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 2016 2017 2018
COP 2010 Overview Narrative
NEW NARRATIVE
This mechanism will provide direct USG support for a broad portfolio of country-driven approaches to build health care systems and strengthen country capacity to deliver quality health care.
Objectives: This mechanism will support a general expansion of the MOHSS's ability to implement cross-cutting programs that leverage investments in HIV/AIDS and other areas across the entire healthcare system. Specific areas of emphasis will include, but not be limited to:
Development of a national quality management program
Strengthen laboratory systems planning and management
Interventions that reduce maternal and infant mortality rates (e.g., the MOHSS Roadmap for the Acceleration of the Reduction of. Maternal and Newborn Mortality.)
Integration of health management information systems
Support for these objectives will focus on strengthening existing healthcare systems, leveraging investments for expanded or new systems, and improving coordination between the public and private healthcare sectors. Support for human capacity development will focus on training and retention of Namibian staff. Special emphasis will be placed on expanding the ability of the GRN civil service to absorb new categories of healthcare workers, and manage short-term contracts to Namibian outsourcing firms. Building transparent and flexible systems will be a priority for this mechanism.
Partnership Framework: 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.
This mechanism will encompass a broad range of activities and commitments described in the PF. Specifically, key objectives supported under the Coordination and Management thematic area will include leadership and governance, human resources/human capacity development, and monitoring and evaluation. This mechanism builds on more than five years of government-to-government engagement through a CDC cooperative agreement with the MOHSS for specific support to the national HIV/AIDS response. In line with PEPFAR's strategic emphasis on mainstreaming HIV/AIDS investments and supporting multi-sectoral interventions, this cooperative agreement will expand CDC's ability to deliver USG-funded technical assistance for health systems strengthening, primary health care, maternal and child health, and other services offered by the MOHSS.
The direct support model have already proven successful in Namibia, where matching MOHSS contributions to primary care services have grown with the PEPFAR-supported scale-up of ART and other HIV/AIDS services.
Coverage: The activities under this mechanism are national in scope.
Health systems strengthening: This mechanism will leverage on-going MOHSS investments in strategic planning, costing, decentralization and multi-sectoral coordination. Expanding PEPFAR's ability to support cross-cutting programs in primary healthcare, maternal and child health, sanitation and nutrition will open opportunities to leverage PEPFAR's HIV/AIDS investments and integrate them into the broader healthcare system. This new mechanism will also improve PEPFAR's visibility in other areas of the healthcare sector, and allow for new collaborations with other development partners.
The mechanism's specific focus on Human Resources for Health will build on recent MOHSS HR policy changes driven by revisions to the Namibian Labour Law in 2009. While the USG will continue to support the GRN civil service as the primary public sector employment mechanism, technical assistance will encourage the development of flexible and diverse HR mechanisms within the civil service, including outsourcing.
Cross-cutting/Key issues: As noted above, this mechanism will promote the development of strong, transparent and flexible human resource systems within the MOHSS. These systems will allow the GRN to recruit and retain a broader spectrum of healthcare workers, including community-based outreach workers. Through the GRN task-shifting initiative, these workers increasingly contribute to non-HIV health promotion activities, including immunization campaigns, clean water and nutrition awareness, and referrals to testing for TB. The efficient management of these community based human resources will reduce Namibia's dependence on external implementing partners and allow for a realignment of resources to improve access to basic healthcare for all Namibians.
Cost efficiency: This mechanism will specifically strengthen MOHSS ability to plan, implement, monitor and evaluate cross-cutting strategies within and beyond the national HIV/AIDS response. In line with the PF requirement that the USG assess the appropriate role for external partners, this mechanism will expand the MOHSS's capacity to identify, choose and finance its own technical assistance. Support for training and HSS will also promote the availability and use of national experts rather than external partners.
M&E: All CDC cooperative agreement grantees must submit a detailed work plan with their annual continuation application. This work plan must be based on PEPFAR indicators and aligned with targets set for each country. Grantees must also submit bi-annual status reports to program managers in Namibia. Data in these reports may be used inform any year-on-year changes to the work plan.
Implementation of the National Strategic Plan for Laboratory Services and strengthening of Namibia's national public health laboratory network. This activity will focus on disseminating, training stakeholders, and implementing technical elements of the National Strategic Plan for Laboratory Services (developed with COP10 funding). It will also include funds for needs assessments, mapping exercises and other technical assistance to develop formal working relationships between all of Namibia's clinical, diagnostic, educational, veterinary, and chemical laboratories under the guidance of the MOHSS.
Continuing Activity
Estimated Budget = $150,000
Training for MOHSS clinical staff in key elements of Emergency Obstetric Care (EMOC). Training courses will focus on the six key elements of EMOC, plus blood transfusion and caesarian section. Decisions on specific courses for COP11 will be made in conjunction with MOHSS based on the national Roadmap for Accelerated Reduction of Maternal and Neonatal Mortality and any activities conducted by the MOHSS in conjunction with the African Union's Campaign for the Reduction of Maternal Mortality in Africa (CARMMA).
