a national palliative care policy as well as palliative care ask-shifting activities within the MOHSS. Lastly, through supportive supervision visits, closer partnerships with districts and communities will allow increased opportunities to leverage HIV/AIDS investments to benefit other community health objectives, e.g., safe water and malaria prevention.

Funding for Treatment: Pediatric Treatment (PDTX): $25,795

NEW/CONTINUING ACTIVITY WITH SUBSTANTIAL CHANGES This is a continuing activity from COP09. It includes two components: (1) personnel-related costs for CDC's HIVQUAL Technical Advisor, (2) a portion of the costs of HIVQUAL program administration. Funding for this activity is reflected 15% in Pediatric treatment (PDTX) and 85% Adult Treatment (HTXS).

1. Personnel-related costs for CDC's HIVQUAL Technical Advisor: Since FY 2007 COP, PEPFAR has funded a technical advisor to assist the Ministry of Health and Social Services (MOHSS) with rollout of the HIVQUAL program The HIVQUAL Technical Advisor provides high-quality technical assistance to PEPFAR country team, MOHSS, technical workgroups, and implementing partners to ensure that the portfolio of program activities contributes to the national HIV/AIDS strategic goals and targets. The HIVQUAL TA assists MOHSS with continuous quality improvement of HIV care and treatment services through leadership of the HIVQUAL initiative as well as through training and monitoring of personnel at participating clinical sites.

2. HIVQUAL program administration. COP10 funds will be used to support general administration of the HIVQUAL program, as well as in-country travel for quality improvement (QI) coaching and training costs related to rolling out the HIVQUAL program in treatment and care settings. The sharing of best practices is necessary to learn from the experiences of others and promote quality improvement. The national coordinators of HIVQUAL participate in QI conferences to learn from others and share experiences. Supportive supervision The HIVQUAL coordinator along with MOHSS staff make frequent support supervision visits to participating clinics throughout Namibia. During these visits the HIVQUAL team assesses the following: 1) quality management programs at the participating clinics; 2) performance measurement of selected core indicators. The HIVQUAL coordinator also provides ongoing QI coaching at participating sites and promotes consumer engagement in HIV care. The HIVQUAL team has regular conference calls with the US-based team and develops and disseminates QI related IEC materials including the HIVQUAL International Newsletter. An assessment tool is used to measure the capacity of the quality management program at each facility. Aggregate facility-specific data provides population-level performance data that indicate priorities for national quality improvement activities and campaigns. Publication and dissemination of these data will be done under the auspices of the MOHSS. An important emphasis of this approach is to develop the skills of providers for collecting and using performance data within their own organizations to improve their systems of care. The HIVQUAL technical advisor will complement other direct technical assistance offered by other members of the CDC technical advisory team (prevention, PMTCT, HIVQUAL, laboratory, health communications. Sustainability COP10 HIVQUAL activities will be conducted under the leadership of the MOHSS Directorate of Special Programs (DSP) in close collaboration with the CDC HIVQUAL Technical Advisor. The HIVQUAL program will support capacity building for QI for all public health facilities providing HIV care and treatment. This approach is in sync with the new PEPFAR vision for sustainability and will ensure integration of the quality improvement program at all levels of management and HIV service delivery. In addition, by building capacity at the national and local levels for quality improvement and use of strategic information by providers for program improvement, the activity will strongly contribute to overall health systems strengthening. Support for the CDC HIVQUAL technical advisor is in line with PEPFAR's vision of constructive, government-to-government engagement through technical assistance.

