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: 2010 2011 2012 2013 2014 2015 2016 2017 2018
SUBSTANTIALLY CHANGED FROM LAST YEAR Objectives
This is a "to be determined (TBD)" partner. A request for proposals for a five-year cooperative agreement was issued in early 2009. An award is expected within the COP10 approval timeframe.
This program cuts across the HVAB, HVOP, HBHC, PDCS and HVCT technical areas. The main goal is to deliver prevention interventions to individuals in household and community settings. These interventions will include: home-based HIV counseling and testing (HCT), HIV education to promote behavior change, referrals to clinical services, counseling on ART adherence, and referrals to PMTCT services
To achieve this goal the program has five objectives: 1. Train at least 250 field officers (FO). 2. Enhance cross-referrals between facility-and community-based programs. 3. Provide basic "Prevention for Positives" counseling to HIV-positive clients. 4. Collaborate with other organizations to avoid duplication. 5. Mobilize and empower individuals and communities to change HIV risk behaviors.
Links to the Partnership Framework (PF) As part of the USG contribution to the PF goal of "enhancing prevention," the USG commits to strengthen the GRN capacity to design, implement and finance comprehensive HIV prevention programs.
The PF is aligned with the priority prevention areas described in Namibia's National Strategic Framework for HIV and AIDS 2010-2015 (NSF), and include: 1. Social and Behavior Change 2. HIV Counseling and Testing 3. Prevention of HIV among the Most-At-Risk and Vulnerable Groups 4. HIV Prevention Involving People Living with HIV and AIDS 5. Medical Male Circumcision 6. PMTCT 7. Post-Exposure Prophylaxis (PEP) 8. Condom Social Marketing and Distribution 9. Prevention of Sexually Transmitted Infections 10. Blood Safety The partner will address all of the above-mentioned prevention priorities with the exception of PEP and blood safety. Coverage and Target population This partner will work in the Omusati, Oshana, Oshikoto, Ohangwena, Kavango, Caprivi, and Khomas regions, which have the highest rates of HIV in Namibia. With the exception of the Khomas Region (Windhoek), the remaining regions are in the north, where the majority of the population resides. Emphasis will be placed on reaching remote populations.
Health Systems Strengthening This program contributes to PEPFAR's broader effort to build human resource capacity by strengthening career pathways within the healthcare sector. The FO cadre could represent an entry-level access point to the GRN civil service, which will be expanded in COP10 to include a new cadre of "Health Extension Workers." With additional training and experience, FO will have the opportunity to advance to extension workers, community counselors, or work in other public health sector positions. FO ensure stronger linkages between health care facilities and communities.
Cross-Cutting Programs and Key Issues This activity addresses several; cross-cutting programs and key issues including gender, economic strengthening, and wraparounds to other health programs.
Human Resources for Health: This program will build human resource capacity by providing training and stipends to over 250 community-based FO. Gender: As part of counseling, FO will refer women to local income and productive resources, as well as gender-specific healthcare and social services (e.g., cervical cancer screening, PMTCT, and gender- based violence programs). Economic Strengthening: The partner will refer HIV-infected individuals to PLWHA support groups, work with existing groups to strengthen them, and help communities to create new groups. Since many PLWHA support groups are involved in microenterprise (e.g., community gardens), program support from the partner will expand these groups' capacity to provide economic support to members. Wraparound activities will include: Child survival (referrals to health facilities); family planning (counseling and referrals); malaria (education and bed nets); safe motherhood (referrals to PMTCT and ANC care); and TB (screening, and referral).
Cost Efficiencies Over Time This activity is designed to be cost efficient. Community-based service delivery and outreach utilizes local volunteers who receive a modest monthly stipend. Expanding this model, which has been implemented in Namibia since 2005, can be done at relatively low cost. The partner will collaborate with other partners and MOHSS to ensure efficient delivery of services and to avoid duplication of efforts. Direct technical assistance is provided by CDC technical advisors. HIV test kits will be procured through the existing MOHSS system. Further cost efficiencies are achieved through utilizing the new community-based networks for other public health activities, e.g., distribution of insecticide-treated bed nets and mobilization for events such as National HIV Testing Day and immunization campaigns.
