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 2013
COP 2010 Overview Narrative
This is a new implementing mechanism but continues Pact Regional Award's previous work.
1. APCA has one comprehensive goal which is to provide technical assistance and build capacity within selected countries across the Southern African region in order to promote the development of palliative care in the region. Specifically in Namibia, APCA contributes to the HIV and AIDS response by scaling-up palliative care provision through a public health approach that strives to balance quality and coverage. The primary emphasis areas are human capacity development and local organization capacity building.
2. The goals that APCA has set in Namibia are directly linked to those within the Partnership Framework in the Focus Area of Care, Treatment and Support. Under this Focus Area, the overarching goal is "To reduce mortality, morbidity and improve the quality of life of those affected by HIV." Palliative care is defined as an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illnesses, including HIV. Therefore, by increasing the number of healthcare providers trained to implement palliative care, more patients will be able to receive it. Palliative care is applicable to patients with HIV and AIDS in their homes, in the community and within public health facilities regardless of whether they are on treatment or not. Therefore this directly contributes to the objectives of the Partnership Framework within the Care Focus Area.
3. Specific target populations include HIV/AIDS care providers at all levels in government, NGOs, CBOs, FBOs and policy makers throughout the entire country.
4. APCA is committed to moving forward palliative care policy, standards and guidelines within Namibia. It is important that palliative care is integrated into standards of care at various levels (basic, primary and tertiary levels) and settings (i.e. home based, antiretroviral therapy, prevention of mother-to-child transmission) so that patients receive comprehensive and holistic services. By improving the quality of care that terminally ill patients receive in their homes, public health facilities are not as burdened by long term patients. This is advantageous to the healthcare system as a whole, and is usually more comfortable for patients and their families.
5. The focus area of APCA's program is palliative care.
6. Part one of the Public Health Evaluation (PHE) planned to begin in COP09 looks at the availability of care services and relative to the palliative care sites as compared to the burden of the disease in catchment areas. It is hoped that this exercise will help to identify gaps in referral procedures that can be amended, and improve cost effectiveness by encouraging organizations to utilize the services of other community organizations and health facilities as appropriate.
7. APCA Namibia is supported by the Southern Africa Regional Office based in Johannesburg, including an M&E officer who is responsible for overseeing the effectiveness and performance of APCA programs in the region.
Finalization of Curricula development and raining Workshops for Public sector , CBOs and the media
Continuing Activity
Estimated Budget = $130,000
Organizational development for 5 HBC care organizations
New Activity
Estimated Budget = $70,000
Travel for program related activities
Estimated Budget = $47,000
TA to MOHSS on Palliative care integration into HBC
Estimated Budget = $100,000
Equipment (computer and internet server)
Estimated Budget = $21,000
Personnel and fringe benefits
Estimated Budget = $147,000
Support strengthening of referral networks between HBC and facility based care
Estimated Budget = $52,000
Administration and other Direct Costs
Estimated Budget = $50,591
Support roll out of community PHDP with PLHIV support groups and integration into HBC
Estimated Budget = $320,000
Palliative care research
Estimated Budget = $50,000
ADDITIONAL DETAIL:
Capacity building of HBC organizations: During FY2010 COP funding distributed among several activities such as training of nurses, ongoing support and mentorship of 11 Palliative care nurses, support for bi-annual meetings of personnel from different sites, training of staff and volunteers at two new CAA sites and 5 other HBC organizations. Funding will also travel and consultancy fees for facilitators from Zimbabwe (Island Hospice) and APCA (UGANDA), costs for clinical placements in Zimbabwe for 2 new CAA nurses + 1 CAA HQ staff as well as specialist level training for two CAA nurses at Hospice Africa Uganda or any other relevant palliative course .CAA PC activities are a continuation of activities from FY2009 to strengthen CAA PC activities and to make it one of the centers of excellence in Namibia.
Implementation of standards: This is a new activity introduced now in FY2010. At a national level, a standards adaptation and implementation meeting will be held with key stakeholders such as Ministry of Health, development partners and service providers, firstly to introduce them to the palliative care standards and secondly, to identify strategies for adaptation and implementation. This will be a one day meeting for a total of 40 participants. These strategies will be incorporated within wider project activities.