Funding for Strategic Information (HVSI): $1,518,700

NEW/CONTINUING ACTIVITY WITH SUBSTANTIAL CHANGES

This is a continuation of COP 09 activities. It includes four components: (1) support for Strategic Information (SI)-related database systems (ePMS/HIS) and programs; (2) salary support for three CDC technical advisors; (3) support for an HIV prevalence survey in correctional facilities, and; (4) technical assistance for rapid assessments, population size estimations and behavioral surveillance of most at risk populations (MARPS). 1) Database and SI program support: Namibia has adopted or developed information systems for the ART and TB programs that are separate from the routine Health Information System (HIS). These clinical systems are patient-based (with one record per patient per encounter), unlike the routine HIS systems, which collect aggregated data. CDC will support technical assistance to maintain, update and integrate these systems. This support will include training, supportive supervision to clinical sites, database management, updating the software based on user feedback, and revising protocols (e.g., due to changes in ART guidelines). Additional support will promote software standardization across MOHSS M&E units, and ensure software licenses are up to date. 2.) Support for three technical advisors (M& E, Health Management Information Systems, SI): The Monitoring and Evaluation technical advisor provides direct support to the MOHSS Response M&E department (RM&E). The technical advisor will provide support on epidemiological methods for program evaluation, surveillance activities, research, and operational research. The Health Management Information Systems (HMIS) technical advisor will support the development, expansion and integration of MOHSS health information systems across multiple technical areas (ART, PMTCT, VCT, pharmacy, and lab). The Strategic Information (SI) advisor supports routine program monitoring, program evaluation, data capture and tool development, data triangulation, costing, PEFPAR-related SI, and other special SI projects. In COP10 these three positions will be funded as Personal Service Contractors (PSC). 3. Prison HIV prevalence survey: The HIV/AIDS Program in the Government of Namibia's Department of Prison Services, Ministry of Safety and Security has requested technical assistance from CDC for an HIV prevalence survey among inmates in the national prison system. Although voluntary HIV counseling and testing is currently offered in correctional facilities, there is varied delivery and uptake of these services, and the rate of HIV infection among prisoners and prison staff is unknown. An assessment of potential routes of HIV transmission in prisons will inform the development of prison HIV/AIDS prevention programs, and serve as an advocacy tool for HIV/AIDS-related prison policies. The survey will be conducted in six Namibian prisons. It will include HIV testing as well as an assessment of behavioral risk behaviors. 4. Rapid assessment, population size estimation, and bio- behavioral survey of MARPS: This is a new activity in COP10. To enhance understanding of HIV epidemiology among most at risk populations in Namibia (e.g., sex workers and men who have sex with men), CDC will support formative work and surveys among these vulnerable populations. Supportive supervision: The SI, M&E and HMIS advisors will complement other direct technical

assistance offered by other members of the CDC technical advisory team (prevention, PMTCT, HIVQUAL, laboratory, health communications). Supportive supervision will be provided through site visits, day-to-day on-site collaboration, and in conjunction with training.

Sustainability: Support for CDC technical advisors is in line with PEPFAR's vision of constructive, government-to-government engagement through technical assistance. Through other technical areas (Health Systems Strengthening), CDC will continue to support the MOHSS to build additional human resource capacity within the MOHSS civil service. This support will emphasize the creation of HR structures to absorb a wide range of healthcare personnel, including community-based prevention counselors and nurses with integrated training in HIV/AIDS, IMAI and IMIC. Direct technical assistance in this area will also contribute to the development of a national palliative care policy as well as palliative care ask-shifting activities within the MOHSS.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $388,087

NEW/REPLACEMENT NARRATIVE WITH SUBSTAINTIAL CHANGES

This activity includes two primary components: (1) continuing support for a CDC Prevention Technical Advisor to the Ministry of Health and Social Services (MOHSS) (2) start-up funding to assess implementation and piloting of CDC's Families Matter! Intervention.

1. CDC Prevention Technical Advisor: The CDC Prevention technical advisor supports a national counterpart in the Directorate of Special Progammes. The MOHSS prevention coordinator provides leadership on national prevention activities. The USG prevention advisor works closely with his MOHSS counterpart and provides ongoing technical assistance to plan, implement, and enhance prevention programming. Additional technical assistance by the TA will include capacity development to provide national leadership on the most evidence-based prevention strategies available, including behavioral change interventions and medical interventions (e.g. male circumcision,).

In addition, the prevention TA supports a process to adapt best practices from other countries and to promote dissemination of best practices from within Namibia at the national and international level. This includes support for the development of a National Prevention Strategy and the National Prevention Technical Advisory Committee.

