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
COP 2010 Overview Narrative
The Management Sciences for Health/ Strengthening Pharmaceutical Systems (MSH/SPS) program in Namibia is a continuing implementing mechanism from FY09. In COP09, this IM funded activities under HTXS, PDTX, HVTB, HVSI and OHSS. In COP10, HVTB is no longer being funded.
MSH/ SPS has four objectives: 1) improve governance in the pharmaceutical sector, 2) strengthen pharmaceutical management systems to support priority public health services and interventions, 3) contain the emergence and spread of antimicrobial resistance (AMR), and 4) expand access to essential medicines. These objectives will be achieved through partnership, capacity building, and coordination with partners to ensure efficiency and sustainability of interventions.
To improve governance in the pharmaceutical sector, SPS implementing mechanism will enhance the registration, inspection, quality assurance and post marketing surveillance units of the Namibia Medicines Regulatory Council (NMRC), resulting in more efficient and effective regulatory system for timely registration of antiretroviral and essential medicines. SPS will also continue to support review of the National Medicines Policy (NMP), and the development and implementation of the National Pharmaceutical Master Plan.
To strengthen pharmaceutical management systems to support priority public health services and interventions, SPS will develop and implement strategies that strengthen systems, human resources and institutional capacity at various levels for the delivery of pharmaceutical services. This involves supporting the Pharmacy Management Information System (PMIS); the facility level patient Electronic Dispensing Tool (EDT); supporting pharmacy human resources; and strengthening of pre and in-service training of pharmaceutical personnel. These activities will gradually be transitioned to the MoHSS as PEPFAR resources declines.
To contain the emergence and spread of AMR, SPS will support MoHSS in enhancing rational use of medicines by strengthening therapeutic committees and training at facility level. The Program also ensures institutional systems strengthening and the development of cost-effective and sustainable interventions for the containment of spread of antimicrobial resistance. Interventions include monitoring HIV drug resistance early warning indicators (EWIs), adherence interventions, and implementing infection control activities.
ARVs are essential medicines in Namibia that should be continuously available in all health facilities. SPS provides technical assistance to MoHSS and other partners to improve access to essential medicines by strengthening systems for managing pharmaceuticals in the public sector and supports decentralization and interventions aimed at reducing the cost of ART in the private sector.
In line with the partnership framework agreement, MSH/SPS program will focus on key priority areas of treatment, care and support by contributing to expanding ART services, and on key area of coordination and management as it relates to pharmaceutical services.
SPS focuses on leadership and governance in the pharmaceutical sector, community systems strengthening, human resources for health capacity development, and strengthening monitoring and evaluation systems.
SPS has a national coverage and the target population is the entire population of people living with HIV/AIDS in Namibia.
SPS contributes to Health Systems Strengthening by using the adapted capacity building pyramid model as a conceptual framework for building capacity of pharmaceutical services. Key components are:
Operationalization of structure, systems, and roles through development and implementation of policies, regulations, procedures guidelines and other governance structures
Strengthen Human Resources for Health capacity and provision of equipment and requisite infrastructure including in-service and pre-service training at the National Health training centre (NHTC) and the University of Namibia to increase supply, skills and competence of personnel
Deployment of essential tools and information systems for strengthening health systems at facility and national level
Cross -cutting Issues: Increasing gender equity in HIV/AIDS activities and services.
SPS has developed and supports systems that ensure that patient data on ART is disaggregated by gender and age, appropriately analyzed and shared with decision makers.
In order to build efficiency and sustainability, SPS will support scale-up and increased access to ART through decentralization and public-private partnerships. Increasing focus will be on transitioning activities to MoHSS, particularly with regard to the newly recruited pharmacy personnel.
SPS will partner with the National Medicines Policy Coordination, Response Monitoring and Evaluation and Quality Assurance units of MoHSS in implementing national pharmaceutical related M&E systems for pharmaceutical care. Support will also be provided to MoHSS staff to conduct annual data quality audits in 20 sites and facilitate supportive supervision visits, a crucial element in data quality assurance (DQA). SPS will also strengthen data feedback and dissemination mechanisms with quarterly feedback to sites and annual feedback during the pharmacy forum. SPS will conduct two Public Health Evaluations in COP10.