Integration of palliative care into 5 HBC programs: Five organizations representing various levels of service delivery (i.e. primary, secondary, and tertiary) will be identified and site assessments conducted based on best practices and WHO standards to determine the level at which they are currently providing palliative care and to identify gaps and opportunities for strengthening palliative care across all levels of care that they provide.
Organizations will be supported to develop quality improvement plans based on the results of the assessment aboveto address organizational management, holistic care provision, children's palliative care, education and training and research and management of information. Training for staff and volunteers at each organization as appropriate will be conducted in Quarter 4. 300 volunteers will be trained in FY2012. Trainings will need to fit the needs and dynamics of each organization.
National Palliative Training Curriculum: This activity is a continuation from FY2009. To be able to increase access to palliative care knowledge, skills and to develop local expertise, the program will address the educational needs of health professionals including the use of morphine for pain control.
The national PC curriculum that was started in FY09 will be finalized together with the national training institutions, MOHSS, HCWs and I-TECH. The training curriculum will be piloted with 25 health workers for appropriateness and quality. HW for the pilot will be drawn from different parts of the country to be able provides well representative feedback. APCA will work with other partners like IHZ to conduct the pilot and TOT for 25 national trainers. Funding for this activity will cover consultant fees, flights, meals, per diem and accommodation. National trainers will be equipped with palliative care skills and exposure to national curriculum. In future, all PC trainings will then be carried out by the national trainers who will provide ongoing training support as this will help to build the capacity of health professionals quickly and locally.
Support will also be provided to the University of Namibia (UNAM) National Health Training Centre (NHTC), International University of Management (IUM) and ITECH to provide palliative care training for 25 personnel (i.e. lecturers in medical, nursing and other relevant programmes) so that they can integrate palliative care into their practice.
National Advocacy and Policy Development: This activity is also continuing from FY2009 with the review of 5 identified national policies being conducted. The development of the policy and guidelines is expected to be completed in this funding cycle. A stakeholder's meeting will be held with representation from government and non-governmental organizations to adapt the APCA palliative care standards and use them as a guiding document for policy development and to be coordinated by the MOHSS and APCA.
Advocacy training will be held for the 12 member task Force to build upon their PC knowledge and to equip them with skills to better drive PC at the national level. Pain medication sensitization workshops will be conducted to increase awareness of the need and appropriate usage of pain medicines amongst 22 MOHSS doctors and pharmacists. These will be done in combination with site sensitizations to maximize resources; this also helps to create demand for PC training.
Technical Assistance to the MOHSS: This is aimed at continuing integration of Palliative care in to Home based Care through support of roll out of training on integrated HBC standards and guidelines to CSOs. This will also include facilitating the activities of the Palliative care task force and Community based care Reference Group coordinated by MOHSS. Additional activities will be to ensure that CHBC organizations abide by the National CHBC standards and finalization of the mapping process already being supported with GFATM resources. When finalized a director of services would be developed that will facilitated stronger bi-directional linkages between the health facilities and CHBC organizations.
TA will be provided to the MOHSS for strengthened referral between community based care and facility care based care through implementation of the referral systems being developed by MOHSS with IntraHealth Capacity Project Support In addition , 9 site sensitizations at hospitals proximal to the CAA sites will be conducted with the coordination of the MOHSS. The meetings will target MOHSS regional and districts management. The meetings will attempt to orient public health facilities to palliative care and facilitate discussions with CAA on how best to collaborate to ensure smooth referrals between community and facility care settings.
Technical Assistance to the MOHSS to create systems that allow palliative care trained nurses to carry medicines in the community. Scope of Practice that allows nurses trained in PC to carry PC essential medicines has been developed. It is anticipated that during this FY, the SOP will be approved by the MOHSS and the pilot of this can commence in the last quarter. This activity requires ongoing advocacy and sensitization and as a result, APCA will support a study tour for 4 senior Pharmaceutical Services staff to observe nurse prescribing in Uganda will be conducted. Staff at pharmaceutical services will learn about models of nurse prescribing and will be encouraged to support the pilot in Namibia.
