PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2010 2011 2012 2013 2014
COP 2010 Overview Narrative
This is a single eligibility follow-on mechanism to replace an expiring Track 1 cooperative agreement with The Blood Transfusion Service of Namibia (NAMBTS). Although this IM is listed as a "TBD partner," NAMBTS will be the only entity eligible for the award. A single eligibility request for proposals (for a five year cooperative agreement) will be issued in November 2009. An award to NAMBTS is expected within the COP10 approval timeframe.
This IM will support activities in the HMBL technical area. However, many of the activities will have cross-cutting impacts beyond the prevention of HIV. Specific HIV prevention objectives for the PEPFAR-supported blood safety program include:
1. Maintaining (and reducing) the low HIV prevalence among voluntary, non-remunerated blood donors. In COP09, HIV prevalence among blood donors stood at <.50%. This will be accomplished through 100% screening of all donated blood for HIV, Hepatitis B and C, and syphilis.
2. Doubling the blood donation rate among youth. In COP09, less than 15% of all donations were collected from donors aged 16-25.
3. Linking school-based education programs targeting blood donors to broader HIV prevention and healthy lifestyles messaging delivered in schools.
4. Training clinical staff to reduce unnecessary blood transfusions.
Links to the Partnership Framework (PF)
As part of the USG contribution to the PF goal of "enhancing prevention," the USG commits to support NAMBTS as the GRN-authorized partner responsible for the safety and adequacy of the national blood supply. USG commitments in the PF are aligned with the HIV prevention priorities described in Namibia's National Strategic Framework for HIV and AIDS 2010-2015 (NSF).
1. Social and Behavior Change
2. HIV Counselling and Testing (HCT)
3. Prevention of HIV among Most-At-Risk and Vulnerable Groups
4. HIV Prevention Involving PLWHA
5. Medical Male Circumcision
6. PMTCT
7. Post-Exposure Prophylaxis
8. Condom Social Marketing and Distribution
9. Prevention of Sexually Transmitted Infections
10. Blood Safety
With funding through this new IM, NAMBTS will directly contribute to the Blood Safety objectives and commitments described in the PF documents and in the NSF. As noted above, PEPFAR investments in blood safety will also have a number of cross-cutting benefits, including indirect contributions to HCT and PMTCT by referring blood donors with HIV reactive test results to HCT and PMTCT services. As the sole entity responsible for supplying hospitals and clinics with blood for transfusion, NAMBTS directly contributes to strengthening the broader primary healthcare system. Since a substantial proportion of the nation's blood supply is consumed by children (malaria anemia) and pregnant women (post-partum hemorrhage), PEPFAR investments in blood safety directly contribute to improving maternal and child health outcomes (MCH).
Coverage and Target population
The activities supported through this mechanism are national in scope. NAMBTS supplies screened blood and blood products to 41 hospitals and clinics in all of Namibia's 13 regions. With PEPFAR support, NAMBTS has expanded access to blood transfusion services by pre-positioning Type O (universal donor) blood at facilities that lack cross-matching capacity. In COP10 PEPFAR will support and evaluate this strategy, and support improvements in local cross-matching capacity where cost effective.
Health Systems Strengthening
The blood safety program also invests in capital infrastructure at the facility level (e.g., ward-based cold chain) and in training for clinicians in the appropriate use of blood. NAMBTS also trains laboratory technicians in the proper handling of blood and the production of quality-assured blood products (e.g., packed red cells, platelets). In COP10, NAMBTS will work with CDC and the MOHSS to create training internship opportunities for laboratory technician students at the Polytechnic of Namibia.
Cross-Cutting Programs and Key Issues
Access to safe blood can improve maternal and child health outcomes. In COP10, CDC and NAMBTS will work with the MOHSS Directorate for Primary Health Care to track blood utilization patterns and measure the impact of safe blood on clinical outcomes. This evaluation will also look at blood utilization among ART patients. Investments in laboratory technician training opportunities will also build Human Resources for Health.
Cost Efficiencies Over Time
An innovative cost-recovery system currently provides a sustainable source of funding for NAMBTS. Through this system, NAMBTS is reimbursed by public and private insurance programs. NAMBTS is also engaged in negotiations with private sector pharmaceutical companies in South Africa regarding the potential sale of plasma. Supporting Namibia as an exporter of plasma to the South African and, potentially, global, plasma markets would substantially enhance NAMBTS's ability to sustain itself over the long-term. PEPFAR will continue to support quality assured laboratory practices during the accreditation process with the South African Bureau of Standards.
Monitoring and Evaluation Plans
NAMBTS will maintain, expand and align the M&E system developed under the Track 1 cooperative agreement. NAMBTS will submit bi-annual reports on all of its indicators. These reports will indicate any changes to the M&E system during the reporting period. As noted above, an impact evaluation will be conducted on the clinical use of blood.