Monitoring and Evaluation Plans The partner is required to have an extensive monitoring and evaluation (M&E) plan that is linked to
PEPFAR and GRN indicators. The partner will submit bi-annual reports on the number of individuals reached, individuals tested, and individuals linked to services. The partner will have a system for adjusting program activities based on M&E information. The evaluation plan will include indicators for each program activity. In addition, an impact evaluation will be included in the TBD partner's scope of work
NEW/REPLACEMENT NARRATIVE WITH SUBSTANTIAL CHANGES
This activity is a continuation from COP09. It includes one primary component: Support for a "to be determined (TBD)" partner to provide community-based HIV prevention, HIV counseling and testing, and referral services through door-to-door, household outreach in six high prevalence regions in Namibia. Specific activities under the HBHC program area will include: 1) The door-to-door delivery of educational materials and counseling about HIV, STI, and TB prevention, care, and treatment to households; 2) referrals to clinical services; 3) technical assistance and other support for PLWHA support groups, and; 4) training.
A request for proposals for a five-year cooperative agreement was issued in early 2009. An award is expected within the COP10 approval timeframe. As such, reference to a "TBD partner" will be made throughout this narrative.
In COP10, the TBD partner will train and deploy at least 250 Field Officers (FO) to conduct door-to-door counseling and outreach sessions, as well as HCT, with individual households. Details on these activities may be found in the HVOP, HVAB and HVCT narratives. These 250 FO will also perform the following HBHC-related activities:
1) HIV, STI, and TB information outreach. FO will identify households with individuals at increased risk of HIV, STI, and TB infection. FO will provide in-home information about HIV, STI, and TB prevention, care and treatment services to household members.
2) Referrals to HIV, STI, and TB care and treatment services. Households and individuals at risk of HIV, STI, and TB will receive referrals to appropriate testing, care and treatment services. FO will make the referrals during home visits. In certain cases, FO may also accompany patients to facilities to ensure the individual obtains appropriate treatment. FO will also make referrals and linkages to care for PMTCT and family planning related services.
3) Technical and other assistance to PLWHA support groups. FO will provide organizational assistance, guidance, leadership and encouragement to community-led PLWHA support groups. The TBD partner and the FO will also help these local groups coordinate with other groups in other regions, and with the national response. The TBD partner will ensure that FO have appropriate information, education and communication (IEC) materials (e.g., on addressing stigma and discrimination) to use in trainings and informational sessions with these groups.
4) Training. The TBD partner will provide extensive training for FO on the most up-to-date, evidence- based, approaches for effective prevention and referral counseling, and for strategies to address HIV and TB prevention, care and treatment. The TBD partner will also produce appropriate job aids and tools for
the FO, as well as supporting IEC materials for clients.
Sustainability: With a shift towards greater emphasis on sustainability and local ownership within PEPFAR, recruiting and deploying field officers in their own communities is a good example of an efficient utilization of resources in a constrained budget environment. On this note, the TBD partner will be expected to have strong local roots in Namibia. Efficiencies will achieved by a focus on recruiting and deploying staff within their own communities.
The TBD partner will develop an assessment and evaluation system to track financial (e.g., cost per test performed by FO), administrative (e.g., logistics, supervision, coordination with MOHSS, HR), and technical (e.g., testing uptake by first-time clients) indicators. Data collected through this system will be used to revise program activities, as needed, and contribute to national monitoring and evaluation systems. These data will also be used to determine if additional tasks might be shifted to FO in future years. If the FO model is successful in expanding home-based HCT, other task-shifting opportunities may be considered for screening and Directly Observed Treatment for TB; PMTCT follow-up and mobilization; ART adherence support; and/or alcohol counseling and referrals.
PEPFAR will work with all partners to encourage data sharing in line with the commitments and objectives outlined in the National Strategic Framework (NSF) and the Partnership Framework Implementation Plan (PFIP).
This program contributes to PEPFAR's broader effort to build human resource capacity by strengthening career pathways within the healthcare sector. Since all of the FO will be Namibian, these individuals will model and reinforce professional skills, as well as health-promoting behaviors to the general public. The FO cadre could represent an entry-level access point to the GRN civil service, which will be expanded in COP10 to include a new cadre of "Health Extension Workers." With additional training and experience, FO will have the opportunity to advance to become extension workers, community counselors, or work in other public health sector positions. In addition, FO ensure stronger linkages between health care facilities and communities.
