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: 2011 2012
COP 2011 Overview Narrative
SUBSTANTIALLY CHANGED FROM LAST YEAR
The USG provides direct support to the Ministry of Health and Social Services (MOHSS) to strengthen public health infrastructure and build human resource capacity to improve access to comprehensive HIV/AIDS care.
To achieve these objectives, CDC supports the MOHSS to perform the following activities:
1. Clinical care to patients with HIV/AIDS.
2. Procurement and distribution of ARV drugs
3. PMTCT and Early Infant Diagnosis services for pregnant women and their babies
4. HIV counseling and testing.
5. Renovations of health facilities and training centers
6. Identify trainees for pre-service training in nursing, medicine, pharmacy, counseling, and laboratory sciences.
7. Combination HIV prevention, including PMTCT, ABC, male circumcision, blood safety and referrals to care and treatment.
8. Community mobilization to expand access to PMTCT, VCT, and other services.
9. Monitoring and evaluation and surveillance
10. Quality improvement in HIV/AIDS care and treatment, and in the diagnosis and treatment of related infections, including STIs and TB.
Links to the Partnership Framework
This activity closely supports the USG and GRN commitments in the Partnership Framework (PF) currently under development.
In Namibia, unlike many other PEPFAR-supported countries in sub-Saharan Africa, a majority of the annual PEPFAR budget is currently structured to provide direct support to GRN and other local entities. A large portion of that direct support is provided to this partner, the MOHSS. The MOHSS currently has a mandate to manage and coordinate the national HIV/AIDS response in accordance with the current national strategic plan for HIV/AIDS (MTP 3), and the new National Strategic Framework for HIV/AIDS (NSF), which will be finalized in 2010.
PEPFAR is committed to strengthening GRN capacity and ownership, especially in the areas of human resources, and the financing and operation of national healthcare systems. In COP10, PEPFAR will emphasize the GRN's capacity to plan, oversee, manage and, eventually, finance a growing share of the commitments made in the four priority areas identified by the PF: Prevention; Treatment, Care and Support; Impact Mitigation; and Coordination and Management.
Coverage and Target population
This mechanism is designed to support activities with a national scope. The public sector is structured in a three-tier hierarchy comprised of central, regional and district levels. The central level (MOHSS) has responsibility for policy formulation, regulation, planning, management and development. The regional directorates oversee 34 districts which are ultimately responsible for service delivery. With one national referral hospital, three intermediate hospitals, 30 district hospitals, 44 health centers, and more than 265 clinics, the public sector is the largest provider of healthcare. At the same time, a substantial imbalance exists in the healthcare workforce, with the majority of health professionals working in the private sector. Addressing this imbalance is a priority area for the USG.
Health Systems Strengthening
In 2008, MOHSS, with support and involvement from other healthcare stakeholders (including USG), conducted a comprehensive review of the government's health and social service systems. Two areas of structural weakness within the GRN (public sector) healthcare system stood out: Unequal access to health facilities and human resources.
In COP10, USG technical assistance for the MOHSS will focus on the following areas:
Capacity building of all cadres of health workers (frontline and support)
Strengthening of partnerships between the public and private sectors (including companies, insurance schemes, and private providers) to jointly achieve national goals and objectives for health
Strengthening civil society's ability to participate in health sector dialogue.
Organizational, financial, and management support to MOHSS to strengthen its role as steward and foster equitable resource allocation.
Expanding the decentralization process
Situation analyses and the development of engagement strategies.
Cross-Cutting Programs and Key Issues
This activity's main cross cutting area is Human Resources for Health. This program will contribute to PEPFAR's broader effort to build human resource capacity by improving the capacity of MOHSS to recruit, manage and retain staff. USG support for pre and in-service service training will also build a sustainable pool of Namibian healthcare workers in nursing, medicine, pharmacy, counseling, and laboratory sciences.
Cost Efficiencies Over Time
USG technical assistance in this area will support the development of transition plans. These plans should include, but not be limited to, discussions on: 1) Costs; 2) non-financial resources needed to meet program goals (e.g., human resources, equipment); 3) resource mobilization strategies, and; 4) options to institutionalize the activity within a particular sector (e.g., GRN, NGO community, for-profit, etc.).
Over time, the USG is committed to working with MOHSS to identify activities that may be absorbed completely by the GRN, that require continuing technical assistance from the USG, and that could be terminated.
Monitoring and Evaluation Plans
The MOHSS will build on M&E plans and systems developed to date with PEPFAR support. All indicators will be aligned with the NSF and PEPFAR targets. Bi-annual reports will identify progress and describe any necessary changes based on available evidence.
Support for equipment and supplies for ART and palliative care facilities. This reflects a proportion of CDC's total support to MOHSS for the procurement of equipment and supplies. Equipment and supplies are also funded under HTXS, MTCT, and PDTX.
Continuing Activity
Estimated Budget = $108,750
HPV and cervical cancer screening, including a needs assessment, PAP smear equipment and supplies, as well as onsite training
Estimated Budget = $100,000
ADDITIONAL DETAIL:
Funding under this activity supports the procurement of equipment for HIV-related clinical care, including tools to improve clinical monitoring. To address barriers to proper care of HIV-infected women, equipment has, and will continue to be, procured to improve gynecological screening and care of HIV-positive women to more adequately address HIV-related conditions such as cervical dysplasia and reproductive tract infections.
Funding will further be used to replace outdated equipment in existing Integrated Management of Adolescent and Adult Illnesses (IMAI) sites as well as to procure new equipment for new sites joining the IMAI network. This includes office supplies and tools essential for IMAI palliative care rollout, including printing of IMAI patient cards and files, as well as scales, examination tables, lamps, and other standard clinical equipment.
The procurement of new equipment will also support the national task-shifting initiative, which is central to the success of the IMAI strategy. Taking on tasks previously provided by physicians, nurses will increasingly provide palliative care including screening and treatment of patient with minor OI, Nutrition assessment and management. The nurses will also manage pre- ART clients as well as stable ART clients who have completed their first six months of ART without incident. Furthermore they will provide appropriate referrals and linkages with Community-based Health Care (CBHC) organizations.