During FY 2010, APCA will also develop in collaboration with I-TECH, MSH and SCMS a training curriculum for palliative care nurses on medicine safety and supply chain management. The training is expected to take place in the next FY.
Media workshop on Palliative Care for local media outlets (NBC, One Africa, etc) will be held in quarter 2. The workshop will be held in collaboration with MISA Namibia to increase awareness of PC amongst media outlets. Media events/ World Palliative and Hospice Day will be held to increase public awareness of palliative care. Awareness will also be done through development and dissemination of PC materials such as brochures, posters, etc.
Positive Health dignity and Prevention: Support integration of Positive Health dignity and Prevention in to HBC: Through partnership with a PLHIV advocacy and training organization there will be continued support for integrating Positive, Health Dignity and Prevention packages through implementing tailored programs with HBC providers and support groups. This would include funding for the sub-grantee to procure the community PwP kits, train PLHIV support groups and facilitate implementation of PHDP activities across the 13 regions in Namibia.
Palliative Care Research: This is an activity carried over from FY09 because MOHSS approval for the research protocols was delayed. A street survey to explore the priorities and preferences of the Namibian public with regards to end-of-life care, death and dying in order to inform appropriate care that reflects public preferences and priorities will be conducted. Not more than 200 people will be interviewed in identified sections of Windhoek. The research will be used to inform policy and guideline development as well as the national curriculum. Data collection tools and methodologies are described in the research protocols which is available upon request.
TA and logistics support to MOHSS(DSP and PHC/CBHC) for trainings, curricula and guidelines development
Site assessments to 5 HBC organizations (Training for staff and volunteers at 3 organization)
Estimated Budget = $15,000
Estimated Budget = $36,000
Promotion and support of quality pediatric palliative care within CHBC programs
Estimated Budget = $54,000
Equipment (server and computers)
Estimated Budget = $5,000
Estimated Budget = $30,000
Capacity building of HBC organizations: During FY2010 funding will be distributed among several activities such as training of nurses, on-going support and mentorship of 11 Palliative care nurses, support for bi-annual meetings of personnel from different sites, training of staff and volunteers at two new CAA sites and 3 other HBC organizations. Funding will also cover for 2 mentoring visits from APCA (UGANDA), clinical placements in Zimbabwe for 2 new CAA nurses + 1 CAA HQ staff, specialist level training for two CAA nurses at Hospice Africa Uganda or any other relevant palliative course in Africa which include flights, accommodation, meals and per diems for entire training period. CAA PC activities are a continuation of activities from FY2009 to strengthen CAA PC activities and to make it one of the centers of excellence in Namibia.
Integration of palliative care into 5 HBC programs: Five organizations representing various levels of service delivery (i.e., primary, secondary, tertiary) will be identified and site assessments undertaken at each organization to determine the level at which they are currently providing palliative care. This assessment will be undertaken based on the best practices and WHO standards will aim to identify gaps and opportunities for strengthening palliative care across all levels of care, including organizational management, holistic care provision, children's palliative care, education and training and research and management of information. Organizations will be supported to develop quality improvement plans based on the results of the assessment above. This will be through meetings with the management and care providers in each organization. They will be encouraged to incorporate these plans in their programmes. Some of these plans will be addressed through this project for example through training organizational staff on implementation of the standards.
Promotion and support for quality pediatric palliative care including TB/HIV screening and management, will be supported in collaboration MOHSS (TB/Leprosy control program and CHBC Division) through updating HBC training curriculum and materials and rolling out training of care providers at all levels. Through work with a PHDP led sub-grantee Positive, Health, Dignity and Prevention activities for HIV + children and adolescents will be carried out.
Training for staff and volunteers at each organization as appropriate will be conducted in Quarter 4. 300 volunteers will be trained in FY2012. Trainings will need to fit the needs and dynamics of each organization.