This activity is a continuation from COP09. It includes one primary component: Support for a "to be
determined (TBD)" partner to provide community-based HIV prevention, HIV counseling and testing, and referral services through door-to-door, household outreach in six high prevalence regions in Namibia. Specific activities under the HVCT program area will include: 1) Mobilizing communities to access mobile HCT services operated by the Ministry of Health and Human Services (MOHSS), and; 2) Delivering HCT services during household outreach visits.
A request for proposals for a five-year cooperative agreement was issued in early 2009. An award is expected within the COP10 approval timeframe. As such, reference to a "TBD partner" will be made throughout this narrative. In COP10, the TBD partner will train and deploy at least 250 Field Officers (FO) to conduct door-to-door counseling and outreach sessions, as well as referrals, with individual households. Details on these activities may be found in the HVAB, HVOP and HBHC narratives. The 250 FO will perform the following HVCT-related activities: 1) Community mobilization to access MOHSS mobile HCT services. FO will use their unique position in the community to mobilize demand for mobile HCT services offered by the MOHSS. These services are delivered through four MOHSS vans, which will operate across several regions. Each MOHSS mobile team includes a camper van staffed by four community counselors (two to provide counseling and testing and two to coordinate logistics and supplies), a nurse, and a driver. FO will develop a monthly schedule with the MOHSS to ensure consistency (e.g., the first Thursday of each month) and maximize public awareness. FO will also work with the MOHSS team, community leaders, and local radio stations to promote each outreach visit. To support this activity, the TBD partner will provide FO with salaries, transportation (e.g., a bicycle or transportation costs), printed materials (e.g., flyers and IEC materials in local languages), and support for public and MOHSS coordination meetings (e.g., tents, office space). 2) Delivery of HCT services during household outreach visits. In 2008, the MOHSS Permanent Secretary approved the delivery of HCT in non-traditional settings for the first time. FO will receive training in rapid testing before rapid test kits are deployed with FO as part of their standard household outreach toolkit. The TBD partner will work closely with MOHSS to ensure that all guidelines and procedures are followed in the implementation of household-based testing. All rapid test kits used by FO will be procured and provided by the MOHSS Central Medical Stores. USG technical advisors for HCT will provide technical assistance to the TBD partner, and, where possible, individual mentoring to FOs. Sustainability: With a shift towards greater emphasis on sustainability and local ownership within PEPFAR, recruiting and deploying field officers in their own communities is a good example of an efficient utilization of resources in a constrained budget environment. On this note, the TBD partner will be expected to have strong local roots in Namibia. Efficiencies will achieved by a focus on recruiting and deploying staff within their own communities.
This is a continuing activity from COP09. It includes one primary component: Support for a "to be determined" (TBD) partner to provide community-based HIV prevention, counseling, testing and referral services through door-to-door and community outreach. Specific activities under the PDCS program area will include: 1) Referral services (to care and treatment for families, especially children; 2) Technical assistance for community support groups for PLWHA 3. Support for the coordination and integration of activities with the Ministry of Health and Social Services (MOHSS). A request for proposals for a five-year cooperative agreement was issued in early 2009. An award is expected within the COP10 approval timeframe. As such, reference to a "TBD partner" will be made throughout this narrative. In COP10, the TBD partner will train and deploy at least 250 Field Officers (FO) to conduct door-to-door counseling and HCT sessions, household-based referrals to HIV and TB care and treatment, and
community outreach. Details on HCT activities may be found under HVCT. Referral services are described under HBHC. Home-based HIV prevention messaging is described in HVOP and HVAB. Specific PDCS activities will include: 1) Referral services (HIV, STI, and TB care and treatment, as well as preventive care) for families. FO will work with families to promote whole-family health. An emphasis will be placed on ensuring that family members of an HIV positive person (including children) are tested for HIV. In addition, testing or referral for TB will be emphasized when at least one member may have TB disease, as children have a higher risk of developing primary TB In addition, to an emphasis on referrals for early identification of HIV and TB exposure, cotrimoxazole prophylaxis and early initiation of ART in those who test HIV-positive will also be emphasized. Adolescents will require special attention; and FO will include in their activities, age- appropriate prevention messages for youth, including such messages as delaying sexual debut and abstinence. FO will also be vigilant on child sexual abuse as a cause of pediatric HIV, and make appropriate referrals to government protection units.
