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 2014 2015 2016 2017 2018
COP 2010 Overview Narrative
SUBSTANTIALLY CHANGED FROM LAST YEAR The HHS/HRSA cooperative agreement with I-TECH Namibia is a continuing mechanism from FY09. CDC Namibia provides oversight for these activities. This mechanism aims to build the capacity of the Ministry of Health and Social Services (MOHSS), and the University of Namibia (UNAM) to train healthcare workers to deliver HIV and other healthcare services. These activities also leverage and complement other PEPFAR investments in health systems strengthening.
Objectives: I-TECH Namibia has 10 objectives under this mechanism: (1) Increase health workers' capacity to provide integrated PMTCT services in MCH/ANC sites, including early infant diagnosis (EID); (2) Increase HCW ability to provide sexual prevention messaging, including information on sexually transmitted infections and prevention with positives; (3) Increase HCW ability to deliver male circumcision services; (4) Increase public and private sector HCW capacity to provide effective ART to adults as part of comprehensive HIV care and treatment services; (5) Increase public and private sector HCW capacity to provide effective care and treatment to children living with HIV/AIDS; (6) Increase public and private sector HCW capacity to diagnose and treat TB/HIV co-infection; (7) Increase MOHSS capacity to provide HCT services, including couples counseling and rapid HIV testing (RT); (8) Disseminate HIV training program results and lessons learned to government, partners, and other stakeholders as part of an integrated M&E strategy; (9) Increase HIV content in pre-service and in-service nurse training curricula; (10) Increase MOHSS capacity to utilize Digital Video Conferencing (DVC) facilities to strengthen and expand the National HIV/AIDS response.
Partnership Framework: This mechanism encompasses a broad range of activities and commitments described in the Partnership Framework currently under development. This mechanism supports key objectives under all four thematic areas, specifically: Prevention (male circumcision and PMTCT), Treatment, Care and Support (TB/HIV, palliative care and ART services), Impact mitigation (food security/nutrition), and Coordination and Management (human resources/human capacity development, and monitoring and evaluation).
Coverage: The activities under this mechanism are national in scope. The target populations include: doctors, registered nurses, enrolled nurses/midwives, pharmacist assistants, and laboratory staff. I-TECH works with the National Health Training Center (NHTC) network and UNAM to train in-service and pre-service healthcare workers. The NHTC network consists of the national center in Windhoek, and four regional training centers. In addition, I-TECH works with the Faculty of Medical Science at UNAM to train student nurses on HIV-related topics. For the past five years, this mechanism has supported a UNAM review of its nursing curricula to integrate HIV topics. In addition, through this mechanism, clinical instructors are recruited and deployed to UNAM and the NHTC network to teach HIV components of the revised curricula. HIV clinical mentors are recruited and deployed to high-volume sites to strengthen the capacity of local physicians to deliver quality HIV care and treatment. These mentors also support HCW to implement strategies to mainstream HIV services with other healthcare services.
Health systems strengthening: The key contributions of this mechanism relate to in-service and pre-service capacity development of HCW. This mechanism contributes to the global PEPFAR goal of training 140,000 new HCW. This mechanism supports long-term national capacity building by providing support exclusively to Namibian institutions (NHTC and UNAM).
Cross-cutting/Key issues: This mechanism will contribute to Human Resources for Health objectives through cross-cutting support for in-service and pre-service education for public health professionals. Cross-cutting technical assistance supported by this mechanism will emphasize nutrition policy development, other healthcare curriculum development and HCW training.
Cost efficiency: Activities supported under this mechanism are integrated with CDC's direct technical assistance to the MOHSS, both at the national level and in the field. By supporting training activities exclusively through MOHSS structures and systems, this mechanism avoids parallel or duplicative training efforts. Hiring of trainers, tutors and other key staff is coordinated with MOHSS and CDC through a cost-efficient local human resources contractor. I-TECH deliberately works with collaborating institutions to integrate recurrent costs, including staff salaries and benefits into the institutions' annual budgets. In COP09 alone, four regional trainers were fully absorbed into the NHTC (MOHSS) staff establishment.
M&E: The monitoring and evaluation of this mechanism includes PEPFAR indicators and a more detailed I-TECH M&E annual plan. I-TECH maintains a robust M&E system to capture progress towards objectives, to compare progress towards achieving goals, and to improve the quality of training and capacity building activities. A detailed M&E plan is developed each year and is reported to CDC and HRSA on a quarterly basis. Other data collection tools have been developed and are used to monitor outputs and outcomes of capacity building. I-TECH is committed to transferring operational control over these systems to its Namibian partners.