HPV and cervical cancer screening. With the launch of the 2010 HIV treatment guidelines, for the first time ever in Namibia the MOHSS now recommends routine annual cervical cancer screening for all HIV infected adult women. With the scale up of this activity facilities will need to be equipped with the tools such as speculums, slides, lamps, cervico-brushes etc and other equipment necessary for PAP smears. Onsite training will be needed to train providers in PAP smear specimen collection, preservation and logistics for transport to the laboratory for analysis. The referral system for management of patients found to have abnormal results will also need to be refined. Furthermore, the implementation plan for wide scale roll out of this initiative has not been yet been clearly defined. Defining this plan will require an understanding of the capacity of the provider network in conducting PAP smears, the logistics of specimen collection and processing at the laboratory, and the laboratory capacity to process large amounts of annual PAP smears. Furthermore the capacity to deal with abnormal PAP smear results in terms of both basic clinical and specialist management is currently poorly understood. In COP11, PEPFAR's support to the MOHSS for the cervical cancer prevention and treatment within HIV programs will therefore include support for the MOHSS to conduct an assessment of the country needs and readiness for the larger cervical cancer prevention program and treatment program. The activities will also focus on refinement of policies and protocols, IEC materials, printing and distribution of these tools for the scale up of cervical cancer prevention activities among HIV infected women. The key outputs of these activities will result in enhancing better understanding of the country's cervical cancer screening program, its maintenance as well as the monitoring of a quality cervical cancer screening and treatment program.
Funding will support routine bio-clinical monitoring tests (CD4, viral loads, full blood counts, liver function tests, syphilis and Hepatitis B screening, renal function tests, and other tests depending on the ART regimen) for patients at MOHSS facilities.
Estimated Budget = $4,856,357
Continued support for approximately 10% of the facility-based lay-Community Counselors (CC) program. Community Counselors. Funding for the Community Counselor (CC) program is distributed among six activity areas: Abstinence and Be Faithful (15%), Other Prevention (20%), counseling and Testing (35%), Preventing Mother to Child Transmission (10%), Adult Treatment (10%), and HIV/TB (10%). This includes salaries for 650 CCs who are deployed in public health sites to work on activities such as HCT, ARV, TB, PMTCT, etc, as well as correctional facilities; training implemented by MOHSS through a local training partner; supervisory support visits by MOHSS staff persons who directly supervise the CCs; and support for planning meetings and an annual retreat for CCs.
Estimated Budget = $328,437
Support to MOHSS systems to procure, store, monitor, and distribute nutritional supplements in line with the Food by Prescription program for approximately 2,500 PLWHA, including children.
Equipment and supplies for ART sites, including tools to improve clinical monitoring, gynecological screening, and Integrated Management of Adolescent and Adult Illnesses (IMAI) services.
Estimted Budget = $80,000
Ongoing support of one mobile unit to deliver prevention, care and treatment services to remote communities
Estimated Budget = $120,000
Administration costs associated with the MOHSS administration of Potentia/MOHSS contracts for health care workers.
Estimated Budget = $20,000
Renovations for ART, TB, PMTCT and other public health facilities
Estimated Budget = $500,000
Expansion of adolescent adherence support and disclosure activity commenced by UNICEF and MOHSS Directorate of Special Programs at Katutura Hospital
New Activity
Estimated Budget = $74,000
Support to the MOHSS School and Adolescent Health Program. This initiative is managed by the Directorate for Primary Health Care and implemented in conjunction with the Ministry of Education. Parental and other community involvement will also be stressed. The program focuses on delivering a comprehensive menu of health promotion messages to in-school youth. PEPFAR funds will support the inclusion of HIV/AIDS prevention messaging, and promote the expansion of this initiative to more schools. PEPFAR funds will leverage proposed support from other bi-lateral and multi-lateral donors.
Estimated Budget = $40,056
1) Routine bio-clinical monitoring tests. All bio-clinical monitoring tests will be performed by the Namibia Institute of Pathology (NIP). With new treatment guidelines approved in 2010, it is anticipated that the need for bio-clinical monitoring services will increase above the COP 10 estimate of services for approximately 90,700 ART patients. Funding will also support CD4 monitoring of non-ART patients enrolled in palliative care. These funds, which will reimburse NIP, are routed to the MOHSS rather than NIP to increase MOHSS ownership and oversight of bio-clinical monitoring costs. The MOHSS will also begin linking clinical and laboratory data systems to allow clinicians to access the lab results as soon as they are available. This linkage will reduce turnaround time and improve data quality. MOHSS has lowered the ART enrollment threshold which will mean more individuals will be put on treatment sooner. The demand for bio-clinical monitoring tests will increase.
2) Community Counselors. Namibia introduced the CC program in 2004 as part of the national task-shifting initiative. Facility-based CCs provide HIV counseling and testing (HCT); adherence, prevention, and male circumcision counseling; and provide referral services. CCs play a major role in supporting clinical PMTCT providers in antenatal clinics. CCs also support provider initiated HTC in TB, STI clinics and other settings. In addition, CCs distribute condoms, promote and conduct couples HCT, and encourage all of their clients, but particularly people living with HIV and AIDS (PLWHA), to reduce high-risk behaviors through faithfulness to one partner. CCs address cultural norms that factor into HIV transmission, including lack of health care seeking behavior by men, multiple sex partners, transactional and trans-generational sex, power inequities between men and women, and alcohol abuse. Funding is also used to support refresher training workshops on HCT related topics such as male circumcision, prevention for PLWHA, and alcohol abuse. Finally, as outreach HCT services expand in Namibia, CCs will enhance provision of such activities through mobile units as well as nontraditional facility-based outreach activities.