The prevention TA also supports a local partner's program to provide community-based, door-to-door

prevention. In 2009, this partner's activities were assessed and enhanced by placing an additional emphasis on behavior change (e.g., abstinence, HIV testing, links to services, and reduction in sexual risk behaviors).The TA works with the local partner to adopt curricula incorporating AB messaging proven to be effective.

2. Needs Assessment and Pilot Activities for CDC Families Matter!

PEPFAR will add a new intervention to promote positive parenting practices and effective parent-child communication about sexuality and sexual risk reduction for parents and guardians of 9-12 year olds. .

The Families Matter! Program (FMP) intervention is an adaptation of the US-based "Parents Matter!" curriculum which CDC has evaluated in the US. The ultimate goal of FMP is to reduce sexual risk behaviors among adolescents, including delayed onset of sexual debut, by giving parents tools to deliver primary prevention to their children. Families Matter! is a community-based, group-level intervention that is delivered over five consecutive 3-hour sessions.

Funding for the first year of FMP in Namibia would include resources to assess how the FMP can be incorporated into the work of existing partners. A needs assessment will take place, as well as pilot implementation based on needs assessment results. Resources would also be used for travel expenses for technical assistance from CDC Atlanta. Additional resources will be used for translation of materials, trainings, and workshops.

Supportive supervision: The CDC prevention technical advisor is embedded in the MOHSS Directorate of Special Programmes. As such, the advisor is available to provide day-to-day assistance to the MOHSS prevention coordinator and other colleagues and other partners. The prevention advisor will complement other direct technical assistance offered by other members of the CDC technical advisory team (VCT, PMTCT, HIVQUAL, health communications). Supportive supervision will be provided through site visits and in conjunction with training courses offered by other partners (e.g., I-TECH). The CDC prevention technical advisor also serves as a conduit for additional expert technical assistance from CDC headquarters and from international and regional counterparts. This role as a "twinning" advisor promotes regional and south-to-south cooperation.

Sustainability: Support for the CDC Prevention TA is in line with PEPFAR's vision of constructive, government-to-government engagement through technical assistance. Through other technical areas

(Health Systems Strengthening), CDC will continue to support the MOHSS to build additional human resource capacity within the MOHSS civil service. This support will emphasize the creation of HR structures to absorb a wide range of healthcare personnel, including community-based prevention counselors and nurses with integrated training in HIV/AIDS, IMAI and IMIC. Direct technical assistance in this area will also contribute to the development and implementation of a national prevention strategy and the national prevention technical advisory committee.

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $559,448

NEW/REPLACEMENT NARRATIVE WITH SUBSTAINTIAL CHANGES

This is a continuing activity from COP09, and includes two main components: (1) salary support for a CDC PMTCT technical advisor (TA), and; (2) support for two CDC PMTCT field support nurses based at Oshakati State Hospital.

USG will to continue to work closely with MOHSS at the national, regional and service levels in the 34 health districts to monitor the implementation and expansion of PMTCT services to all 256 antenatal care (ANC) sites.

Specific activities include:

1) Support for a CDC PMTCT Technical Advisor to the MOHSS. The CDC PMTCT technical advisor (TA) supports a national counterpart in the Directorate for Primary Health Care (PHC). In COP10, the TA will continue to support revisions to the MOHSS PMTCT guidelines based on revised guidance from WHO. The TA will be involved in making sure costing implications are taken into consideration. The TA will also work to increase collaboration with other key related program areas; including care and treatment, ART (Pediatrics and Adult), OVCs, lab, prevention, strategic information (SI) and others. Additionally, the TA will assist with curriculum development activities for PMTCT, early infant diagnosis of HIV, ART, Pediatric ART, Integrated Management of Adult Illness (IMAI), Integrated Management of Childhood Illnesses (IMCI), and infant feeding. Lastly, supervisory support visits will be undertaken to provide mentoring and technical backstopping to the regions.

