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
COP 2010 Overview Narrative
The Capacity Project is continuing from FY09. In COP09, this IM funded activities under MTCT, HVAB, HVOP, CIRC, HBHC, HTXS, PDCS, PDTX, HVTB, HVCT, HVSI, and OHSS. In COP10, HVSI is no longer being funded.
The overall objectives under the award are to: 1) build the capacity of indigenous organizations to respond to and implement HIV programs, leading to an increased number of Namibians who know their HIV status, and 2) improve access to high quality HIV prevention, care and support, and treatment services for people affected and infected with HIV.
Since 2006, IntraHealth has been supporting the Government of the Republic of Namibia (GRN) and its partners to reduce the spread and impact of HIV/AIDS through building the capacity of indigenous organizations. Currently, the project has sub-awards with nine local organizations with plans to transition Anglican Medical Services to a tenth sub-award recipient. In addition, IntraHealth supports the activities of two professional organizations, the HIV Clinician's Society and The Pharmaceutical Society of Namibia.
Intermediate award objectives will be met by providing technical support in HIV clinical services, and prevention and capacity building to the indigenous organizations in partnership with the GRN, stakeholders, private providers and other implementing partners in Namibia. The key intermediate results (IRs) are as follows:
1. Increased capacity of indigenous organizations to respond to the epidemic and to implement HIV/AIDS-related programs,
2. Strengthened capacity of local organizations to provide high quality, age-appropriate HIV/AIDS prevention programs and referrals at the health facility and community levels,
3. Improved opportunities for Namibians to know their HIV status by improving local organizations' ability to provide quality HIV/AIDS counseling and testing services at medical facilities and in communities,
4. Strengthened capacity of local organizations to provide HIV/AIDS care and treatment services for both adults and children, and
5. Increased capacity of the Ministry of Health and Social Services (MOHSS) to manage human resources for health (HRH) through support to the development and implementation of a human resources information system (HRIS).
IntraHealth and its partners are working to achieve the objectives while contributing substantially to the goals of the GRN and PEPFAR program, specifically the Partnership Framework (PF). In an effort to ensure sustainability, IntraHealth supports the GRN in building the capacity of the HR department in the MOHSS through the development of an HRIS, as well as strengthening the capacity of indigenous NGOs and faith-based organizations (FBOs) working in remote areas. Specifically, IntraHealth is helping organizations strengthen financial, human resources, compliance and other management systems so that these institutions will be ready for transition to direct support. IntraHealth is concurrently strengthening partners technical expertise to help them provide quality HIV prevention, care and treatment services. The five IRs are closely linked to the National Strategic Framework and the PF, targeting prevention, treatment, care and support.
The program targets Namibians of all ages and gender, with specific emphasis on at-risk populations. IntraHealth works with indigenous organizations covering rural, semi-rural and urban areas in 11 of Namibia's 13 regions.
Human Resources for Health (HRH) are fundamental to the sustainability of HIV programming. IntraHealth is making significant progress with the MOHSS to strengthen its capacity to manage HRH with health workforce data nearly completed. MOHSS staff has also participated in key capacity building activities on the use of data for decision making. The program will continue to build the capacity of MOHSS and will extend the pilot of the HRIS to all regions in Namibia.
The focus of IR1 is to increase the cost effectiveness of the program by helping build the capacity, beginning with the larger, more developed organizations, and gradually assisting the smaller organizations, to implement HIV programs. Over time, this will enable IntraHealth to have a reduced presence, shifting to a more supportive role to provide targeted technical assistance. IntraHealth will also work with the local organizations to continue seeking economies of scale as their HIV care and treatment programs expand. One example is the development of an electronic patient management system. As a cornerstone of long term care to PLHIVs, this system not only supports quality care and treatment, it also enables clinics to schedule patients more easily and assist with defaulter tracing.
Monitoring and evaluation is fundamental to the success of the program and is a critically important mechanism for strengthening partner capacity. Through a system of data collection, analysis, reporting and feedback, IntraHealth will work closely with its partners, USAID, and MOHSS to ensure the program is on track, while helping to build partners' capacity to monitor and evaluate HIV programs. IntraHealth is committed to ensuring that information produced is timely, valid, precise, accurate and reliable, and will routinely monitor the quality of the information generated, conducting data quality audits with staff from partner organizations to improve this information.
Ensure provision of quality palliative care services and pain management by all partners through quarterly support and supervision, in-service training and clinical mentorship
Continuing Activity
Estimated Budget = $78,500
Support partners to strengthen pre-ART follow up visits including clinical monitoring, OI prophylaxis for all eligible adult patients.
Estimated Budget = $21,000
Support partners to continue to scale up nutritional assessment and counseling and support.
Estimated Budget = $40,000
Support partners to strengthen spiritual counseling and support
Estimated Budget = $55,000
Conduct joint support and supervisory visits with MoHSS
Estimated Budget = $10,000
Continue to support HIVCS to train private and public practitioners in palliative care.