Enhance public-private partnership to increase access to ART information and services
(meetings, trainings workshops, technical assistance, advocacy activities, data analysis and dissemination)
Continuing Activity
Estimated Budget = $250,000
Support implementation and monitoring of standard treatment guidelines and guideline technical committees (development, dissemination, implementation, compliance monitoring, systems for revisions)
Estimated Budget = $124,823
Support the development and implementation of adherence interventions
(treatment literacy materials, routine adherence monitoring tools )
Support monitoring of Antimicrobial Resistance (AMR) and strengthening the monitoring and interventions for HIV Drug Resistance (HIVDR) including analysis and use of Early Warning Indicators (EWI)
Estimated Budget = $200,000
Strengthening human resource capacity and systems for the delivery of sustainable pharmaceutical services to support ART service delivery
(staff secondment, training of staff on pharmaceutical management, new guidelines)
Estimated Budget = $580,000
Strengthen environmentally safe disposal of pharmaceutical waste in the private sector
(assessment of the current waste management, implement key findings, training of pharmacists and health inspectors)
Estimated Budget = $120,000
ADDITIONAL DETAIL:
This is a continuing activity from COP10. In COP11 Management Sciences for Health implementing the Strengthening Pharmaceuticals Systems project (MSH/SPS) will work with Ministry of Health and Social Services (MoHSS) to scale up on previous achievements and consolidate on the activities.
SPS will continue to support initiatives for scaling up ART coverage in both the public and private sectors and facilitate engagement of the private sector in ART service delivery.
SPS proposes to enhance the quality of care through the management of treatment standards. SPS will also continue to provide technical support to the Technical Advisory Committee (TAC) of the MoHSS and other guideline committees to review treatment guidelines to ensure that they are in line with recommended international guidelines and best practices.
SPS will build on the COP10 adherence baseline study and adherence improvement initiative to continue to provide support to encourage and ensure adherence to treatment schedules to minimize defaulters and the risk of HIV drug resistance over time. This will include providing support to health facilities to monitor their own Early Warning Indicators (EWIs) and also SPS will support the MoHSS to provide support to facilities that are not performing well to improve EWI performance.
Support sites in scaling up pediatric ART coverage
(technical assistance, training, equipments, EDT support)
Estimated Budget = $180,000
Support implementation of adherence interventions in children
Estimated Budget = $90,072
Strengthen national capacity for delivery and monitoring of pediatric ART services
(Technical assistance, training, data analysis)
Estimated Budget = $103,000
SPS will continue to support the scale-up ART coverage through strategies for enhancing provision of ART to remaining health facilities; strengthen provision of pediatric ART; standardize and offer a comprehensive care package to ART patients including children. SPS will also support Pharmaceutical services to implement interventions for enhancing integrated adult and pediatric ART services (e.g., quality assurance).
Ensuring adherence to ART in pediatrics is often complicated by several factors. These include inadequate tools for monitoring pediatric adherence and the often low treatment literacy levels of caregivers who may make errors in the administration of medicines to children; and who may not fully appreciate the need to adhere to prescribed treatment.
In COP11, SPS will continue to provide support for IEC material to promote pediatric adherence.
SPS will continue to support the development of models of care that enable adequate management and follow-up of pediatric ART cases by improving data collection and analysis to inform interventions that will improve adherence and treatment outcomes. SPS will leverage the use of the electronic dispensing tool, EDT to collect and analyze pediatric ART data that will inform improvement of services.