2) CDC PMTCT field support nurses. These nurse mentors are stationed in Oshakati State Hospital, the largest hospital in the north. Working with MOHSS staff, these nurses conduct supervisory support visits to PMTCT sites. They provide on-site monitoring, training, and assessment of the quality of services,

patient flow, and record keeping. These visits also help to identify challenges and future training needs. In COP10, the nurses will emphasize monitoring of rapid testing services in PMTCT settings, the integration of PMTCT with other HIV prevention, care and treatment services, and conduct trainings for traditional birth attendants. The field nurses will cover facilities in six regions: Oshana, Oshikoto, Ohangwena,Omusati, Kunene (new) and Kavango (new). CDC/Oshakati field nurses partner with other programs to identify needs, facilitate and implement supportive programs.

The field nurses will also continue to support the collection of PMTCT data at ANC and delivery sites, and support health care workers with monitoring and evaluation activities, including the use of local data for program improvement. As part of this effort, the nurses will emphasize community outreach workers' work to follow-up mother-baby pairs and refer at risk mothers and babies back to PMTCT services. The field support nurses will work on strengthening community outreach utilizing existing community based organizations to encourage women to present early for ANC, and will work towards establishing mother- to-mother support groups that will provide psychosocial support and support for safe infant feeding, as well as help to ensure retention in ANC and care and treatment for HIV-positive women and their families as appropriate.

Supportive Supervision: The CDC TA for PMTCT will provide supportive supervision for the CDC field nurses, and for MOHSS staff at the national and sub-national levels. This assistance will be complemented by supportive supervision from a PMTCT coordinator employed by the MOHSS with Global Fund support. The CDC field nurses will provide follow-up supervision and mentoring the local and facility-based community outreach workers, as well as to other nurses.

Sustainability: This activity leverages Human Resource for Health (HRH) funding from the Global Fund, which supports a PMTCT Coordinator within the MOHSS system. Support for the CDC TA and the CDC field nurses is in line with PEPFAR's vision of constructive, government-to-government engagement through technical assistance. Through other technical areas (Health Systems Strengthening), CDC will continue to support the MOHSS to build additional human resource capacity within the MOHSS civil service. This support will emphasize the creation of HR structures to absorb a wide range of healthcare personnel, including community-based lay counselors and nurses with integrated training in HIV/AIDS, IMAI and IMIC. CDC support for early infant diagnosis and mother-baby tracing will leverage PEPFAR funds for PMTCT to improve maternal and child health outcomes, two priority objectives for the USG and the GRN.

Funding for Laboratory Infrastructure (HLAB): $272,320

NEW/CONTINUING ACTIVITY WITH SUBSTANTIAL CHANGES

This is a continuing activity from COP09. It includes one component: 1) partial salary support for a

laboratory technical advisor on the CDC Namibia staff. This advisor will provide expert support and

assistance to the Namibia Institute of Pathology (NIP), the MOHSS, and other partners involved in

laboratory services. Since this laboratory scientist will also support TB activities, 30% of the funding is

described in the HVTB program area. HLAB supports the remaining 70%.

Since 2005, CDC has supported a laboratory scientist to provide technical assistance to NIP and the

MOHSS. This advisor has helped to develop and implement standard operating procedures for quality

services related to diagnostic DNA PCR, CD4, HIV incidence testing, and TB and HIV drug resistance

testing.

The advisor will continue to work with the International Laboratory Branch Consortium (ILBC) to

coordinate ongoing information sharing between NIP and other laboratories, as well as the technical

activities describe in the ILBC narrative In addition, the advisor will provide oversight and technical

assistance to support the activities described in the NIP HLAB narrative. Specifically, the advisor will

work with NIP and MOHSS to improve linkages between clinical patient records and laboratory records.

The advisor will work with NIP and MOHSS to capture and link the new e-PMS patient data with

information captured by the NIP Laboratory Information System. This linkage will improve tracking and

program reporting systems.

The advisor will also contribute to sustainability at NIP and MOHSS through mentorship and skills

transfer to laboratory staff nationally. This support will also improve utilization and data sharing between

NIP and MOHSS. The advisor will also support a new cooperative agreement with the Polytechnic of

Namibia. This new implementing mechanism will support laboratory training and "twinning" activities

between the Polytechnic and international technical assistance partners (e.g., University of Arkansas).