Salary support
Estimated Budget = $307,154
Operational costs (rent, utilities, communications)
Estimated Budget = $28,000
ADDITIONAL DETAIL:
Quality palliative care (Basic Health Care):
IntraHealth will ensure that local faith-based organizations (CHS, LMS and AMS) provide all HIV-infected adults with high quality care and treatment in order to reduce morbidity and mortality related to HIV and AIDS. The entry point into care will be done through registration of PLHIV at ART clinics. This step will enable ART centers to determine the immunological and clinical status of PLHIV in order to then determine eligibility for ART and/or opportunistic infection (OI) prophylaxis. Quality services will be ensured through quarterly support and supervision, mentorship and on job/ in-service training.
Positive Health Dignity and Prevention:
IntraHealth will work with FBO facilities to ensure that the facility based prevention for PLHIV activities is rolled out according to the Namibian guidelines being implemented in the public health facilities. Efforts will include training of care doctors, nurses, prevention officers and community counselors and ongoing supportive supervision and mentoring
Spiritual care for PLHIV:
To complement clinical care, IntraHealth will continue to support the implementation of spiritual counseling. The healthcare workers were trained to identify and refer patients requiring spiritual counseling and care to clergy who were also trained on the basic facts about HIV/AIDS and providing non-discriminative support to PLHIV. PLHIV will be able to express their feelings and their spirituality in order to help alleviate the psychological burden and, ultimately, to improve coping capabilities.
Support training in palliative care:
For effective palliative care management, doctors, nurses and counselors need to be equipped with knowledge and skills in palliative care. IntraHealth will continue to collaborate with the MoHSS, other USG partners and the HIV Clinicians Society in facilitating the training of staff during COP11. IntraHealth will meet travel and per diem expenses). HIVCS will be supported to conduct palliative e care trainings for doctors and nurses in both the private and public sector through 2 day trainings as well as CPD meetings at least once every quarter.
Nutritional assessments:
Several studies have demonstrated poor nutrition or malnutrition among PLHIV is associated with higher mortality rates even on ART. Nutritional assessment and counseling and support will therefore be strengthened through training, clinical mentorship, supportive supervision and kitchen corner initiatives at various faith-based sites (including provision of local foods & education on food hygiene). Assessments will include weights at each visit, heights and MUAC (for pregnant women). Onandjokwe and Oshikuku district hospitals are amongst the pilot sites for the FBP and will be supported to implement this activity.
Provide technical assistance to partners to ensure quality of care (Organization development, grant management, mentorship)
Estimated Budget = $105,000
Support partners to increase ART outreach centers
Estimated Budget = $69,000
Support partners to strengthen linkages between ART services and PMTCT, outpatients and general in patients including TB wards (through in-service and on job training, monthly interdepartmental meetings/ therapeutic meetings)
Estimated Budget = $61,500
Support partners to develop strategies to reduce patients lost to follow up
Estimated Budget = $60,000
Continue collaborating with MSH in implementation of the treatment literacy approach to improve treatment adherence (quarterly meetings)
Estimated Budget = $20,000
Support district specific trainings in ART
Support HIVCS ( CPD meetings and annual conference)
Conduct joint support visits with the MoHSS
Equipment (e.g. computers, scales, lactate meters etc)
Estimated Budget = $50,000
Continuing Acticity
Estimated Budget = $1,037,336
Operational costs
Estimated Budget = $87,000
Quality of Care:
IntraHealth will continue to support integrated and comprehensive HIV care and treatment services for adults in faith-based hospitals, health centers and outreach services operated by CHS, AMS and LMS. The main goal is to improve the quality of life of all HIV-infected individuals. The overall treatment strategy will focus on building the capacity of partner organizations to implement, sustain, and scale up quality HIV treatment services for adult patients.
Through quarterly support and supervision, mentorship, in-service and on job training, IntraHealth will ensure partners adhere to the national ART guidelines and maintain high quality of care for patients on ART. The local partner organizations will also be capacitated to conduct effective supervision of ART programs.
Expand ART outreach service delivery:
In order to reach more people in need of ART services and increase the ART coverage, the number of ART outlets need to be extended. IntraHealth will seek to gradually extend the number and types of outlets offering ARV services over the life of the project. In COP11 IntraHealth will support the expansion of additional outlets offering ARV services, mainly through outreach.
ART training:
In order to maintain high quality care of ART patients, it is important to continue training doctors, nurses and pharmacists both in the public and private sectors in ART guidelines. IntraHealth will continue to support the training for ART clinic staff, including ART guidelines for all new staff, and refresher trainings for those already providing HAART. This will be done in collaboration with the HCS, MoHSS and I-TECH. The HIVCS will be supported to provide training through both the didactic courses as well as CPD meetings at least once every quarter.
IMAI Training:
The increase in the number of patients initiated and currently receiving treatment since the beginning of the ART program in Namibia has resulted in high workloads for doctors who are in limited supply. IMAI training for nurses could alleviate this burden as IMAI trained nurses can among other duties clinically stage patients, screen for OI and prescribe prophylaxis and review and prescribe ART for patients stable on treatment. Task shifting these duties from the doctor to the nurse could potentially reduce the burden on the doctors and improve efficiency. IntraHealth will support training for 10-15 RNs in IMAI in COP11.