Training to enhance health care workers (HCW) capacity to diagnose and manage Sexually Transmitted Infections (STI) in people living with HIV (PLHIV). At least five training courses will be proposed for health care workers.
Continuing Activity
Estimated Budget = Redacted
Strengthen STI surveillance in health facilities. The TBD partner will conduct training-of-trainers (TOT) courses on the revised surveillance tools and monitoring system.
Training of doctors and pharmacists in the clinical care of HIV patients, and diagnosis and management of opportunistic infections (OIs). The TBD partner, in collaboration with MOHSS and a technical working group, will revise the curriculum for "Clinical Care of HIV, AIDS and Opportunistic Infections" to correspond with the introduction of new national guidelines. Training will target government doctors and pharmacists.
Training of nurses in HIV/AIDS-related nutrition. The TBD partner will continue to support the revision of a national curriculum on HIV/Nutrition Management and will conduct regional trainings. In all curriculum development activities, the TBD partner will emphasize the transfer of curriculum development skills to educators at the University of Namibia and the NHTC.
Training of healthcare workers (HCW) in prevention for persons living with HIV (PWP) program. The TBD partner will revise and print training materials, posters, patient-provider flipbooks, provider cards, and patient educational materials.
Estimated Buget = Redacted
Supportive supervision/quality assurance for nutrition-related programs within MOHSS clinical sites. Two to three tutors will assess facilities, supplies, and the quality of nutrition services, and provide feedback and supervision.
Procure training equipment for the nutritional training programs described above.
HIV Physician Clinical Mentoring support to HCWs in caring for patients with HIV. HIV expert physician clinical mentors will continue to provide mentoring support primarily to doctors in 11 of the 13 regions of Namibia.
Distance Learning Training. The TBD partner will propose a distance learning program. This may include hands-on technical support for digital video conferences at NHTC and Regional Health Training Centers, as well as internet-based opportunities.
At least one nurse mentor will be proposed to provide overall mentoring and technical assistance in care, support, and treatment training and supervision.
New Activity
Training for cervical cancer screening and monitoring. This training will include practical sessions for pap smears and assessing the results of those tests. Equipment will be procured for training courses, which will also include instruction the use of a new MOHSS-developed form to track data on cervical cancer screening.
ADDITIONAL DETAIL:
Work plan details will be provided by the TBD Partner after the award is made.
Training in the management of antiretroviral therapy (ART) based on revised ART guidelines. Additional training will be conducted on HIV/TB treatment based on revised guidelines expected in 2011. Public sector physicians will be prioritized, but training courses in ART management will also be organized for private sector physicians.
Support to HIV Physician Clinical mentors, including travel, per diem, trainings, computers, and equipment. These clinical mentors will be deployed to 11 of Namibia's 13 regions. Adults HIV treatment guidelines and reference materials will be provided to all of the supported facilities.
Training of health care workers (HCW) and expert patient trainers in the Integrated Management of Adult Illnesses (IMAI) strategy. This will include support to MOHSS to revise national IMAI curriculum to reflect task-shifting priorities and protocols.
Training for regionally-based MOHSS nurse clinical instructors. The nurse clinical instructors will receive training to become nurse mentors in their respective regions.
Procure clinical training equipment related to the courses described above and below.
Training of nurses in ARV adherence counseling. This will include at least one train-the-trainer course for staff from different regions.
Supportive Supervision/Quality Assurance/Quality Improvement. This QA-focused supervision will cover ART services and the cervical cancer screening project.
Distance Learning Training. The TBD partner will propose a distance learning program.
A detailed work plan will be provided by the TBD partner after the award is made.
Training of health care workers in HIV counseling. This will include focused training courses on client-initiated and Provider-initiated (PITC) counseling and testing approached.
Training of health care workers, DAPP/TCE field officers and others in rapid HIV testing. This will include first-time and refresher training.
Follow up supportive supervision visits will be conducted to facilities whose staff has received ITECH training. These visits will promote the transfer of learning and provide on-site mentorship. Visits will be coordinated with the MOHSS, NIP and other stakeholders to encourage collaboration and avoid duplication.
Training for 20 case managers and expert patients.
Distance learning training. The TBD partner will propose a distance learning program to complement supportive supervision and classroom training.
Training of doctors, and pharmacists in comprehensive pediatric HIV care. The TBD partner will support MOHSS to pilot an interactive course on psychosocial and practical aspects of HIV disclosure. This course will include a train-the-trainer element. In addition, the TBD partner will conduct regional training courses. The Katutura Pediatric communicable disease clinic will considered for development into a Center of Excellence for hands-on training of health care workers from other regions. (See additional details in Pediatric Treatment).