3) Nutrition support for PLWHA on ART, including children. The MOHSS will also collaborate with community based organizations to link recipients of the nutrition supplement with sustainable nutrition and income generating strategies such as gardening projects in their communities.
4) Procurement of basic clinical equipment. No additional information.
5) Mobile Services/Outreach Team. Funding will support the ongoing implementation of a mobile service unit to deliver prevention counseling, CT services, and ART and other primary health care outreach services to remote areas of Namibia. Two other mobile units are reflected in MOHSS' efforts in the HVOP and HVCT program areas. Each mobile team will consist of a camper van, two community counselors, a nurse, and a driver. Human resources will be covered through Potentia. Using data and input from regional stakeholders, the teams will develop a monthly schedule of visits to remote communities. Teams will work in conjunction with DAPP field officers and other community outreach groups, community leaders, as well as local radio stations to promote outreach services. Funding will also be used to cover related supplies and materials for the mobile unit, e.g., tents, equipment, IEC materials, lab equipment, etc.
6) HR Administration Costs. In 2009, a new Labour Law required HR contractors to shift legal responsibility for contract staff from the contractor to the client. This was done to establish a clear employee-employer relationship between the client and contract staff. With this change, private HR contractors may continue to provide HR services (e.g., recruitment, payroll management), but may no longer be the formal "employer." In response to this change, the MOHSS expanded the duties and staff of the Deputy Director of the Directorate of Special Programmes (DSP) to assume direct management of these contract staff. Potentia was previously responsible for this work. This transition represents a significant shift in the day-to-day management of contract staff. It is an important step in the development of GRN systems to manage the eventual full absorption and financing of these staff either as civil servants or as contractors.
7) Renovations. Funds will supplement Ministry and Global Fund resources to renovate existing public health facilities in order to deliver HIV, PMTCT, and TB services.
8) Adolescent treatment adherence and disclosure support initiative:
The MOHSS is currently working on a 15-month pilot project with a Civil Society Organization (Positive Vibes) funded by UNICEF at Katutura Hospital with the following objectives:
To promote positive living and prevention for adolescent clients of the Katutura ART clinic
To equip HIV positive adolescents with correct knowledge and skills for HIV prevention and reduction in HIV positive pregnancies
To develop a cohort of trained HIV positive adolescents who can serve as mentors and supportive peers to others
Based on consultations with stakeholders during the COP11 planning process, there was a recommendation to support the continuation and expansion of this novel initiative as an initial attempt to bridge the gap of providing targeted support services to adolescents in HIV treatment and Care. In COP11 PEPFAR will support the continuation and possible expansion of the initiative
9) Since independence, Namibian educational officials have been concerned about the impact of poor health on learners' educational development and performance. The MOHSS and Ministry of Education have joined forces to raise awareness among learners, parents and teachers about a range of health issues faced by youth. These include: Nutrition, general hygiene, teenage pregnancy and reproductive health, alcohol, sexual and drug abuse, HIV/AIDS, and mental health. The School and Adolescent Health Programme was launched after Independence, but implementation has been limited by a lack of funds, logistical challenges, and a lack of technical capacity among healthcare workers (to communicate effectively with children and adolescents) and among teachers (to identify and support learners). In 2008, the MOHSS assessed the School and Adolescent Programme, and wrote a National Policy for School Health. COP2011 funds will support nationwide dissemination and training on key elements in the policy. PEPFAR support for these activities will address gaps in the GRN's budget for this program, which has received commitments from the Finnish Government and WHO for program implementation after the training phase.
Continued support for approximately 35% of the facility-based lay-Community Counselors (CC) program. Community Counselors. Funding for the Community Counselor (CC) program is distributed among six activity areas: Abstinence and Be Faithful (15%), Other Prevention (20%), counseling and Testing (35%), Preventing Mother to Child Transmission (10%), Adult Treatment (10%), and HIV/TB (10%). This includes salaries for 650 CCs who are deployed in public health sites to work on activities such as HCT, ARV, TB, PMTCT, etc, as well as correctional facilities; training implemented by MOHSS through a local training partner; supervisory support visits by MOHSS staff persons who provide supervision and support to the CCs; and support for planning meetings and an annual retreat for CCs.
Estimated Budget = $1,449,531
Procurement and distribution of HIV test kits and supplies. ~375,000 was added to this budget line for the procurement and distribution of HIV test kits and supplies for DAPP/TCE for home-based testing roll out. In addition, test kits will be used for behavioral surveillance surveys for HIV prevalence studies amongst MARPS (sex workers and men who have sex with men).
Estimated Budget = $1,457,704
Promotion of HIV counseling and testing (HCT) through Namibia's National HIV Testing events. The event has witnessed more men accessing CT services compared to the routine data obtained from HCT facilities.
Estimated Budget = $50,000
Ongoing support of one mobile unit to deliver prevention, care and treatment services to remote communities. This activity, together with the annual national testing day and the door to door approach is aimed at reaching out to more male clients and couples. Anecdotally male clients seem to prefer a social approach compared to a medical approach to testing as evidenced by Namibia's NTD data.
1) Community Counselors. Namibia introduced the CC program in 2004 as part of the national task-shifting initiative. Facility-based CCs provide HIV counseling and testing (HCT); adherence, prevention, and male circumcision counseling; and provide referral services. CCs play a major role in supporting clinical PMTCT providers in antenatal clinics. CCs also support provider initiated HTC in TB, STI clinics and other settings. In addition, CCs distribute condoms, promote and conduct couples HCT, and encourage all of their clients, but particularly people living with HIV and AIDS (PLWHA), to reduce high-risk behaviors through faithfulness to one partner. CCs address cultural norms that factor into HIV transmission, including lack of health care seeking behavior by men, multiple sex partners, transactional and trans-generational sex, power inequities between men and women, and alcohol abuse. Funding is also used to support refresher training workshops on HCT related topics such as male circumcision, prevention for PLWHA, and alcohol abuse. Finally, as outreach HCT services expand in Namibia, CCs will enhance provision of such activities through mobile units as well as non-traditional facility-based outreach activities. These outreach activities are aimed at reaching out to more males and couples as well as some hard to reach communities with little access to HCT services.