Support partners to improve treatment adherence and retention in care:
IntraHealth will support partners to develop strategies to reduce patients lost to follow up, and support partners to address barriers to adherence in order to improve retention in care and minimize treatment failure and the development of viral resistance in patients. In addition, bringing the services closer to the communities through outreach activities will also contribute to the increased retention in care and better adherence profile. IntraHealth will also continue collaborating with MSH and MoHSS to implement treatment literacy tools in all the FBHs.
Technical Assistance to the MoHSS:
IntraHealth will regularly participate in technical advisory committees, contributing to the development and update of national guidelines, as well as participating in various national committees and training programs. IntraHealth will also conduct joint supportive supervisory visits along with MoHSS staff, which is an opportunity to mentor and further increase collaboration.
Training of counselors on HCT guidelines.
Continued technical assistance provided to partners to strengthen HIV counseling and testing services within the facility and in the community and satellite clinics (outreach HCT)
Continue to ensure provision of quality counseling and testing through quarterly supportive and supervisory visits.
Build capacity of partners to conduct HCT supportive supervision
Estimatd Budget = $35,000
Continue providing HCT services at 10 New Start Centers (4 Standalone and 6 Integrated)
Estimated Budget = $42,000
Support all New Start centers to conduct mobile/ outreach HCT to hard to reach communities at least twice a month
Estimated Budget = $85,000
Provide a mobile HCT unit to cover hard to reach populations
New Activity
Estimated Budget = $200,000
Support the NTD HCT activities
CT counselors, nurses , CM's and CC's will continue to use the dual protection counseling tool with women and girls seeking family planning as referred from CVCT/PITC *
Estimated Budget = $35,000
Support male conferences and HCT days to improve HCT access to males
Support partners to intensify PITC at the Integrated centers (training, QA visits, PIA)
Estimated Budget = $75,000
Continue providing expanded services at HCT centers such as screening for TB, STI, FP, alcohol use and MC with appropriate referrals.
Estimated Budget = $25,000
Continue to support partners to implement PIA and improve program performance
Estimated Budget = $30,000
Continue to support partners to implement the safety net program to address psychosocial needs to C&T staff
Support community mobilization activities
Equipment (e.g. computers)
Salary support to 10 HCT centers
Estimated Budget = $1,088,451
Estimated Budget = $101,000
Technical assistance:
IntraHealth has been a lead provider of TA in VCT since beginning work in Namibia, and has primarily focused on providing technical assistance to partner organizations through working closely with local management. The aim is to teach local partner management teams to incorporate QA and M+E systems so that they may manage their own centers independently and sustainably. IntraHealth will continue to provide EQA through quarterly support and supervision and mentorship visits to centers, even for partners that would have graduated to direct funding. IntraHealth will also continue to provide TA to the MoHSS VCT technical working group and also work closely with NIP on algorithms, protocols and quality assurance.
Mobile and Outreach HCT:
Increasing HIV testing is critical to controlling the epidemic in Namibia. Consequently, IntraHealth will provide significant support to local partners to increase access to testing and encourage uptake of counseling and testing services. Increasing access will include scaling up outreach/mobile testing services to hard to reach communities within their respective communities. The outreach HCT will continue to be done in conjunction with the MoHSS PHC and with the approval of the respective MoHSS RMT. In order to make this activity a success, IntraHealth will work with its partners to improve rapport with their respective RMTs which could in turn expedite the process of approving outreach C&T sites. Emphasis will also be put on linking those clients testing HIV positive to care and treatment services. A mobile unit will also be procured for mobile HCT counseling and testing in hard to reach populations.
Provider Initiated Testing and Counseling (PITC):
PITC activities will be intensified after HCT guidelines are approved and signed off. The six IntraHealth supported integrated centers will be focusing on this strategy to ensure most clients/ patients visiting the hospital (OPD and In-patients) are routinely offered HCT irrespective of their clinical presentation. With an average OPD visits per person in the districts supported by IntraHealth being between 1.0 to about 1.5, this is a huge opportunity to ensure almost every person is tested in the districts at a much lower cost. Staff from partner organizations will be trained in PITC.
Community Mobilization:
IntraHealth will support local partners to carry out community mobilization sessions to encourage uptake of counseling and testing services and to improve overall cost effectiveness. Local partners will also provide group educational sessions before pretest counseling sessions to help shorten the service time clients spent at the site. In addition, group information sessions will also allow counselors to focus more on specific individual risk assessments rather than general information giving.
Male Testing Days:
IntraHealth will continue to support all local partners to develop and utilize a variety of other strategies to increase uptake of counseling and testing services. Partners will conduct "male only" testing days to try and increase the uptake of counseling and testing services by men. IntraHealth will track the number of individuals receiving counseling and testing services through these various events and initiatives.
Quality of counseling and testing services:
In addition to increasing access to HIV counseling and testing, IntraHealth will work closely with partners to ensure that quality is maintained and enhanced as services are scaled up. IntraHealth will continue to conduct, support, and supervise in order to ensure that quality of counseling and testing is maintained and that staff adhere to HCT guidelines and SOPs. The performance improvement approach will continue to be utilized to ensure that local teams develop strategies or interventions to close gas identified during these support visits. IntraHealth will continue to provide on-the-job training and mentorship.