HIV Clinical Mentors (CM) support to healthcare workers (HCW) managing children with HIV. The TBD partner will continue to support six experienced HIV physician Clinical Mentors (CMs) who provide mentoring support for MOHSS doctors managing adults and children with HIV in 11 of Namibia's 13 Regions (see Adult Treatment).
Support for Community Based Child Growth Monitoring (CBCGM) and procurement of equipment for growth monitoring. The TBD partner will conduct trainings, procure nutrition training materials and equipment, and will print and disseminate infant and child nutrition related information, education and communication. Additionally, the TBD partner will purchase infant/child nutrition related books for an additional 8 resource centers within the National Health Training Network (NHTC) and for several campuses within the University of Namibia (UNAM) network. Courses on Management of Severe Acute Malnutrition will be conducted.
A Distance Learning component will be proposed by the TBD partner to strengthen clinicians' ability to treat and care for HIV-infected children.
Training of doctors and pharmacists in pediatric HIV treatment, including pre-ART and ART services, opportunistic infections, growth and nutrition, psychosocial issues and palliative care.
HIV Clinical Mentor support to HCWs managing children with HIV. This work will continue in 11 of 13 regions, and will include the provision of reference materials in pediatric care to each supported site.
Support for training in Community Based Child Growth Monitoring (CBGM) including treatment of severe acute malnutrition. Reference materials will also be procured and distributed to the supported sites.
Supportive Supervision/Quality Assurance/Quality Improvement. Clinical mentors will also support clinical staff to use data to address problems and develop new programs.
Distance Learning Training. The TBD partner will propose a distance learning solution.
Training workshops in various health sector tools including ART, PMTCT, HCT, TB, and STI to improve skills in data collection, data entry, data cleaning, data analysis, and data use. Participants include regional staff, and specifically data clerks. Follow-up training evaluations will be conducted.
System for Program Monitoring (SPM) trainings. The SPM is the system through which all non-health sector HIV/AIDS related activities are reported through the Ministry of Regional and Local Government to the National AIDS Commission. This training provides instruction in M&E and utilization of the SPM system for Regional M&E officers, community liaison officers, and regional implementers. Technical assistance for training and curriculum development will be provided to other partners involved in community-based M&E trainings.
Support for continuing evaluation, implementation, supportive supervision, data management, and report writing for a task-shifting demonstration project in 9 sites for transferring care of ART patients from physicians to nurses.
Support for a training needs assessment (TNA) for health care workers. The TNA has collected significant data from all relevant HIV/AIDS training stakeholders including: national level coordination, policy makers at MOHSS, and non-governmental training providers. This activity will continue with data collection and also analysis and report writing. This activity is being conducted in collaboration with the MOHSS, Training Support Coordination Unit.
Support for National Health Training Center capacity needs assessment. This activity is being conducted in collaboration with the NHTC to enhance the capacity of the training network to provide high quality pre-service and in-service education. In order to assess the network's capacity to achieve its mission, a comprehensive assessment will be carried out which will inform an action plan to implement changes accordingly.
Support for UNAM pre-service training assessment of nursing school. This activity is being conducted in collaboration with the University of Namibia (UNAM) to enhance the institution's capacity to provide high quality pre-service education to nurses. UNAM nursing school has embarked upon a twinning project with a US-based nursing school and this assessment will inform the twinning project's focus.
Support for Health Information Systems capacity building and training support for regional HIS officers in data entry, data analysis, data use, and data quality. Follow-up training evaluations will also conducted.
Strategic Information TA for data triangulation, most at risk population (MARPs) rapid assessment, behavioral surveillance survey (BSS) and population size estimation implementation, data analysis and report writing. The MARPS activities will target female sex workers and men who have sex with men for prevention planning.
Strengthen the National Health Training Centre's (NHTC) capacity to deliver in-service and pre-service training for nurses. The focus of this assistance will be to support expert tutors based at the NHTC. These tutors will also play a role in efforts to identify training gaps and support NHTC's role in a coordinating structure with other training institutions, e.g., Polytechnic of Namibia, UNAM and the National Council on Higher Education.
Strengthen University of Namibia's capacity to deliver quality pre-service training for Registered Nurses. This activity will include professional development for UNAM faculty, the initiation of "twinning" relationships with nursing departments and schools in South Africa, and the revision of UNAM curricula and the Lecturer's Resource Guide.