Supportive Supervision: The laboratory advisor will complement other direct technical assistance offered

by other members of the CDC technical advisory team (prevention, PMTCT, HIVQUAL, health

communications). Supportive supervision will be provided through site visits, day-to-day on-site

collaboration, and in conjunction with training courses offered by other partners (e.g., ILBC).

Sustainability: Support for the CDC laboratory advisor is in line with PEPFAR's vision of constructive,

government-to-government engagement through technical assistance. Through other technical areas

(Health Systems Strengthening), CDC will continue to support the MOHSS to build additional human

resource capacity within the MOHSS civil service. This support will emphasize the creation of HR

structures to absorb a wide range of healthcare personnel, including community-based prevention

counselors and nurses with integrated training in HIV/AIDS, IMAI and IMIC. Direct technical assistance in

this area will also contribute to the development of a national palliative care policy as well as palliative

care ask-shifting activities

Funding for Care: TB/HIV (HVTB): $260,995

NEW/CONTINUING ACTIVITY WITH SUBSTANTIAL CHANGES

This is a continuing activity from COP09, includes three primary components: (1) continued technical support for the Electronic TB Register (ETR), (2) partial support for salary and related personnel costs for a continuing CDC Technical Advisor for Laboratory Services, and (3) support for salary and related personnel costs for a TB Laboratory Advisor. Both advisors will be assigned to the Namibia Institute of Pathology (NIP).

1. Electronic TB Register. Namibia is one of several southern Africa countries that adopted the ETR developed by the BOTUSA Project (Botswana-CDC collaboration) in Botswana. The ETR records information on HIV status and use of ART in TB/HIV patients and is used to measure key indicators and monitor expansion of HIV care and treatment among TB patients. The ETR is expected to further contribute to enhancements in TB surveillance, and inform improvements in TB prevention, early detection, and treatment. , CDC will continue to support the Ministry of Health and Human Services' (MOHSS) ongoing implementation of the ETR through a local contract with WAMTech of South Africa. WAMTech is the sole provider of ETR software and support.

In 2008, Namibia has reported over 300 cases of multidrug resistant TB (MDR TB), and approximately 20 cases of Extensively Drug Resistant TB (XDR TB) have been confirmed. The MOHSS is interested in adding an X/MDR component to the ETR to enhance monitoring and surveillance of X/MDR TB cases.

2. CDC Technical Advisor for Laboratory Services. The CDC/Namibia office has seconded a laboratory technical advisor to the Namibia Institute of Pathology (NIP) since 2005. The original scope of work for this position was to serve as a liaison between CDC, NIP, and the MOHSS to build capacity and to ensure quality for HIV bioclinical monitoring. Since then, the technical advisor has become more involved in strengthening NIP capacity for TB diagnosis, including culture and DST. He has worked closely with the International Laboratory Branch Consortium (ILBCP) to facilitate short- and long-term technical advisors to work alongside NIP staff. This collaboration aims to build staff expertise and to upgrade the TB laboratory, with an ultimate goal of obtaining accreditation. The laboratory technical advisor salary is reflected in HVTB (0.20 FTE) and the HLAB Program Areas (0.80 FTE). The lab technical advisor has also provided technical assistance related to the diagnosis and ongoing monitoring of X/MDR TB cases in Namibia.

3. TB Laboratory Advisor. COP10 funds will support an advisor to provide mentoring and on-the-job

training to NIP technologists and technicians performing TB culture and drug sensitivity testing, both at the national and peripheral level. As possible, this advisor will provide similar support to private laboratories in the country.

Supportive Supervision: The laboratory advisor will complement other direct technical assistance offered by other members of the CDC technical advisory team (prevention, PMTCT, HIVQUAL, health communications). Supportive supervision will be provided through site visits and in conjunction with training courses offered by other partners (e.g., the International Laboratory Branch Consortium partners).