Developing capacity of partners to conduct HCT Support and Supervision:
IntraHealth will continue to develop the capacity of local partner organizations to conduct effective HCT support and supervision through training, coaching and mentorship of their HCT supervisors and other program management staff. This will ensure sustainability of HCT QA and allow IntraHealth to continue focusing on its TA role.
Support Implementation of Performance Improvement Approach:
To ensure high performance of staff and high standards across all supported sites, IntraHealth will continue to support implementation of the performance improvement (PI) approach using important determinants based on the national protocol. These determinants will include environment and supplies, job expectations, performance feedback, motivation and incentives, skills and knowledge, among others. The PI model empowers the local teams to identify gaps, determine the root causes and develop and monitor interventions to close those gaps.
Safety Net Program:
Counselors in Namibia who provide counseling and testing on a routine basis are deeply affected by burnout due to the intense emotional drain and persistent exposure to thoughts revolving around HIV and its impact. Recognizing this, IntraHealth initiated and will continue to rollout out a "safety net" program to address the psychosocial needs of counseling and testing staff. The program will be developed jointly with partners and counseling and testing site staff, and will serve as a forum for counselors to discuss individual welfare issues.
Support partners staff to ensure all HIV+ pediatric patients are registered into care according to national guidelines
Estimated Budget = $22,000
Support partners to strengthen active pre-ART follow up visits
Estimated Budget = $17,000
Ensure partners provide OI prophylaxis for eligible children as per national guidelines through quarterly support and supervision.
Support partners to scale up nutrition assessments counseling and support through quarterly support and supervision, mentorship, and in-service training.
Strengthen quality services through pediatric clinics
Estimated Budget = $19,998
Quality of care:
To assure quality of care for all pediatric patients enrolled in care and pre-ART, IntraHealth will conduct quarterly support and supervision and mentorship visits. A checklist will be utilized to check and assess compliance of partner staff with national guidelines. Areas of focus will be strengthening registration of all HIV positive children into care; strengthening the follow up of pre-ART patients; strengthening nutritional assessments counseling and support screening for OIs and provision of OI prophylaxis for eligible patients. The close follow up of pre-ART patients will ensure the children can be initiated on ART as soon as they are eligible for treatment. IntraHealth will also strengthen the in-service training program in all the FBHs in order to update all practitioners on current trends on care of HIV positive children. Onandjokwe and Oshikuku district hospitals are amongst the pilot sites for the FBP and will be supported to implement this activity
Pediatric clinics:
IntraHealth will continue to support new and existing pediatric ART clinics in all the FBHs. Such clinics have facilitated high quality of care for children on ART as caregivers are taught how to care for the children, and in places such as Onandjokwe and Nyangana, a pediatrician has been able to schedule and conduct consultations on these particular days.
Support partners to increase number of ART outreach centers and thus increase access of ART for children.
Support partners to develop strategies to increase early detection and HAART initiation for eligible pediatric patients
Support partners systems to strengthen linkages of ART services to/ with PMTCT, pediatric wards and PHC/ EPI clinics
Estimated Budget = $45,000
Strengthen EID (DNA PCR) through supporting national training, in-service training, on job training and meetings to minimize missed opportunities.
Rollout child counseling skills to all hospitals (training of nurses and counselors)
Ensure provision of quality of care for pediatric patients on ART through quarterly support and supervision.
Estimated Budget = $14,762
Strengthen linkages:
It is important to strengthen linkages of pediatric ART services to in-patient and outpatient services, PHC/EPI clinics and PMTCT clinics. These linkages would enable all children seen in these clinics/ departments to be screened and offered HIV testing which would enable them to access treatment early and improve survival. Most children under five come to PHC clinics for immunizations. Strengthening linkages with this unit would enable all HIV exposed babies due for DNA PCR testing to be referred for testing or better still be tested in the same PHC and thus minimize loss to follow up and enable early enrollment in care and treatment. In-service training of the staff in these departments would be conducted by the local management teams.
Child Counseling:
A lot of HIV positive children who were enrolled into care and treatment since the beginning of the ART program have graduated to adolescence. As some of them may start asking questions about their status and as some may become sexually active, it becomes important to disclose to them their HIV status. Disclosure is the cornerstone to treatment adherence. Healthworkers need to be empowered to handle disclosure issues for children and adolescence; hence IntraHealth will support and facilitate training of nurses, doctors and counselors from all the FBHs in child counseling skills.
Provide Technical Assistance to MoHSS RM&E division on ePMS
Quarterly Technical Support and Supervision to Partner Organizations and the sites
Estimated Budget = $12,000
Conduct quarterly feedback meetings with partner staff
Continue to develop capacity of partners to conduct DQAs and improve data quality through training and mentorship
Continue to develop capacity of partners to mine and analyze data they are generating
Continue to develop capacity of partners in data use for program planning and improvement
SPSS training for partner staff
Technical Assistance to MoHSS:
IntraHealth will continue to provide technical assistance to the MoHSS RM&E division in the following areas:
ePMS
o one ePMS ToT for 10 MoHSS national and regional staff (5 days)
o continued mentorship on maintaining ePMS and trouble shooting
reviewing PMTCT tools
actively participate in national M&E committee
Technical Support to Partners:
IntraHealth will continue to conduct quarterly support and supervision and mentorship to partners. The support will also capacitate partner staff to conduct data cleaning and data quality assessments to improve data quality.
