This is a new implementing mechanism but continues Pact Regional Award's previous work.

1. APCA has one comprehensive goal which is to provide technical assistance and build capacity within selected countries across the Southern African region in order to promote the development of palliative care in the region. Specifically in Namibia, APCA contributes to the HIV and AIDS response by scaling-up

palliative care provision through a public health approach that strives to balance quality and coverage. The primary emphasis areas are human capacity development and local organization capacity building.

2. The goals that APCA has set in Namibia are directly linked to those within the Partnership Framework in the Focus Area of Care, Treatment and Support. Under this Focus Area, the overarching goal is "To reduce mortality, morbidity and improve the quality of life of those affected by HIV." Palliative care is defined as an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illnesses, including HIV. Therefore, by increasing the number of healthcare providers trained to implement palliative care, more patients will be able to receive it. Palliative care is applicable to patients with HIV and AIDS in their homes, in the community and within public health facilities regardless of whether they are on treatment or not. Therefore this directly contributes to the objectives of the Partnership Framework within the Care Focus Area.

3. Specific target populations include HIV/AIDS care providers at all levels in government, NGOs, CBOs, FBOs and policy makers throughout the entire country.

4. APCA is committed to moving forward palliative care policy, standards and guidelines within Namibia. It is important that palliative care is integrated into standards of care at various levels (basic, primary and tertiary levels) and settings (i.e. home based, antiretroviral therapy, prevention of mother-to-child transmission) so that patients receive comprehensive and holistic services. By improving the quality of care that terminally ill patients receive in their homes, public health facilities are not as burdened by long term patients. This is advantageous to the healthcare system as a whole, and is usually more comfortable for patients and their families.

5. The focus area of APCA's program is palliative care.

6. Part one of the Public Health Evaluation (PHE) planned to begin in COP09 looks at the availability of care services and relative to the palliative care sites as compared to the burden of the disease in catchment areas. It is hoped that this exercise will help to identify gaps in referral procedures that can be amended, and improve cost effectiveness by encouraging organizations to utilize the services of other community organizations and health facilities as appropriate.

7. APCA Namibia is supported by the Southern Africa Regional Office based in Johannesburg, including an M&E officer who is responsible for overseeing the effectiveness and performance of APCA programs in the region.

This is a continuing activity from FY 09 but under a new implementing mechanism.

This continued activity has five main components: (1) to expand and develop the palliative care program with Catholic AIDS Action (CAA), (2) to support the MOHSS in developing national guidelines and standards for palliative care, (3) to build capacity for palliative care at all levels, (4) to support the development of a functional National Palliative Care Task Force, and (5) to implement Phase 2 of the Palliative Care Public Health Evaluation. HCD is a key cross-cutting area.

1. The CAA palliative care program will expand to the final four offices. This will require additional staff, training, and mentorship at the new sites. The existing sites will continue to need strengthening through ongoing mentorship and training. As the nurses at the original sites become more experienced, they will also take part in trainings and mentoring of others. It is hoped that CAA will become a centre of excellence for palliative care in Namibia that can be used as a site for clinical placements. APCA will assist to facilitate the collaboration between the MOHSS and CAA. Standard Operating Procedures for the nurses will be developed in collaboration with the MOHSS. Social workers will be hired for some of the palliative care sites. They will need to attend palliative care training and be mentored.

2. APCA will support the MOHSS in developing the National Palliative Care Standards and Guidelines to

ensure quality care and open access. These will provide a mandate for the MOHSS to roll out palliative care more widely, increasing the number of patients with improved quality of life.

3. APCA plans to increase the capacity of key stakeholders in the implementation of palliative care services through education and training. Building on the work of COP 09, APCA will provide assistance to the MOHSS and national training institutions to disseminate the National Palliative Care Training Curricula and guide tertiary training institutions in adapting it into pre-service curricula.

4. APCA will continue to support the National Palliative Care Task Force in their aim of becoming a National Association of Palliative Care. Once established, APCA will provide mentorship and organizational development so that they can become a sustainable source of palliative care expertise and advocacy.

5. The Public Health Evaluation beginning in COP 09 will be ongoing and mid-term results will be used to improve programming as appropriate.

APCA works closely with its partners to ensure sustainability. Through a large investment in human capacity development and utilizing models of integration into existing structures, APCA plans to devolve work to local institutions and eventually take a supervisory and mentorship role. APCA will support training efforts of the MOHSS with technical assistance and funding as required, working to improve local ownership of programs.

APCA will develop and implement a minimum data set for palliative care in Namibia in conjunction with the MOHSS. Following its adaptation, there will be piloting of the training for its use along with implementation and scale up. Data quality is ensured through ongoing data checks, supervision and mentorship of the PC sites and by completing Trainet forms that are part of a larger training database. APCA is working with CAA to assist them in implementing a quality assurance tool that will involve interviewing patients and families.