2) Procurement of HIV Test Kits and Supplies. MOHSS will continue to purchase the following: Determine and Unigold HIV test kits (using a parallel testing algorithm) for approximately 175,000 clients at 305 MOHSS facilities; Clearview Complete 1/2 or a MOHSS-approved rapid test device for tie-breaker re-testing in discordant cases ; HIV rapid test starter packs to launch new testing sites; and rapid HIV test supplies for training CCs. These will be procured and distributed by the MOHSS Central Medical Stores. As HIV testing technologies are advancing to include antibody/antigen combination rapid tests that can detect acute HIV infection, the MOHSS will continue feasibility assessments of new kits including, oral fluid rapid HIV testing kits for use in specific settings. Test kits for an additional 85,000 clients to launch new door-to-door testing sites; and rapid HIV test supplies for training DAPP Field Officers. These will be procured and distributed by the MOHSS Central Medical Stores. MOHSS will also continue a feasibility assessment for implementing oral fluid rapid HIV testing in specific settings, including outreach and correctional settings as well as related quality assurance support.
3) Promotion of HCT through an Annual National HIV Testing Event. Note: This item was reduced to reflect the actual costs of the last two HIV testing events, and takes into account some carryover from this past year's event. This event typically costs U.S. $250,000, and after carry over funds are spent in 2011, this line item may need to be increased in future COP planning cycles. This activity will support the MoHSS's efforts to continue promoting and coordinating a national event that has proven to be highly effective in increasing demand for HCT in Namibia. Funding will support promotional activities in all 13 regions, including drama presentations, radio announcements, other entertainment/educational events, and production and distribution of print and electronic materials. Outreach-based HIV counseling and testing services will be provided during the national testing Day event. Namibia has held three successful NTD events and witnessed more men accessing HCT services compared to any other times. After carry over funds are spent in 2011, this line item may need to be increased in future COP planning cycles.
4) Mobile Services/Outreach Team. Funding will support the ongoing implementation of a mobile service unit to deliver prevention counseling, CT services, and ART and other primary health care outreach services to remote areas of Namibia. Two other mobile units are reflected in MOHSS' efforts in the HTXS and HVOP program areas. Each mobile team will consist of a camper van, two community counselors, a nurse, and a driver. Human resources will be covered through Potentia. Using data and input from regional stakeholders, the teams will develop a monthly schedule of visits to remote communities. Teams will work in conjunction with DAPP field officers and other community outreach groups, community leaders, as well as local radio stations to promote outreach services. Funding will also be used to cover related supplies and materials for the mobile unit, e.g., tents, equipment, IEC materials, lab equipment, etc.
Support for basic clinical equipment required to provide pediatric care services
Estimated Budget = $123,116
Support for DNA PCR tests required by Ministry of Health and Social Services' (MOHSS) Early Infant Diagnosis (EID) Program
Estimated Budget = $1,120,000
Follow-up of HIV exposed infants: Support to expand the special initiative to strengthen follow up of HIV-exposed babies in all regions in Namibia
Estimated Budget = $150,000
HIV-infected children have been accommodated in HIV care and treatment services since the inception of the ART program in Namibia. The estimated ART coverage among the pediatric population is close to 100%. As PMTCT program effectiveness increases, more pediatric infections will be averted and fewer children will be born HIV infected and require treatment. The program budget for care and support is shared with HBHC, with approximately 85% supporting adult services and 15% supporting pediatrics through PDCS.
1) Clinical Equipment and Supplies. Funding under this activity supports procurement of equipment necessary to provide essential HIV-related clinical care, including tools to improve clinical monitoring and care for children. Emphasis will continue to focus on tools (e.g., MUAC tapes, scales and height boards) to monitor growth and nutritional status in pre-ART sites and maternal and child clinics. Additionally, job aides and patient education materials will be produced, printed and disseminated to improve nutritional knowledge of health workers and clients.
Funding will further be used to replace outdated equipment in existing ART clinics and Integrated Management of Adolescent and Adult Illnesses (IMAI) sites as well as to procure new equipment for additional new sites in support of the national ART decentralization process. This includes office supplies and tools essential for IMAI palliative care rollout, including printing of IMAI patient cards and files, as well as scales, examination tables, lamps, and other standard clinical equipment.
The procurement of new equipment will also support the national task-shifting initiative, which is central to the success of the IMAI strategy. Taking on tasks previously provided by physicians, nurses will increasingly provide palliative care including screening and treatment of patient with minor OI, Nutrition assessment and management. The nurses will also manage pre-ART clients as well as stable ART clients who have completed their first six months of ART without incident. Furthermore, they will provide appropriate referrals and linkages with Community-based Health Care (CBHC) organizations.
2) HIV DNA PCR testing for early infant diagnosis. PEPFAR funds will continue to support training of technicians and technologists from the Namibia Institute of Pathology (NIP) and other laboratories in PCR; procurement of new equipment; support for the processing of specimens; and training for health workers in the collection of DBS specimens.
3) Follow-up of HIV exposed infants: Follow up of HIV-exposed infants and linking them up to care and treatment has for long been identified as a key gap in the implementation of the Namibia PMTCT program. The MOHSS with the support of UNICEF in 2009 commission a pilot program in 4 regions (Khomas, Oshana, Caprivi and Oshikoto) which aims to establish a strong program model to ensure appropriate follow up and linkages to care and support of HIV-exposed infants. UNICEF is providing funding for this initiative only for the pilot phase slated to be completed in 2011. This model is expected to be rolled out nationally to minimize loss to follow up of HIV-exposed babies and improve outcomes. In COP11 PEPFAR will support the MOHSS in the expansion of the implementation of this initiative to cover all the regions.
Estimated Budget = $849,232
Support to MOHSS systems to procure, store, monitor, and distribute nutritional supplements in line with the Food by Prescription program for approximately 600 HIV-positive children.