Quarterly feedback meetings will also be conducted with each partner after each quarterly report in order to build capacity of partners to write reports effectively.
SPSS training:
In order to encourage partners to make use of their data to inform programming, it is essential to build capacity for partners to be able to comfortably use software such as SPSS for data analysis. IntraHealth will train 10 partner staff in SPSS.
VCT Database Trainings:
Funding will support capacity building by conducting two refreshers training on VCT database system including data collection and reporting tools. The training is intended for VCT receptionists, counselors and site managers. For each training, 10 staff members will be trained for 2 days.
Continue strengthening and supporting the Stakeholder Leadership Group (SLG) as well as to include new stakeholders (MoF, Lutheran Medical Services (LMS) and Private Sector) and providing TA to guide MoHSS and SLG for national HRIS
Estimated Budget = $1,250
Assess the investment in Data Center is providing the intended HRIMS benefits in terms of increased system availability, reliability and security.
Estimated Budget = $2,000
Optimize the use of HRIMS:
As a source to produce quarterly HRM statistics
Data driven decision making (DDDM) workshop for MoHSS(interdepartmental & selected partners) to expand the use of HRIMS data.
Estimated Budget = $1,500
Obtain access to HR data in Private Health Facilities
HFR already collects registration details of health professionals, but does not capture it as part of their current data due to it being Excel based.
Estimated Budget = $5,000
Work with SLG to identify priority activities and partners
CHS already rolling out VIP Payroll system hence will be able to provide reliable HR data in electronic format
HFR need a system to capture data collected by them
Other FBO's LMS, etc.
Graduating CHS (Consultant)
Estimated Budget = $11,232
Graduating CHS (TA Travelling)
Estimated Budget = $1,000
Preparing LMS for graduation (Consultant)
Estimated Budget = $16,848
Preparing LMS for graduation (TA Travelling)
Estimated Budget = $1,050
Provision of Technical Assistance (salary support for technical advisor)
Estimated Budget = $56,120
Graduation refers to capacity building of organizations to receive funding as a prime partner rather than as a sub-partner.
It is essential to build on the momentum created by rolling out the HRIMS to all 13 regions in Namibia and maximize the investment to date through ensuring the HRIMS is optimally used. A one day workshop that coincide with the MoHSS' National Planning Meeting will go a long way in allowing directorates within the ministry as well as selected partners to collaborate on how to use the data that can be obtained from the HRIMS.
Health workers in Private Health Facilities:
By automating the HRIMS, we provided health worker information in the public sector, but not yet health worker information in private health facilities. This activity will allow us to capture health workers at a private health facility and will be verified at least annually since operating a private health facility is subject to annual renewals. This will bring us a step closer to providing MOHSS with updated health worker information at a national level. The approach is to develop a User Requirements Specification that can be used to source a system to automate the process. Alternatively, a fourth generation language can be used to rapidly develop a system for use by MoHSS to capture the data they're currently collecting through the registration and renewal of private health facility process.
Graduating CHS:
In order to prepare CHS for graduation, we have developed a graduation plan based on addressing the shortcomings highlighted by the DCAA Audit report no 2191-2009U17740001. This is a two phased approach with the first phase due for completion in COP10 which will deliver the required policies and procedures to address the significant issues highlighted by the DCAA Audit report. COP11 will focus on making the necessary changes on the accounting and personnel systems to implement the policies and procedures at head office as well as at branch level.
Preparing LMS for graduation:
Our work with LMS is still in the initiation phase with the key focus on obtaining the necessary buy in for the graduation process. Once we have secured buy-in, we will be using a toolkit developed for participatory identification of capacity building needs which will allow us to generate a baseline that can be used to track progress for organizational development in LMS.
Continue advocacy and communication with stakeholders
Support to traditional circumcisers
Support adult and neonatal trainings with MoHSS and ITECH
Estimated Budget = $130,000
Support HIVCS in engaging the private sector in two MC training
Infrastructure support (prefabs/ minor renovations in FBO facilities)
Equipment, materials and supplies
Support rollout of MC to all the district FBHs (including demand creation)
Estimated Budget = $38,000
Support to national MC program (in country MC campaigns including WHO volunteer program as well as task shifting advocacy and engagement)
Salary support (level of efforts MOs, nurses, counselors facilitating MC)
Estimated Budget = $27,324
Support to National Male Circumcision (MC) Program:
The national MC task force was directed by National AIDS Executive Committee (NAEC) to pilot MC activities at selected sites throughout the country. The MC targets set by NAEC look quite ambitious but in order for MC to have an impact in preventing HIV transmission, it is necessary to circumcise this number of men and male neonates. The targets set for 2010- 2015 are 816,000 men and 64,000 male newborns. IntraHealth will support the MoHSS efforts to achieve these targets through training of healthcare workers (travel, per diems and accommodation and trainer), quality assurance and support visits, equipment, commodities and supplies, MC campaigns and support of in country volunteer programs among other areas.