Support MOHSS to develop human resource capacity to utilize the Distance Learning (Digital Video Conference system) without external technical assistance. The DVC system is currently largely operated by staff linked to projects. Transferring these skills to MOHSS staff is a key COP11 objective.
Training of regional and district managers and health care workers to orient them on the Namibian policy for Male Circumcision and its implementation.
Training of trainers (TOT) in MC. With the rollout of the national MC program there is a need to increase the number of trainings. MC clinicians will be trained to train other clinicians in MC.
Continuing Activty
A Namibian MC operational manual with specific standard operating procedures based on the Namibian MC curriculum and the standard WHO Manual will be developed to be used in trainings as well as for an ongoing reference material.
Training of doctors, nurses, and community counselors as MC service providers, including follow-up certification, diathermy training, and follow-up support visits. Non-consumable surgical equipment and consumable commodities may be required for use in the training courses.
The Namibian MC program initially concentrated on training and service delivery for adults. However, neonatal circumcision is an important component of the national MC policy and for the future of the program. A neonatal MC curriculum training will be developed.
National comprehensive supportive supervision to the MC sites for quality assurance.
Community counselors play a key role in recruitment, health education and providing counseling services for the MC program. While community counselors are trained as part of the team in MC, there is a need to incorporate MC modules in the courses provided for all community counselors. Materials will be updated and provided the MC community counselor training.
The original WHO MC recommendations did not include diathermy as one of the key competencies to be learnt as part of the MC services provision. However, WHO now endorses the use of diathermy in MC as a way improving service provision and increasing the number of clients served. MC providers will be trained on this new technique and will incorporate diathermy into the training curriculum.
Training of healthcare workers in ART settings (HCW) in prevention for persons living with HIV (PLWHA) (PWP program). Funds will also cover revision and print training materials, posters, patient-provider flipbooks, provider cards, and patient educational materials associated with the project.
Training on alcohol-related HIV prevention, as well as the Brief Motivational Interviewing (BMI) methods for screening and referral for alcohol. The BMI course will be delivered to HCW both within and outside of the ARV clinic settings, as well to correctional staff.
Trained case managers (CM) and expert patients based within ART clinics and ANC sites will receive ongoing refresher training.
Using semi- structured clinical support visit assessment tools, tutors from the National Health Training Centers/Regional Health Trainings Centers will provide quarterly visits to the facilities in their regions to ensure transfer of learning, provide on-site mentorship and support, identify gaps, and make recommendations for improvement for all program areas Continuing $2,000.
Training for health care workers based in correctional facilities in TB and HIV to increase awareness of TB/HIV co-infection.
To complement the didactic training and information dissemination support, The TBD Partner will continue to provide distance learning opportunities for health care workers Continuing $5,000
Training of nurses in the provision of PMTCT and EID services. In 2010 the ministry revised the PMTCT regimen in line with the WHO recommendations. The training curriculum will be revised to reflect the new national guidelines and promote the concept of a family-centered approach to PMTCT including assuring male-friendly service provision by health care providers. National trainings will take place.
Procurement of training supplies for EID training.
Using semi- structured clinical support visit assessment tools, tutors from the Regional Health Training Centers will conduct quarterly clinical support visits to facilities providing PMTCT/EID services in the regions to ensure transfer of learning and to provide on-site mentorship. During these visits, tutors will work as a team to assess the facility, supplies, and quality of service provision in PMTCT/EID.
To complement the didactic training and information dissemination support, the TBD Partner will continue to provide distance learning opportunities for health care workers to enhance their knowledge about management of PMTCT patients. This will include digital video conferences as well as internet-based distance learning opportunities.
Training of public sector doctors and pharmacists on TB/HIV co-infection. New TB guidelines will be finalized in 2010. The curriculum will be updated accordingly. The updated guidelines will focus on TB screening in HIV patients, testing for HIV in suspected TB cases, provision of isoniazid preventive therapy (IPT) to all eligible HIV positive persons, as well as TB infection control including WHO's "3Is" and the surveillance and management of DR TB.
Training of private sector and correctional facility nurses in the management of TB/HIV co-infection.
Provision of training materials for TB/HIV training in the public sector.
Supportive Supervision/Quality Assurance for facilities and staff providing HIV/TB services.
Training of district and regional managers in TB/HIV collaboration to strengthen on programmatic collaboration.
Designing and pilot testing a new DR-TB (Drug Resistant Tuberculosis) course.
To complement the didactic training and clinical mentoring support, distance learning opportunities for health care workers to enhance their knowledge about management of HIV/TB patients including infection control and DR TB. This will include digital video conferences as well as internet-based distance learning opportunities.
For additional detail please see human resources for health (HRH) database.