Palliative care awareness and capacity is growing and developing in Namibia as a result of ongoing training, technical assistance and mentorship. However, limited in-country expertise necessitates ongoing support to key stakeholders, namely the MOHSS. APCA will act as a source of technical expertise to the MOHSS and other stakeholders so that national efforts to integrate and implement palliative care utilize best practice models.

Ongoing mentorship and supportive supervision are critical to the successful integration and development of palliative care. Recognizing that palliative care is relatively new to Namibia, APCA sees

mentorship as the cornerstone of capacity building. Within the CAA program, the nurses and volunteers receive ongoing mentorship visits from palliative care experts to observe their practice, provide them with feedback and coach them on quality improvement. Phase Two of the Palliative Care PHE will identify the value of mentorship by comparing the CAA nurses who receive ongoing input through mentorship and nurses from a variety of public health facilities who do not. The evaluation aims to identify a model of mentorship for facility based staff that can be used with the National Palliative Care Curriculum as it is disseminated throughout the country.

APCA plans to build local capacity in palliative care whilst creating an enabling policy environment for implementation. By integrating palliative care into existing institutions and building the capacity of national stakeholders, including the MOHSS, palliative care becomes part of the continuum of care of HIV/AIDS patients and others living with life limiting illnesses.

The work of APCA in Namibia will be coordinated by an in-country project coordinator with the support of an administrator and technical support officer. Overall oversight of the program will remain with APCA head office and other ACPA staff will provide technical assistance as required.

This is a continuing activity from FY 09 but under a new implementing mechanism.

This continued activity has four main components: (1) to expand and develop the palliative care program with Catholic AIDS Action (CAA) with special attention to the needs of children, (2) to support the MOHSS in developing national guidelines and standards for palliative care that specifically addresses the needs of children (3) to build capacity for pediatric palliative care at all levels, and (4) to work with the MOHSS and other stakeholders to develop a framework for palliative care monitoring and evaluation for Namibia. HCD is a key cross-cutting area included in the program.

1. APCA will provide technical assistance to CAA to further develop and expand the palliative care program with specific attention to the needs of children. The palliative care program with Catholic AIDS Action (CAA) will expand to the final four offices, so that all CAA offices are implementing palliative care. This will require additional staff, training and mentorship at the new sites. The existing sites will continue to need strengthening through ongoing mentorship and training. As the nurses at the original sites become more experienced, they will also take part in trainings and mentoring of others. It is hoped that CAA will become a centre of excellence for palliative care in Namibia that can be used as a site for

clinical placements. Social workers will be hired for some of the palliative care sites. They will need to attend palliative care training and be mentored. The role of the social workers will be multi-faceted, but a large emphasis will be on children. It is hoped that they will be able to address some of the emotional and social issues facing children, families and other OVC. The social workers will be trained in bereavement and will be assisted in developing programs that support children specifically in their grief. OVCs in need of palliative care will be identified through the existing OVC program at CAA by strengthening internal referrals. The palliative care needs of a growing number of HIV positive adolescents including disclosure issues, self esteem, and psychosocial support will be addressed.

2. APCA will support the MOHSS in developing National Palliative Care Standards and Guidelines incorporating the specific palliative care needs of children.

3. APCA will build capacity in pediatric palliative care at all levels by ensuring that all palliative care training curricula include a component on children, particularly adolescents and their distinctive needs.

4. APCA will work with the MOHSS and other stakeholders to develop a framework for palliative care monitoring and evaluation for Namibia. The Public Health Evaluation beginning in COP 09 will be ongoing and mid-term results will be used to improve programming as appropriate. It is anticipated that the PHE will highlight some of the needs of children requiring palliative care, which will be used to inform program planning and technical support provided to the MOHSS. The results will also help APCA support the MOHSS to develop a framework for palliative care monitoring and evaluation for Namibia, and APCA will provide technical assistance in developing the tools for ongoing monitoring and evaluation of palliative care such as the APCA African Pediatric Palliative Outcome Scale.

APCA plans to build local capacity in palliative care with special attention to the needs of children, whilst creating an enabling policy environment for implementation. By integrating pediatric palliative care into existing institutions and building the capacity of national stakeholders, including the MOHSS, palliative care becomes part of the continuum of care of pediatric patients and others living with life limiting illnesses like HIV/AIDS.

Within the CAA program, the nurses and volunteers receive ongoing mentorship visits from palliative care experts to observe their practice, provide them with feedback and coach them on quality improvement. The work of APCA in Namibia will be coordinated by an in-country project coordinator with the support of an administrator and technical support officer. Overall oversight of the program will remain with APCA head office and other ACPA staff will provide technical assistance as required.