Technical Assistance:
IntraHealth will continue to actively participate as a member of the Namibian MC task force. IntraHealth will also play a key role in Namibia as a source of information on MC to other stakeholders and decision-makers. IntraHealth will use this opportunity to advocate for integration of MC in all prevention activities.
Support rollout of MC to FBHs:
IntraHealth will, in conjunction with MoHSS and ITECH, continue to build the capacity of its partners to offer MC as an element of the national prevention strategy and ensure coverage of key points including sexually transmitted infection screening and management, behavioral counseling, provider-initiated testing and counseling, condom promotion and distribution. In addition, support and monitoring of performance, supply chain management, side effects post-procedure and demand creation will also be provided. Counseling and testing centers will continue to serve as entry points to MC information, education and referrals.
In COP11, the project will continue to support the training of doctors, nurses, counselors and managers in MC in order to enable the scale up of the program in the FBHs. IntraHealth will continue to supervise providers to ensure that quality services are offered and complications from MC are managed effectively.
Traditional Circumcisers:
Traditional circumcisers do conduct a significant number of circumcisions particularly in communities known to circumcise their male children. To ensure safe MC by traditional circumcisers, IntraHealth will support advocacy, communication, information, service delivery and supply of necessary kits as required. Training and advocacy will cover other pertinent areas such as infection control, biohazard waste disposal, messaging and monitoring and evaluation of these activities.
Continued technical assistance provided to six FBH to integrate and strengthen HIV prevention education, SBCC and consistent high quality prevention messaging with hospital staff and within the environs of the hospitals
Estimated Budget = $14,500
Continued supportive supervision to FBH prevention programs in order to ensure high quality delivery, consistency and accuracy of messaging and integrated M+E procedures
Estimated Budget = $21,280
Continued training of prevention staff to ensure they have the up to date knowledge and methodologies to provide high quality services to staff and community members.
Facility based prevention officers will continue to train hospital staff in the drivers of the epidemic to ensure staff impart accurate information to patients and strengthen overall response to the epidemic.
Estimated Budget = $8,000
Facility based prevention officers will start/train CC's to conduct "pregnancy planning" sessions with HIV positive mothers as identified through PMTCT programming.
Continuing Activity ***
Facility based prevention officers will start/train CC's to conduct "HIV prevention planning" sessions with mothers who test HIV negative through pre-natal clinics
Facility based prevention officers will continue to use the dual protection counseling tool with women and girls seeking family planning.
Estimated Budget = $7,500
Facility based PO's will conduct both community and facility based PwP sessions.
Estimated Budget = $11,000
Continued technical assistance to the wider prevention community, partners and the Office of the President
IntraHealth will develop a user friendly manual for women living with HIV on safe pregnancy and female reproductive health
Estimated Budget = $6,500
Estimated Budget = $178,540
The IH prevention team will continue to provide TA to FBH partners and New Start franchise partners with the following aims; Strengthened capacity of FBH + New Start partners to provide high quality HIV prevention messaging to patients, facilities that have staff well trained in HIV prevention and BCC methodology, facilities that identify opportunities to impart prevention messaging PIPM-and then fill the opportunity, facilities that have HIV prevention strategies integral to operations, facilities that become leaders in HIV prevention messaging and dissemination, healthier facilities- thereby more adept at imparting prevention messaging, increased uptake of New Start services, planned pregnancies amongst women living with HIV. Increased uptake of male involvement in VCT/PICT services and further HIV related services.
Supportive supervision:
As per the cooperative agreement between IH and USG, the IH prevention team will continue to provide sub-grantee monitoring to prevention partners. The aim of this activity is; To ensure quality services are being offered through observation, feedback to the partner and corrective suggestion, to assist the partner to learn to do this themselves through working also with the managers, to provide mentoring and on-site training to implementers and managers again so that they begin to do this for themselves, to ensure proper M+E is being done.
Training:
As a quality assurance and capacity building intervention, the IH prevention team will conduct 4 trainings during year COP11. These training will equip prevention staff to provide holistic HIV prevention services across the age groups and spectrums of hospital clients. Trainings will be on: safe motherhood-helping HIV+ women to plan pregnancies, HIV general refresher\up-date course, training for nurses and CC's in the use of the dual protection counseling tool and gender sensitivity and referrals.
Direct service provision:
***please note, direct service provision is described here but not to be done by IH prevention team but by FBH partners, in particular the PO's, with IH TA. The IH prevention team will assist FBH staff to integrate female empowerment programming in terms of HIV into day to day work. This will take the form of pregnancy planning sessions for HIV+ women, HIV prevention planning sessions for HIV- women and dual protection counseling for women seeking family planning. The PO's will also continue to provide training to hospital staff on the drivers of the epidemic and conduct PwP sessions with HAART clients and community members.