Estimated Budget = $160,000
Continuing supportive supervision will be provided by MOHSS staff in the Directorate for Primary Health Care. Specialized supportive supervision in the appropriate clinical use of blood will be provided to MOHSS hospitals by a blood transfusion medical officer seconded to the Ministry from the Blood Transfusion Service of Namibia. The NAMBTS medical officer's salary will be covered by NAMBTS; PEPFAR funds in this line item will support logistics and the dissemination of training materials. USG technical advisors will work with MOHSS and NAMBTS to coordinate and facilitate the medical officer's secondment.
Estimated Budget = $50,000
Drafting and publication of a National Quality Management Strategy. This is a continuing activity from COP10. In COP11, MOHSS representatives who attended an international conference on quality management and conducted a quality management infrastructure assessment will solicit and document stakeholder input on quality management issues, and will write a new national strategy for quality management across the public health system.
Estimated Budget = $40,000
Support for infrastructure and human capacity development for the new Health Information System (HIS) Directorate in the MOHSS. This activity will build on HIS workforce development activities funded in COP10 and on outcomes from the 2010 HIS Leadership Forum. It will also support the procurement of hardware and software to address gaps in the HIS data collection and management system.
Estimated Budget = $100,000
Support the GRN to develop and implement a capacity building plan to operationalize the new NSF coordination framework. Support the GRN to organize and conduct an inclusive and evidence-based national Joint Annual Program Review. Strengthen capacity of key decision making and coordination mechanisms and structures to ensure broad participation, effective leadership and coordination, participatory planning, informed policy development, regular oversight, etc.
Estimated Budget = $105,000
Develop training tools to strengthen facilitation, decision-making and problem solving skills for the national, sectoral and regional multi-sectoral coordination structures to enhance their effectiveness and oversight role.
Estimated Budget = $20,000
Support the establishment and functioning of sectoral coordination committees (4-6 committees).
Estimated Budget = $30,000
ADDITIONAL DETAIL:
The MOHSS will refine its annual work plan in conjunction with CDC technical advisors and other members of the USG combined technical team.
1) Implementation of National Strategic Plan for Laboratory Services and strengthening the National Public Health Laboratory network. Strengthening the policy environment for health care services is a priority for the government of Namibia. Because most laboratory services are delivered by a parastatal entity (NIP), the ministry of health's ability to oversee the laboratory network is weak. Projects like this will strengthen the MOHSS's oversight role and contribute to the development of a public health network that will include human diagnostic and research laboratories, agricultural laboratories, veterinary laboratories, and laboratories specializing in environmental analyses. The MOHSS plans to develop the network using the hub-and-spoke model with MOHSS as the hub for the network of participating laboratories.
2) Emergency Obstetric Care training. This activity will support government's push to revitalize maternal and child health care services within the MOHSS Directorate for Primary Health Care (DPHC).
3) Supportive supervision. This activity will be expanded in COP11 to integrate training and supervision in the appropriate clinical use of blood into the DPHC. This training had previously been supported by PEPFAR through the Blood Safety program area. However, since this activity is more aligned with GHI goals for health care systems strengthening, COP11 funds will support logistics, printing and other costs associated with the dissemination of training materials based on the NAMBTS Guidelines on the Appropriate Clinical Use of Blood (GACUB) curriculum. USG technical advisors will work with NAMBTS and MOHSS to coordinate the seconding of a NAMBTS medical officer to strengthen blood transfusion capacity within DPHC. (This medical officer's salary will be paid by NAMBTS.) By supporting the secondment of a blood service medical officer within the MOHSS, this linkage will also address a perception gap between MOHSS hospitals which transfuse blood and NAMBTS, which is a private NGO. Because NAMBTS lacks authority to instruct MOHSS hospital staff, this gap has led to a slow uptake of training materials at the hospital level. Other supportive supervision will be linked to the other essential elements in the WHO Emergency Obstetric Care tool kit.
4) Quality Management. Quality assurance in the national ART program (through HIVQUAL) has created efficiencies and allowed rapid expansion of services. The quality management techniques that have made the ART program a success will be applied to the rest of the health care sector through these activities.
5) Health Management Information Systems (HMIS). These activities complement IT and strategic information activities funded by PEPFAR through HVSI, and will strengthen the capacity of the upcoming new HIS Directorate to use the District Health Information System (DHIS) software in the MOHSS to collect, manage, analyze and disseminate routine M&E data.
6) In terms of multisectoral coordination, the three sub-activities listed above and the estimated budgets are subject to revision based upon further interagency dialogue with the MOHSS. The principle purpose of the activity is to support the GRN to operationalize the new NSF, specifically the coordination framework and associated structures. The USG intends to support the GRN in the optimal manner to strengthen multisectoral coordination of the national HIV/AIDS response. This support will be directed to the appropriate GRN Ministry or office responsible for NSF coordination. The selection of a prime partner is therefore subject to further consultation with the GRN and finalization of the NSF coordination framework.