Estimated Budget = $250,000
1) Routine bio-clinical monitoring tests. Funding will support routine bio-clinical monitoring tests (CD4, viral loads, full blood counts, liver function tests, syphilis, Hepatitis B screening, renal function tests, and other tests depending on the ART regimen) for pediatric patients at MOHSS facilities. These tests will be performed by the Namibia Institute of Pathology (NIP). With new pediatric treatment guidelines approved in 2010, it is anticipated that the need for bio-clinical monitoring services will increase above the COP 11 estimate of services for 10,000 pediatric ART patients. Funding will also support CD4 monitoring of non-ART patients enrolled in palliative care. These funds reimburse NIP, but are routed to the MOHSS rather than NIP to increase MOHSS ownership and oversight of bio-clinical monitoring costs. The MOHSS will also begin linking clinical and laboratory data systems to allow clinicians to access the lab results as soon as they are available. This linkage will reduce turn-around time and improve data quality.
2) Nutrition support for HIV-positive children on ART. PEPFAR will support MOHSS systems to procure, store, monitor, and distribute nutritional supplements in line with the Food by Prescription program for approximately 600 HIV-positive children. The MOHSS will also collaborate with community based organizations to link recipients of the nutrition supplement with sustainable nutrition and income generating strategies such as community gardening projects.
3) Procurement of basic clinical equipment. Funding will include tools to improve clinical monitoring, gynecological screening, and Integrated Management of Adolescent and Adult Illnesses (IMAI) services.
Support for the Ministry of Health and Social Services (MOHSS) RM&E unit for essential responsibilities and functions including printing of patient records, forms, procurement of computer equipment necessary for data management, supportive supervisory visits and capacity-building for best practices and data quality measures in M&E methods.
Estimated Budget = $279,800
Support for the management of two national systems, the MOHSS Health Information Systems (HIS) and national database server, will include technical and computer support.
Support for an ART outcomes evaluation. This activity will evaluate clinical outcomes of patients on care and treatment to provide information for program progress and future planning. This activity will be ongoing in COP11 to finalize the report and disseminate the results.
Support for the 2012 sentinel surveillance survey in antenatal clinics (ANC). The ANC sentinel surveillance is a priority activity for the MoHSS that provides the necessary data to determine the national HIV prevalence estimate for Namibia. COP11 funding will support planning, tool development, training, site selection, supportive supervision, data analysis, and printing and dissemination of the final report.
Support for the HIV drug resistance prevention monitoring survey. This is an annual routine survey among 5-6 large ART sites that will assess drug resistance in patient cohorts through record review and genotype sequencing. This monitoring will determine if ART drug resistance is emerging in the patient population that will inform any necessary changes in drug regimens or other patient care. This funding is in addition to drug resistance funding through SPS under the treatment program.
Estimated Budget = $70,000
1) RM&E Program Support. The following items will be supported to expand and enhance the capture, processing, and dissemination of routine data produced by programs within the national HIV/AIDS response:
Computers, software upgrades, monitors, printers, and uninterrupted power supplies will be procured for all new data clerks and HIS officers in ART, PMTCT, CT, and TB clinic sites. The COP11 budget will also include funds for repairs and replacement parts for computer systems which are identified by MoHSS staff.
The production of approximately 20,000 patient books in accordance with the latest GRN and WHO standards.
Routine printing of necessary patient record forms and site registers for collection and dissemination of routine ART/PMTCT/CT/TB/MC data.
Printing and dissemination of the RM&E Annual Report, triangulation report, and progress reports.
Travel for RM&E staff to conduct supportive supervision, mentoring, data collection and other reporting.
M&E trainings and conferences for national staff.
2) MOHSS Health Information Systems (HIS) and National Database Server Support. Technical assistance and upgrades for HIS will be provided at the national and sub-national level. In addition, continuing training and support for the implementation of a national database server. This server will be based in the Officer of the Prime Minister and house integrated healthcare data from across the MOHSS system.
3) Evaluation of ART program. An ART outcomes evaluation is currently being planned to assess quality of care and other clinical outcomes after a rapid scale-up phase of the national pre-ART and ART programs. This activity was recommended after a USG ART program review in 2009.
4) ANC Sentinel Surveillance 2012.The ANC sentinel surveillance round occurs every two years but is funded every year to support activities that span two USG fiscal years. COP11 funding will support planning, tool development, training, site selection, supportive supervision, data analysis, and printing and dissemination of the final report.
5) HIV drug resistance monitoring. Monitoring including genotype testing is currently being piloted in 3 sites and will expand to more sites in COP 11 and in each following year.
Support for scholarships and bursaries for Namibian students in the healthcare sciences. The number of bursaries awarded in COP11 will be determined by the MOHSS based on the level of need demonstrated by applicants and the length of the academic programs in which recipients are enrolled.
Estimated Budget = $1,428,000
Inadequate human resource capacity is among the leading obstacles to the development and sustainability of HIV/AIDS-related health services in Namibia. The USG has recognized pre-service training as instrumental in scaling up and sustaining the national HIV/AIDS response, and to strengthening the overall healthcare system.
Critical human resources gaps exist at all facility levels of the healthcare system, from the national administration to local facilities. The lack of pre-service training institutions for doctors and pharmacists in Namibia, coupled with limited local training opportunities for other allied health professionals, has contributed to a chronic shortage of health professionals.
COP11 will support bursaries for Namibian students with demonstrated financial needs and educational qualifications to train as doctors, pharmacists, pharmacy assistants, nurses, enrolled nurses, laboratory technologists, social workers, public health administrators, epidemiologists, and nutritionists in Namibia, South Africa, Kenya, and elsewhere. Students awarded bursaries through this program will be bonded to serve the MOHSS upon completion of their studies. To assess whether bursary recipients are remaining within the Namibian health workforce, the USG will work with the MoHSS to track the employment status of previous, current and future bursary recipients . USG technical advisors will also facilitate the flow of information about the bursary program between MOHSS program managers and MOHSS leadership. Busary opportunities will be widely publicized and, where appropriate, will be linked to existing USG programs, especially those that reach vulnerable populations. This facilitation will include, where relevant, support for the collection, analysis and dissemination of information captured in human resource information systems.