Reproductive health educational material:
IH will use internal and organizational expertise and in conjunction with the MoHSS, to design a short, easy to understand and culturally sensitive handbook for HIV + women about safe pregnancy, family planning and reproductive health. This material will be for use in all GRN hospitals and hence will be vetted by the MoHSS primary healthcare department
Support district specific PMTCT guidelines training and support supervision
Estimated Budget = $129,000
Assure quality PMTCT services are provided in all facilities by ensuring implementation of PMTCT guidelines through quarterly QA support and supervisory, on-the-job trainings
Support partners to strengthen enrolment into care and treatment for all HIV+ pregnant women
Estimated Budget = $38,500
Continue to support partners to offer preventive counseling for all HIV negative mothers to stay HIV negative
Estimated Budget = $15,500
Support partners to reinforce male involvement through encouraging male partners to participate in couples counseling and testing (male conferences, engaging community leaders)
Support CHS to rollout of RT in satellite facilities in Andara, Nyangana and Oshikuku districts through provision of basic equipment and furniture (fridges, lockable cabinets, tables and chairs)
Estimated Budget = $65,000
Assess quality of PMTCT services provided by partners through implementation of the QoC tool
Support partners to continue implementing Performance Improvement Approaches (PIA) through conducting PI quarterly meetings at each center
Strengthen partners systems to ensure missed opportunities for HCT for mothers and their partners are minimized (through quarterly in-service and on job training, mentorship)
Estimated Budget = $40,500
Strengthen partners systems to ensure all mothers coming to deliver with unknown status are offered HCT at or after delivery and ARV prophylaxis offered to those HIV exposed babies (quarterly in-service and on job training, mentorship, and local case reviews)
Estimated Budget = $22,500
Ensure all HIV exposed babies are offered DNA PCR testing from 6 weeks (through quarterly supervision)
Estimated Budget = $20,500
Support training (travel and per diem and accommodation) of nurses on EID including DBS through MoHSS
Support HIVCS to conduct trainings in PMTCT and EID through CPD meetings at least once every quarter
Estimated Budget = $16,000
Continue to support kitchen corner activities at all the hospitals
Procure equipment and renovate facilities (including prefab option) for EMOC in line with the national road map for the acceleration of the reduction of maternal and neonatal morbidity and mortality
Estimated Budget = $100,000
Conduct trainings on neonatal resuscitation for midwives
Support DCCs to conduct trainings for nurses to identify danger signs in pregnancy
Improve integration/ linkages of FP , PMTCT, HCT, ART & MCH
Develop infection control SOPs for Neonatal units
Develop and pilot a tracking system for HIV exposed babies using the unique identifier (this will be done in collaboration with UNICEF pilot)
Estimated Budget = $980,503
Operational costs (rentals, utilities, communications)
Estimatd Budget = $100,000
Ensure Quality PMTCT services are provided to all HIV-positive pregnant women
IntraHealth's faith-based partners (CHS, LMS and AMS) have successfully offered quality PMTCT services at district hospitals, gradually extending professional care providers into the community for follow-up care of HIV-positive women, babies and children at 48 satellite facilities. The supported PMTCT sites offer the minimum package that includes counseling and rapid HIV testing, counseling for infant feeding options, family planning counseling and referral and antiretroviral (ARV) prophylaxis as per current national guidelines. In addition, eligible HIV+ women are offered HAART. IntraHealth will support partners to strengthen and scale up a comprehensive PMTCT service package in accordance with MoHSS guidelines and algorithms which covers the antenatal care (ANC) period to labor, delivery and postpartum care with special emphasis on mother-infant pair case management. All HIV-exposed infants will be offered DNA PCR HIV testing at six weeks of age.
The focus in year 4 will be to minimize the following missed opportunities:
HCT for pregnant women and their partners who present at ANC
HCT for mothers coming to deliver with unknown HIV status at or after delivery
Providing ARV prophylaxis for mothers testing HIV positive in ANC
Providing ARV prophylaxis to HIV exposed babies
IntraHealth will ensure quality of all PMTCT components through timely collection of data and strengthening of the data management system, training workshops on new PMTCT guidelines (launched in year 2), supportive supervision, implementing performance improvement (PI), and clinical mentoring using established checklists.
A Quality of Care (QoC) tool will also continue to be implemented annually to monitor quality of care being provided in PMTCT settings in all the FBHs.
Kitchen Corner Activities:
Kitchen corner activities will continue to be supported in all the FBHs to provide education to PMTCT mothers on nutrition and how to prepare complimentary food for their babies using locally available foods. This activity will be intensified using a protocol developed by IntraHealth with assistance of FANTA-2. Outcomes of babies who go through this program will be monitored over time.
Support CHS to Expand RT:
To have more coverage in counseling and testing of pregnant women, IntraHealth, in collaboration with the MoHSS and Namibia Institute of Pathology (NIP), will work with the CHS Management to get remaining satellite facilities in Andara, Nyangana and Oshikuku districts certified as rapid testing (RT) sites.
Support Partners to Continue Implementing PIA:
IntraHealth will continue supporting the implementation of the Performance Improvement approach (PIA) in all FBO facilities. Implementation will be continued and expanded in Year 4. IntraHealth believes that the PI approach is a sustainable model that can be adopted by any department within a health facility and used to improve performance. By developing experts in PI within a given facility, this will provide an opportunity for the facility to utilize PI elsewhere. Implementation will involve assisting partners to develop action plans that IntraHealth will follow up on.