2) Technical assistance to community support groups for PLWHA. Assistance will be provided by the FOs, who will emphasize the provision of psycho-social support and advising on small income-generating projects (e.g. community gardens). Special focus will be placed on building PLWHA's capacity and skills to care for HIV-impacted children. Where older children and adolescents are already HIV-infected, additional support will be provided for disclosure of HIV-status, adherence to OI prophylaxis and or ART, caregivers' concerns and referrals to OVC programs.
3) Coordination and integration. The TBD partner and individual FOs will coordinate their activities with other community-based groups. As noted above, a special focus will be placed on coordination with support groups for PLWHA. Such integration will be encouraged where cost savings may be achieved. In each region, the TBD partner will coordinate the FOs activities with the Regional AIDS Coordinating Committees (RACOCs), Constituency AIDS Coordinating Committees (CACOCs), local leaders, and other government and nongovernmental organizations. This coordination will enhance the supervision of FOs and avoid duplication. Links with regional and local coordinating bodies will also allow the FO system to be leveraged to deliver messages about other health events (e.g. National Immunization Days) or to distribute materials such as insecticide-treated bed nets. This leveraging is in line with the "mainstreaming" objectives described in the Partnership Framework Implementation Plan (PFIP) and the National Strategic Framework for HIV/AIDS (NSF). USG technical advisors in the area of pediatric care and prevention will provide technical assistance to the TBD partner. Sustainability: With a shift towards greater emphasis on sustainability and local ownership within PEPFAR, recruiting and deploying field officers in their own communities is a good example of an efficient utilization of resources in a constrained budget environment. The partner will be expected to
have strong local roots in Namibia. Efficiencies will achieved by a focus on recruiting and deploying staff within their own communities.
The TBD partner will develop an assessment and evaluation system to track financial (e.g., cost per test performed by FO), administrative (e.g., logistics, supervision, coordination with MOHSS, HR), and technical (e.g., testing uptake by first-time clients) indicators. Data collected through this system will be used to revise program activities, as needed, and contribute to national monitoring and evaluation systems.
This program contributes to PEPFAR's broader effort to build human resource capacity by strengthening career pathways within the healthcare sector. The FO cadre could represent an entry-level access point to the GRN civil service, which will be expanded in COP10 to include a new cadre of "Health Extension Workers." With additional training and experience, FO will have the opportunity to advance to become extension workers, community counselors, or work in other public health sector positions. In addition, FO ensure stronger linkages between health care facilities and communities.
This is a continuing activity from COP09. It includes one primary component: Support for a "to be determined" (TBD) partner to provide community-based HIV prevention, counseling, testing and referral services through door-to-door outreach. Specific activities under the HVAB program area will include: 1) Door-to-door community outreach with HIV prevention messages; 2) HIV outreach to youth, especially girls and young women, and; 3) training.
A request for proposals for a five year cooperative agreement was issued in early 2009. An award is expected within the COP10 approval timeframe.
In COP10, the TBD partner will train and deploy at least 250 Field Officers (FO) to conduct door-to-door counseling and HCT sessions, household-based referrals to HIV and TB care and treatment, and community outreach. Details on HCT activities may be found under HVCT. Referral services are described under HBHC and PDCS. Home-based HIV prevention messaging is also described in HVOP. HVAB-related activities will include:
1) Home-based HIV prevention messaging. The TBD partner will provide door-to-door, age-appropriate, education and prevention counseling to households and community members. Based on assessments conducted during the outreach visits, individually tailored packages of advice and services will be prepared. These packages should include:
• Information on HCT, as well as the ability to perform HCT on site • Information on strategies to reduce sexual risk taking behaviors (e.g., abstinence, multiple concurrent partnerships, correct and consistent condom use, responsible drinking) • Information and referrals for male circumcision where appropriate. • Tailored prevention information for PLWHA • Referral information and links to appropriate care, and treatment services, including HIV care and treatment services, PMTCT, as well as TB and STI treatment • Referral information for social and mental health services including alcohol, abuse support, gender- based violence, and nutrition support • Condoms as appropriate
Given that many of the clients served by this program will be in rural areas with limited access to services, HCT services will also be offered during the outreach visits. This is a new activity for Namibia. Details on this activity are included in the TBD Budget Code Narrative for HVCT.
2) Outreach to youth, especially girls and young women. Because youth are at high risk for HIV infection, particularly young girls, FO will emphasize abstinence messages to youth under the age of 15 and individuals who are not sexually active. During home-based or school-based sessions with youth, the FO will discuss knowledge about HIV transmission; decisions to avoid HIV infection; delaying the first sexual encounter; and pregnancy and STI risks.