Sustainability: A number of independent assessments of the TB program in Namibia have indicated that TB laboratory services need to be improved and expanded. While short-term assistance from the ILBCP has been beneficial, long-term assistance in this area is essential given staff turnover, the lack of attention that can currently be given to peripheral labs, and the need to implement a comprehensive response to increasing numbers of drug-resistant cases of TB in Namibia. This will be a locally employed staff (LES) position. Sufficient capacity now exists within the country to hire a Namibian

The addition of an LES TB Laboratory Advisor will enhance communication, coordination, and institutional memory between CDC and NIP over the long-term. This addition will also allow the senior CDC Laboratory technical advisor to focus more thoroughly on laboratory system strengthening activities and moving key programmatic activities forward.

Support for the CDC laboratory advisor is in line with PEPFAR's vision of constructive, government-to- government engagement through technical assistance. Through other technical areas (Health Systems Strengthening), CDC will continue to support the MOHSS to build additional human resource capacity within the MOHSS civil service. This support will emphasize the creation of HR structures to absorb a wide range of healthcare personnel, including community-based prevention counselors and nurses with integrated training in HIV/AIDS, IMAI and IMIC.

Cross Cutting Budget Categories and Known Amounts Total: $3,866,918
Human Resources for Health $3,866,918
Key Issues Identified in Mechanism
enumerations.This activity's main cross cutting area is Human Resources for Health. This program will contribute to
enumerations.PEPFAR's broader effort to build human resource capacity by improving the capacity of MOHSS to
enumerations.recruit, manage and retain staff. CDC's support for pre- and in-service service training will also build a
enumerations.sustainable pool of Namibian healthcare workers in nursing, medicine, pharmacy, counseling, and
enumerations.laboratory sciences.
enumerations.
enumerations.
enumerations.Cost Efficiencies Over Time
enumerations.
enumerations.
enumerations.CDC's technical assistance to the MOHSS and other partners supports the development of sustainable
enumerations.engagement and, where relevant, transition plans. These plans are evidence-based. Special emphasis
enumerations.will be given to cost-efficient strategies, including task-shifting and the recruitment and deployment of
enumerations.locally-trained community lay healthcare workers. In COP10, CDC will continue support for on-going GRN
enumerations.costing activities, and conduct programmatic assessments to determine the costs and impact of
enumerations.
enumerations.community-based strategies. These assessments will be linked to the bi-annual PEPFAR reporting
enumerations.calendar, and respond to reporting requirements embedded in the cooperative agreement mechanisms
enumerations.used to manage PEPFAR funds. CDC will also continue support for long-term strategic planning,
enumerations.including the National Strategic Framework and associated costing exercises. Key areas for CDC support
enumerations.in this area include: 1) Actual and projected costs; 2) non-financial resources needed to meet program
enumerations.goals (e.g., human resources, equipment); 3) resource mobilization strategies, and; 4) options to
enumerations.institutionalize the activity within a particular sector (e.g., GRN, NGO community, for-profit).
enumerations.
enumerations.
enumerations.Over time, CDC is committed to working with MOHSS to identify activities that may be absorbed
enumerations.completely by the GRN, that require continuing technical assistance from the USG, and that could be
enumerations.terminated.
enumerations.
enumerations.
enumerations.Monitoring and Evaluation Plans
enumerations.
enumerations.
enumerations.The CDC works with MOHSS and other development partners to strengthen, integrate, and align M&E
enumerations.plans, indicators and systems. All of CDC's program indicators have been aligned with NSF and PEPFAR
enumerations.targets. Bi-annual reports identify progress and describe any necessary changes based on available
enumerations.evidence.
enumerations.
enumerations.
enumerations.
enumerations.
enumerations.Cross-Cutting Budget Attribution(s)
enumerations.
enumerations.
enumerations.
enumerations.
enumerations.Human Resources for Health 3,866,918
enumerations.
enumerations.
enumerations.Key Issues
Addressing male norms and behaviors
End-of-Program Evaluation
Increasing gender equity in HIV/AIDS activities and services
Increasing women's access to income and productive resources
Malaria
Child Survival Activities
Military Populations
Mobile Populations
Safe Motherhood
Tuberculosis
Workplace Programs
Family Planning