Training of midwives on early identification of danger signs :
Midwives at the clinic and health center level will be trained to identify danger signs of maternity complications early and immediately refer to a hospital. This would address partly the third delay in accessing maternal health services. The DCCs will be capacitated to conduct these trainings in their own localities and for their own clinics and health centers. Working with the local DCCs would ensure more nurses/ clinics can be covered in a shorter space of time and at a lower cost, while strengthening the existing healthcare systems and adding an element of sustainability by facilitating recurring trainings and refresher courses. All the FBHs will be covered with these trainings.
Neonatal resuscitation:
Training of midwives in the maternity wards on neonatal resuscitation is a critical area in CHS hospitals. Thorough training of midwives to provide effective resuscitation would significantly reduce the number of infant deaths resulting from asphyxia due to late initiation of effective resuscitation. The 4 CHS hospitals and Odibo will be the focus of these trainings. Onandjokwe hospital does not seem to have a gap in this area probably due to presence of specialist doctors on site who have consistently provided in-service trainings to midwives.
Infection Control:
Neonatal sepsis is one of the identified causes of neonatal mortality in Namibia. IntraHealth, in partnership with the MoHSS, will develop and implement SOPs for infection control in neonatal units. Implementation will involve training one to two midwives from each hospital who will act as a focal person for infection control and who will in turn provide training to the rest of the hospital nursing staff.
Equipment (basic and specialized):
IntraHealth will support procurement of the following basic and specialized equipment for its supported FBHs:
Laryngoscopes (all hospitals)
Resuscitation bed (Oshikuku and Odibo)
CPAP machine(Onandjokwe and Windhoek Central Hospital)
Ultrasound scan (Rehoboth)
Tubes and consumables
CTG machines
Vacuum and forceps extractors where applicable
Developing and piloting a tracking system for HIV exposed babies:
Currently less than 50% of HIV exposed babies are currently being tested in Namibia because of poor follow up of these babies. A data analysis performed for Onandjokwe and Oshikuku, suggests that babies may still be initiated on ART late despite the change in guidelines allowing every baby less than 12 months of age testing HIV positive to be started on ART (Aziz et al 2010). Tracking these babies and testing them at 6 weeks or soon after that, would enable early identification of HIV+ babies and early treatment which would in turn improve their survival. IntraHealth will develop and pilot this tracking system in one of the district hospitals. IntraHealth will collaborate with other partners such as UNICEF to develop this tracking system using unique identifier.
Integrating FP , PMTCT, HCT , ART and MCH:
The majority of clients accessing PMTCT, HCT and ART services in all the FBHs are women. This creates a huge opportunity to reach these clients with FP messaging and commodities. IntraHealth will continue to work with its partners to integrate these services through co-location of FP in all these departments. FP messaging that is sensitive to the teachings of the different churches will be developed and implemented. Co-locating these services will minimize attrition of clients referred for FP from any one of these departments.
Currently babies do present to PHC clinics for immunizations and some of these are HIV exposed babies due for DNA PCR testing and may be missed or if they are identified and referred to PMTCT/ART clinics might not reach there. There is a huge opportunity to have DNA PCR specimens (DBS) collected from the PHC clinics which IntraHealth will explore with its partners in order to minimize attrition.
Support TB Infection Control Activities in all the Faith Based district hospitals/ health center according to the national TB Infection control guidelines (In-service training, departmental meetings, etc)
Ensure partner staff adhere to TB/HIV guidelines in implementing the 3Is approach through quarterly supportive and supervision visits
Estimated Budget = $7,000
Support quarterly meetings between TB and HIV in the district hospitals to improve TB/HIV quality of care
Support partners staff to screen all TB patients for HIV (in-service and on job training, meetings)
Support HIVCS training of doctors and nurses in TB/HIV
Support the Implementation of the 3Is approach :
IntraHealth will continue to support all partners in strengthening TB/HIV collaborative activities. This will be done through reinforcement of the three "I's" to reduce the burden of TB disease among PLHIV as well as initiatives to reduce the burden of HIV amongst TB patients. Through the quarterly support and supervision, IntraHealth will monitor partner staff compliance with the TB guidelines to routinely offer HCT to all TB patients and TB suspects, screen all HIV patients for TB at each encounter/ visit, and providing IPT to eligible patients and designing and implementing TB infection control activities. Emphasis will be placed on supporting local hospital management teams as they develop infection control plans addressing administrative efforts to reduce exposure of both the clients and healthcare workers to TB. Simple measuressuch as maximizing natural ventilation in all wards, consultation rooms and areas, cough hygiene, fast-track screening of patients who are suspected to have TB, and the isolation of all multi-drug resistant (MDR) from non-MDR patientsshould be put in place and strictly enforced.
Support TB and HIV program meetings at district/ hospital level:
In order to optimize the HIV/TB co-infection management, quarterly meetings between TB, ART and NIP staff is of paramount importance. The MoHSS has implemented and coordinated these meetings at regional level. The focus of this activity will be on strengthening these meetings at the local level (district) during which all challenges in the collaborative activities including early diagnosis, treatment, referral and reporting issues will be discussed.