The provision of supplies, equipment, and commodities for male circumcision, including diathermy machines( ~$85,000).
Estimated Budget = $329,703
Technical assistance to the male circumcision task force, related travel for support visits, international study tours, printing of materials, task shifting workshops, and other support as determined by the male circumcision task force.
Estimated Budget = $77,000
As the demand for male circumcision (MC) increases in Namibia, PEPFAR will support the MOHSS to ensure that appropriate supplies, equipment, and commodities are available. These supplies and commodities may include, but will not be limited to, surgical equipment, sterile equipment, local anesthetic, patient education materials and training curricula. In addition, supplies such as surgical beds, lights, privacy screens, and other materials needed to roll out MC are included. Where possible, existing GRN procurement services will be used, specifically the MOHSS Central Medical Stores to order, stock, and distribute the appropriate supplies, commodities, and equipment. A distribution plan will be aligned with the roll-out plan for MC services in all 13 regions.
Continued support for approximately 15% of the facility-based lay-Community Counselors (CC) program. Funding for the Community Counselor (CC) program is distributed among six activity areas: Abstinence and Be Faithful (15%), Other Prevention (20%), counseling and Testing (35%), Preventing Mother to Child Transmission (10%), Adult Treatment (10%), and HIV/TB (10%). This includes salaries for 650 CCs who are deployed in public health sites to work on activities such as HCT, ARV, TB, PMTCT, etc, as well as correctional facilities; training implemented by MOHSS through a local training partner; supervisory support visits by MOHSS staff persons who directly supervise the CCs; and support for planning meetings and an annual retreat for CCs.
Continuing Activity Estimated Budget = $492,649
Support to the MOHSS School and Adolescent Health Program. This initiative is managed by the Directorate for Primary Health Care and implemented in conjunction with the Ministry of Education. Parental and other community involvement will also be stressed. The program focuses on delivering a comprehensive menu of health promotion messages to in-school youth. PEPFAR funds will support the inclusion of HIV/AIDS prevention messaging, and promote the expansion of this initiative to more schools. PEPFAR funds will leverage proposed support from other bi-lateral and multi-lateral donors. This initiative is also partially funded (additional $40,000) in pediatric treatment (PDTX).
New Activity Estimated Budget = $53,428
1) Community Counselors: Namibia introduced the CC program in 2004 as part of the national task-shifting initiative. Facility- based CCs provide HIV counseling and testing (HCT); adherence, prevention, and male circumcision antenatal clinics. CCs also support provider initiated HCT in TB, STI clinics and other settings. In addition, CCs distribute condoms, promote and conduct couples HCT, and encourage all of their clients, but particularly people living with HIV and AIDS (PLWHA), to reduce high-risk behaviors through faithfulness to one partner. CCs address cultural norms that factor into HIV transmission, including lack of health care seeking behavior by men, multiple sex partners, transactional and trans- generational sex, power inequities between men and women, and alcohol abuse. Funding is also used to support refresher training workshops on HCT related topics such as male circumcision, prevention for PLWHA, and alcohol abuse. Finally, as outreach HCT services expand in Namibia, CCs will enhance provision of such activities through mobile units as well as nontraditional facility-based outreach activities.
2) MOHSS MOE School Health Programme: Since independence, Namibian educational officials have been concerned about the impact of poor health on learners' educational development and performance. The MOHSS and Ministry of Education have joined forces to raise awareness among learners, parents and teachers about a range of health issues faced by youth. These include: Nutrition, general hygiene, teenage pregnancy and reproductive health, alcohol, sexual and drug abuse, HIV/AIDS, and mental health. The School and Adolescent Health Programme was launched after Independence, but implementation has been limited by a lack of funds, logistical challenges, and a lack of technical capacity among healthcare workers (to communicate effectively with children and adolescents) and among teachers (to identify and support learners). In 2008, the MOHSS assessed the School and Adolescent Programme, and wrote a National Policy for School Health. COP2011 funds will support nationwide dissemination and training on key elements in the policy. PEPFAR support for these activities will address gaps in the GRN's budget for this program, which has received commitments from the Finnish Government and WHO for program implementation after the training phase.
Continued support for approximately 20% of the facility-based lay-Community Counselors (CC) program. Community Counselors. Funding for the Community Counselor (CC) program is distributed among six activity areas: Abstinence and Be Faithful (15%), Other Prevention (20%), counseling and Testing (35%), Preventing Mother to Child Transmission (10%), Adult Treatment (10%), and HIV/TB (10%). This includes salaries for 650 CCs who are deployed in public health sites to work on activities such as HCT, ARV, TB, PMTCT, etc, as well as correctional facilities; training implemented by MOHSS through a local training partner; supervisory support visits by MOHSS staff persons who directly supervise the CCs; and support for planning meetings and an annual retreat for CCs.
Estimated Budget = $656,212
Procurement of approximately 6 million male and female condoms
Estimated Budget = $450,000
Supporting the Ministry of Health and Social Services' (MOHSS), Department of Social Welfare Services for alcohol/HIV prevention activities, e.g., 13 Regional Coalitions on Responsible Drinking (CORD)
Ongoing support of one mobile unit to deliver prevention, care and treatment services to remote communities.
Travel for the National Prevention Coordinator and National Male Circumcision Coordinator, as well as resources for attendance at relevant trainings and conferences. In addition, relevant prevention supplies and materials will be procured.