3) Training. The TBD partner will provide extensive training for FO on the most up-to-date, evidence- based approaches for effective prevention counseling. The TBD partner will also produce appropriate job aids and tools for the field officers, as well as supporting IEC materials for clients.
Supportive Supervision: In each region, the TBD partner will coordinate the FO activities with the Regional AIDS Coordinating Committees (RACOC), Constituency AIDS Coordinating Committees (CACOC), local leaders, and other government and nongovernmental organizations. This coordination will enhance the supervision of FO and avoid duplication. Links with regional and local coordinating bodies will also allow the FO system to be leveraged to deliver messages about other health events (e.g. National Immunization Days) or to distribute materials such as insecticide-treated bed nets. This leveraging is in line with the "mainstreaming" objectives described in the Partnership Framework
Implementation Plan (PFIP) and the National Strategic Framework for HIV/AIDS (NSF).
USG technical advisors in the area of HIV prevention will provide technical assistance to the TBD partner, and, where possible, individual mentoring to FO.
Sustainability: With a shift towards greater emphasis on sustainability and local ownership within PEPFAR, recruiting and deploying field officers in their own communities is a good example of an efficient utilization of resources in a constrained budget environment. The partner will be expected to have strong local roots in Namibia. Efficiencies will achieved by a focus on recruiting and deploying staff within their own communities.
This is a continuing activity from COP09. It includes one primary component: Support for a "to be determined" (TBD) partner to provide community-based HIV prevention, counseling, testing and referral services through door-to-door outreach. Specific activities under the HVOP program area will include: 1) Door-to-door community outreach with HIV prevention messages; 2) training, and; 3) HIV outreach to special groups and public HIV information campaigns.
A request for proposals for a five-year cooperative agreement was issued in early 2009. An award is
expected within the COP10 approval timeframe. As such, reference to a "TBD partner" will be made throughout this narrative.
In COP10, the TBD partner will train and deploy at least 250 Field Officers (FO) to conduct door-to-door counseling and outreach sessions, as well as household-based HCT and referrals to clinical services. Details on these activities may be found in the HVCT and HBHC narratives. HVOP-related activities will include:
1) Community Outreach. The TBD partner will provide door-to-door, age-appropriate, education and prevention counseling to households and community members. Based on assessments conducted during the outreach visits, individually tailored packages of advice and services will be prepared. These packages should include:
• Information on HIV counseling and testing, as well as the ability to perform on site counseling and testing. • Information on strategies to reduce sexual risk taking behaviors (e.g., abstinence, multiple concurrent partnerships, correct and consistent condom use, responsible drinking). • Information and referrals for male circumcision where appropriate. • Tailored prevention information for PLWHA. • Referral information and links to appropriate care, and treatment services, including HIV care and treatment services, PMTCT, FP services, as well as TB and STI treatment. • Referral information for social and mental health services including alcohol, abuse support, gender- based violence, and nutrition support • Condoms as appropriate.
Details of the HCT activity are included in the TBD HVCT BCN.
2) Training. The TBD partner will provide extensive training for FO on the most up-to-date, evidence- based approaches for effective prevention counseling. The TBD partner will also produce appropriate job aids and tools for the field officers, as well as supporting information, education and communication (IEC) materials for clients.
3) Public Outreach to Special Groups and Public Information Campaigns. The TBD partner will also be expected to conduct other community-based prevention efforts including education for traditional leaders, youth and other groups. The TBD partner will also establish tailored referral guides for each region, and will establish community-based resource centers.
In addition, FO will conduct public events to raise public awareness about HIV STI, and TB prevention, care, and treatment.
Supportive Supervision and Collaboration: In each region, the TBD partner will coordinate the FO activities with the Regional AIDS Coordinating Committees (RACOC), Constituency AIDS Coordinating Committees (CACOC), local leaders, and other government and nongovernmental organizations. This coordination will enhance the supervision of FO and avoid duplication. Links with regional and local coordinating bodies will also allow the FO system to be leveraged to deliver messages about other health events (e.g., National Immunization Days) or to distribute materials such as insecticide-treated bed nets. This leveraging is in line with the "mainstreaming" objectives described in the Partnership Framework Implementation Plan (PFIP) and the National Strategic Framework for HIV/AIDS (NSF).
USG technical advisors in the area of HIV prevention will provide technical assistance to the TBD partner