Strengthening data quality and use of data from the Electronic Dispensing Tool (EDT) at treatment facilities and NDB at the National Level
(training, dissemination, data review)
Estimated Budget = $40,000
Supporting the Pharmacy Management Information System (PMIS)
(upgrade and review of PMIS, training of staff)
Supporting program monitoring and data quality
Estimated Budget = $41,210
Conduct end of program evaluation
Estimated Budget = $20,000
Operational research
This is a continuing activity of Management Sciences for Health/ Strengthening Pharmaceutical systems (MSH/SPS) will focus on: supporting program monitoring and data quality through strengthening data quality and utilization of information from the Electronic Dispensing Tool (EDT) at treatment facilities and the National Database (NDB); and the Pharmacy Management Information System (PMIS). This intervention strengthens pharmaceutical care services by enhancing quality data collection and analysis to ensure evidence based decision making, and sustainability in ART delivery.
In line with increased access to ART services, strengthening pharmaceutical and patient management systems, accurate and timely reporting at all ART sites are pivotal to the effective delivery of ART services. In COP11, SPS will continue to support the MoHSS to implement a comprehensive ART monitoring system, including systems for more reliable monitoring and tracking of ART patient management and for monitoring ART adherence. The focus of SPS support will be more on improved data quality and data use for decision making both at facility and national levels. SPS will also support the MoHSS in rolling out the EDT in lower facilities across Namibia to ensure that all stocks of ARVs and patients accessing care in the pharmacy in all facilities are adequately monitored. SPS will continue to support the integration and harmonization of the Pharmacy Management Information System (PMIS) into the planned integrated health management system of the MoHSS as well as the integration of the EDT and ePMS systems for ART monitoring.
SPS will continue to promote research that will advance and sustain best practices and successful pharmaceutical management interventions deployed during the life of the SPS program in Namibia and support the dissemination of results and adoption of best practices. SPS will support the MoHSS in monitoring patient outcomes in order to optimize the benefits of ART.
Support implementation of strategies and best practices to improve regulatory capacity and processes for a sustainable NMRC
(Technical assistance, training)
Estimated Budget = $150,000
Support monitoring of implementation of the National Pharmaceutical Master Plan (NPMP)
(Technical assistance, advocacy activities, support visits)
Estimated Budget = $75,000
Provide technical support for the implementation of prospective active surveillance for monitoring the safety and effectiveness of ART medicines
(systems for TIPC)
Estimated Budget = $35,000
Support ART and TB programs implement risk management strategies to reduce moderate-to-severe adverse events that impact on patient adherence and treatment outcomes
Support implementation of medication risk management and pharmaceutical care strategies in Windhoek Central Hospital and the carrying out of medication survey
(Technical assistance to allow Central Hospital to meet the standard of the UNAM degree course training)
Improve treatment outcome through effective use of evidence generated from pharmacovigilance activities
Support sustainability plans for the TIPC call centre and scale-up the implementation of treatment literacy interventions
(Training, materials development and dissemination, advocacy)
Estimated Budget = $60,346
In COP10, the SPS Program supported the Namibia Medicines Regulatory Council (NMRC) to implement a five-year strategic plan developed in COP 09 and helped streamline the registration process as well as develop supportive systems and institutional capacity for medicine regulation in Namibia. SPS will continue to provide technical assistance to the NMRC to help institutionalize systems that will enable NMRC to rely on decisions by stringent regulatory authorities and concentrate its limited resources on in-country monitoring for quality, safety and effectiveness of approved medicines. A strengthened NMRC will contribute towards enhanced quality and availability of ART and TB medicines; and other essential medicines in Namibia.
The change in initiation of ART to the CD4 of 350 threshold, and the change in first-line HAART regimens are expected to increase the number of patients exposed to new ARV regimens, which calls for intensive monitoring, management and prevention of potential adverse effects of therapy. SPS will continue to support the TIPC to implement active medicine safety surveillance strategies, use of information gathered and implementation of medication risk minimization strategies to enhance the quality of ART care.
In COP08/09, SPS and MoHSS completed the review of the National Medicines Policy (NMP) and NPMP, which were launched and implemented in COP10. In COP11, SPS will continue supporting the MoHSS in monitoring the implementation of the NMP and NPMP in order to ensure sustainability of pharmaceutical systems in the delivery of ART services.