Estimated Budget = $100,669
1) Community Counselors. Namibia introduced the CC program in 2004 as part of the national task-shifting initiative. Facility-based CCs provide HIV counseling and testing (HCT); adherence, prevention, and male circumcision counseling; and provide referral services. CCs play a major role in supporting clinical PMTCT providers in antenatal clinics. CCs also support provider initiated HCT in TB, STI clinics and other settings. In addition, CCs distribute condoms, promote and conduct couples HCT, and encourage all of their clients, but particularly people living with HIV and AIDS (PLWHA), to reduce high-risk behaviors through faithfulness to one partner. CCs address cultural norms that factor into HIV transmission, including lack of health care seeking behavior by men, multiple sex partners, transactional and trans-generational sex, power inequities between men and women, and alcohol abuse. Funding is also used to support refresher training workshops on HCT related topics such as male circumcision, prevention for PLWHA, and alcohol abuse. Finally, as outreach HCT services expand in Namibia, CCs will enhance provision of such activities through mobile units as well as nontraditional facility-based outreach activities.
2) Condom Procurement. The procurement of approximately six million condoms is a continuation of an activity added in 2007 to leverage the support of the Global Fund, which provides support for the MOHSS' new Smile brand of male condoms and for Femidon female condoms. The planned number of condoms to be procured in Namibia in 2011 is over 20 million. Global Fund is expected to fund 13 million condoms, PEFAR six million, and the Namibian government one million.
3) Alcohol/HIS Prevention. USG funds will support the MOHSS' Coalition on Responsible Drinking (CORD). CORD incorporates media messaging and works with community, business, and health partners, as well as shebeens and breweries to reduce alcohol abuse, a major driver of the HIV epidemic in Namibia. CORD exists in all 13 regions of Namibia and will use these funds to educate business owners and the general public about the association between alcohol consumption, high-risk sexual behavior, and HIV transmission and acquisition.
4) Mobile Services/Outreach Team. Funding will support the ongoing implementation of a mobile service unit to deliver prevention counseling, CT services, and ART and other primary health care outreach services to remote areas of Namibia. Two other mobile units are reflected in MOHSS' efforts in the HTXS and HVCT program areas. Each mobile team will consist of a camper van, two community counselors, a nurse, and a driver. Human resources will be covered through Potentia. Using data and input from regional stakeholders, the teams will develop a monthly schedule of visits to remote communities. Teams will work in conjunction with DAPP field officers and other community outreach groups, community leaders, as well as local radio stations to promote outreach services. Funding will also be used to cover related supplies and materials for the mobile unit, e.g., tents, equipment, IEC materials, lab equipment, etc. The MOHSS requires retesting of 5% of all rapid HIV testing done as part of external quality monitoring. All HCT facilities including outreach and door to door testing should be enrolled in the EQA scheme and are expected to submit 5% specimens for retesting using ELISA at NIP. Additionally, NIP will provide proficiency panels and Quality Control sets to all rapid test delivery points and compile EQA reports for the program.
5) HR Administration Costs. In 2009, a new Labour Law required HR contractors to shift legal responsibility for contract staff from the contractor to the client. This was done to establish a clear employee-employer relationship between the client and contract staff. With this change, private HR contractors may continue to provide HR services (e.g., recruitment, payroll management), but may no longer be the formal "employer." In response to this change, the MOHSS expanded the duties and staff of the Deputy Director of the Directorate of Special Programmes (DSP) to assume direct management of these contract staff. Potentia was previously responsible for this work. This transition represents a significant shift in the day-to-day management of contract staff. It is an important step in the development of GRN systems to manage the eventual full absorption and financing of these staff either as civil servants or as contractors. This line item will cover administration activities of these HR contracts in MOHSS.
Procurement of routine supplies and equipment. This reflects a proportion of CDC's total support to MOHSS for the procurement of equipment and supplies. Equipment and supplies are also funded under HTXS, HBHC and PDTX.
PMTCT training for traditional birth attendants (TBA) Continuing $20,000
Support for a PMTCT information, education, and communication (IEC) campaign Continuing $50,000
Support for case managers to improve follow-up of mother-infant pairs Continuing $200,000
Support to MOHSS systems to procure, store, monitor, and distribute nutritional supplements in line with the Food by Prescription program for approximately 2,500 PLWHA.
Implementation of the new PMTCT guidelines, including printing and distribution of the new MOHSS guidelines, revision and printing of tools and registers, IEC materials, as well as refresher training of providers on these new guidelines.
Estimated Budget = $203,668
1) Namibia introduced the CC program in 2004 as part of the national task-shifting initiative. Facility-based CCs provide HIV counseling and testing (HCT); adherence, prevention, and male circumcision counseling; and provide referral services. CCs play a major role in supporting clinical PMTCT providers in antenatal clinics. CCs also support provider initiated HTC in TB, STI clinics and other settings. In addition, CCs distribute condoms, promote and conduct couples HCT, and encourage all of their clients, but particularly people living with HIV and AIDS (PLWHA), to reduce high-risk behaviors through faithfulness to one partner. CCs address cultural norms that factor into HIV transmission, including lack of health care seeking behavior by men, multiple sex partners, transactional and trans-generational sex, power inequities between men and women, and alcohol abuse. Funding is also used to support refresher training workshops on HCT related topics such as male circumcision, prevention for PLWHA, and alcohol abuse. Finally, as outreach HCT services expand in Namibia, CCs will enhance provision of such activities through mobile units as well as nontraditional facility-based outreach activities.
2) Procurement of supplies and equipment. PEPFAR will support the printing and distribution of revised ANC and maternity registers, as well as monthly ANC and Labor and Delivery summary forms. In addition, hemoglobin meters will be procured to support anemia monitoring for women on AZT-containing regimens. Clinic furniture and equipment for new PMTCT sites will also be procured. Support will also assist in printing and dissemination of the new national PMTCT guidelines.
3) Training for Traditional Birth Attendants (TBA). Approximately 19% of deliveries in Namibia occurred outside of a health facility according to the 2006 DHS (for years 2001-06). These deliveries are conducted by traditional birth attendants (TBA). While it is critical to engage with, and motivate these TBA to refer pregnant women for a skilled birth attendant, some women in remote areas find it hard to present to maternity for delivery. Training on PMTCT, HIV prevention, reproductive health, and referrals will be provided to at least 80 TBA.