Blood Collection (1). PEPFAR funds will support the procurement of blood bags for the collection of human blood and blood products for transfusion.
Continuing Activity
Estimated Budget = $152,232
Blood collection (2). Salary and benefits for one (1) blood donor clinic planning and recruitment officer.
Estimated Budget = $38,342
Blood collection (4). Salary support for two (2) blood donor recruiters.
Estimated Budget = $28,073
Blood collection (5). Salary support for one (1) blood donor counselor (nurse).
Estimated Budget = $35,060
Blood collection (6). Salary support for two (2) blood collection nurses.
Estimated Budget = $46,479
Blood screening. PEPFAR funds cover the cost of a contract with the South African National Blood Service (SANBS) to provide nucleic acid amplification testing on all donated units from NAMBTS.
Estimated Budget = $384,000
Blood utilization (2). Salary and benefits for two (2) laboratory technicians (one senior, one junior) to prepare blood components and manage the central blood bank.
Estimated Budget = $59,503
Blood utilization (3) Salary and benefits for two (2) laboratory technologists (one senior, one junior) to prepare blood components and manage the central blood bank.
Estimated Budget = $55,644
Policy and Sustainability. (1) Salary support for the NAMBTS Operations Manager. This position is responsible for managing the NAMBTS cost recovery system and the CDC cooperative agreement.
Estimated Budget = $58,125
ADDITIONAL DETAIL:
NAMBTS will continue to implement the comprehensive blood safety program described in prior years. Two major changes have occurred since COP10: 1) A new, non-Track 1, cooperative agreement was awarded to NAMBTS in August 2010. This formally signals the transfer of the management and funding of this grantee from Atlanta to the field. 2) In COP11 NAMBTS will absorb the salary and benefit costs for seven of the 18 employees that have been supported by PEPFAR since 2005. This transition will continue in future years, with all 18 employees to be absorbed by NAMBTS by the end of the five year cooperative agreement. NB: $50,000 in COP2011 is one-year money that will be returned to the overall Prevention budget for redistribution in COP2012.
Other specific activities will include:
1) Blood collection. NAMBTS will work to retain current blood donors, expand recruitment activities to schools, and conduct ongoing surveillance of transfusion transmissible infections (TTI) among donors to identify lowest risk sub-groups.
2) Blood screening. NAMBTS will maintain a contract with the South African National Blood Service (SANBS) for all infectious disease screening (including nucleic acid screening for HIV). This arrangement, which will likely remain in place for at least 2-3 more years, is subject to a bi-annual sustainability review, the latest of which occurred in March 2010. Based on the findings of that review, NAMBTS has tentatively set a five year goal to return infectious disease screening to Namibia. This objective may be limited by a lack of trained human resources to operate the expanded testing laboratory. To address this human resource barrier, NAMBTS will work with Polytechnic to identify Namibian students in the laboratory technician program and assist them to attain laboratory technologist qualifications. This assistance may also include training in nucleic acid testing (NAT) through a twinning arrangement with Cambridge University.
3) Blood utilization. NAMBTS will continue to fractionate approximately 90% of the whole blood collected into blood products including packed red cell concentrate, fresh frozen plasma, and platelets. Laboratory technicians in Windhoek will perform this work and ensure quality control for units in quarantine during the infectious disease screening process. In COP2011, CDC will work with NAMBTS and MOHSS to arrange the secondment of one of the NAMBTS medical officers to the MOHSS. Through this secondment, the MOHSS will lead the training program, and facilitate access to public sector hospitals for blood transfusion trainers from NAMBTS. This training is designed to minimize wastage, reduce patients' risk of transfusion-associated reactions, and preserve scarce stocks of blood. Within this activity category, NAMBTS will also work with the MOHSS Department of Clinical Services and NIP to expand and strengthen the national network of blood banks and compatibility testing laboratories, with an emphasis on supervision and quality assurance.
4) Policy and Sustainability. NAMBTS will continue to finance approximately 75% of its operations through an innovated cost-recovery system. Through this system, consumers of blood (the MOHSS, private insurance schemes, individual patients) pay NAMBTS a fixed cost per unit of blood consumed. The Operations manager and finance officer at NAMBTS are responsible for constantly updating the cost-per unit calculation and ensuring invoices are dispatched, and payments received, in a timely manner. To increase NAMBTS's ability to sustain itself, the operations manager will continue to pursue international accreditation of the NAMBTS laboratory. This will allow NAMBTS to enter into plasma sales and export agreements with pharmaceutical companies in South Africa and elsewhere.