4) Support for an IEC campaign promoting PMTCT. A national educational campaign by the Directorate of Primary Health Care to promote PMTCT services in collaboration with the Ministry of Information, Communication and Technology (MICT) will continue in COP11. Funding will be provided to develop, produce, and disseminate PMTCT educational materials for strategic communications in the clinical setting, including the promotion of male involvement. Materials will be produced in local languages as appropriate.
5) Case Managers (CM). CMs will provide assessments to allow for early recognition of client issues that could impact compliance with care and treatment. Through an intervention/service plan CM will address issues that place clients at risk of defaulting on HIV treatment. CMs will:
coordinate resources for clients, including links to and facilitation of social support groups including Civil Society Organizations involved in PMTCT mobilization in communities, and psycho-social support for PLWHA;
facilitate defaulter tracing;
counsel patients on adherence, prevention with positives, ABC, Family Planning (FP), STI services and disclosure/partner referral;
refer patients to other health and social services (e.g., FP, STI services, drug/alcohol treatment and domestic violence); and
encourage men to seek services and to support their partners and children in doing the same.
CMs will work directly with other clinical and lay staff. As part of the development of the overall CM program, an assessment will determine the optimal roles and responsibilities of expert patients (e.g., possible default tracing, education, etc).in support of CM activities.
6) HR Administration Costs. In 2009, a new Labour Law required HR contractors to shift legal responsibility for contract staff from the contractor to the client. This was done to establish a clear employee-employer relationship between the client and contract staff. With this change, private HR contractors may continue to provide HR services (e.g., recruitment, payroll management), but may no longer be the formal "employer." In response to this change, the MOHSS expanded the duties and staff of the Deputy Director of the Directorate of Special Programmes (DSP) to assume direct management of these contract staff. Potentia was previously responsible for this work. This transition represents a significant shift in the day-to-day management of contract staff. It is an important step in the development of GRN systems to manage the eventual full absorption and financing of these staff either as civil servants or as contractors. This line item will cover administration activities of these HR contracts in MOHSS.
7) Nutrition support for PLWHA on ART, including children. The MOHSS will also collaborate with community based organizations to link recipients of the nutrition supplement with sustainable nutrition and income generating strategies such as gardening projects in their communities.
8) Implementation of the new PMTCT guidelines: In 2010 WHO released new PMTCT guidelines to further reduce Mother-to Child transmissions (MTCT) rates in line with the new global initiative to eliminate MTCT by 2015.The MOHSS adapted these guidelines and will be launching them in 2010 Some significant changes in these guidelines are that the maternal component of the PMTCT regimen will now be commenced at 14 weeks of gestation instead of the current 28 weeks. The pediatric component will also see prophylaxis being extended from the current 7 days to 6 weeks in the case of non-breastfed babies and up to 12 months for breastfed babies. Consequently the MOHSS will need to invest significant resources in rolling out implementation of these guidelines. The specific activities supported in this initiative will include curriculum review, review of user tools associated with PMTCT such as registers, summary reporting forms, IEC materials as well as didactic training of providers in these new guidelines and provision of supportive supervision and mentorship to ensure proper implementation of the new guidance throughout the 300+ clinic network where PMTCT services are provided in the country.
Funding support to procure FDA-approved ARVs through the Ministry of Health and Social Services' (MOHSS) Central Medical Stores (CMS)
Estimated Budget = $939,798
This budget area has been substantially reduced over the past three COP submissions as the growing ARV procurement costs are assumed by GRN and Global Fund Financing. The MOHSS CMS procures and distributes all public sector ARVs in Namibia. PEPFAR funding from ARVS has reduced from approximately 4.1 million (U.S. dollars) in COP 08 to less than 1 million (U.S. dollars) in COP 11.
Through a single procurement structure, the CMS uses funds from the MOHSS, the USG, the Global Fund, and other partners to simplify procurement and maximize purchasing power. Funds from MOHSS and other donors will continue to be used to procure non-FDA-approved products. The supply chain for ARVs and related drugs works well and cost-effectively in Namibia, with state-of-the-art pharmacy information system and inventory practices that have virtually eliminated ARV stock-outs.
With USG support, the MOHSS has enhanced its considerable technical capacity to lead all aspects of its national treatment program, from care and treatment guidelines to pharmaceutical management, forecasting, procurement and supply chain management. The GRN is well positioned to sustain this leadership into the future. The GRN recognizes that its absorption of ARV costs is an important step toward sustainability of its treatment program, and has been increasing the portion of ARV costs covered by MOHSS funding over time, while USG contributions have declined.
Procurement of HIV Test Kits and Supplies for TB patients and suspects
Estimated Budget = $200,000
Lab diagnosis and bio-clinical monitoring for TB
TB Drug Resistance Surveillance
Estimated Budget = $134,609
2) Procurement of HIV Test Kits and Supplies for TB patients and suspects. MOHSS will continue to purchase the following: Determine and Unigold HIV test kits (using a parallel testing algorithm) for approximately 50,000 TB patients and suspects at 250 MOHSS facilities; ELISA or an MOHSS-approved rapid test device for tie-breaker re-testing in cases of discordance; HIV rapid test starter packs to launch new testing sites; and rapid HIV test supplies for training CC. These kits and supplies will be procured and distributed by the MOHSS Central Medical Stores.
3) Support for aggressive DR TB case finding: There are over 372 cases of drug resistant TB cases in Namibia, including 23 Extensively Drug Resistant (XDR) TB. Namibia Institute of Pathology (NIP) will continue to provide diagnostic support to MOHSS for aggressive DR TB case finding through C/DST and rapid molecular test of all at risk patients including (HIV positive patients, previously treated patients and DR contacts).
4) TB Drug Resistance Surveillance: MOHSS will expand TB drug resistance surveillance with technical assistance from CDC and laboratory support from NIP.
