The Capacity Project (CP) has been supporting the Government of the Republic of Namibia and civil society to reduce the spread and impact of HIV/AIDS by providing technical assistance to local organizations in governance and systems, prevention, treatment and care, which in turn builds organizational and institutional capacity. Specifically, CP strengthens financial and grant management, human resources, compliance and other health management systems so that these institutions are ready for transition to non-USG funding. The program operates in all regions in Namibia. IntraHealth and partners will contribute to the goals of the USG Partnership Framework and GHI by: 1) Positioning HIV/AIDS services within health systems, with an emphasis on service integration and maternal, neonatal and child health; 2) Transferring direct implementation, leadership and accountability of project deliverables/functions to Namibian partners to ensure ownership and sustainability; 3) Ensuring clinical excellence through evidence-based service delivery, performance improvement approaches, mentoring and supportive supervision; 4) Expanding access through technical assistance to increase community referrals and service integration; and 5) Promoting leadership and management through human resources strengthening and forming partnerships with the private sector and financial accountability. These efforts will help improve cost efficiencies over time. Furthermore, they are in line the GHI strategic focus of increased access and transition.A performance monitoring plan with measurable indicators, based on next generation indicators and custom indicators, has been developed to track results under this IM. A summative evaluation is expected at the end of the project. No vehicle purchases envisaged.

Under this budget code in COP12, The Capacity Project, through IntraHealth International, Inc. (IH) will continue to support roll-out of the the Ministry of Health and Social Services (MOHSS) bi-directional referral network developed in COP10 and 11 to ensure a continuum of care to and from the community and health facilities for people living with HIV/AIDS (PLWHA). Support includes on-job training and mentorship and will be monitored through review of referral registers and slips.

IH will ensure that local FBO sub-partners provide all adult PLWHA with high quality care and treatment to reduce morbidity and mortality.

IH will support the implementation of a chronic disease model for HIV care encompassing enrollment into care and treatment, screening, treatment and prophylaxis for opportunistic infections (OIs), psychosocial and adherence support, routine bio and clinical monitoring and follow up to ensure early initiation of ART according to national guidelines, nutritional assessment counseling and support (NACS) and positive health dignity and prevention (PHDP). To complement clinical care, IH will continue to support the implementation of spiritual counseling. Healthcare workers were trained to identify and refer patients requiring spiritual counseling and care to clergy who were also trained on the basic facts of HIV/AIDS and on providing non-discriminative support to PLWHA. PLWHA will be able to express their feelings and their spirituality in order to alleviate the psychological burden and, ultimately, to improve coping capabilities.

IH will continue to collaborate with the MoHSS, USG partners and the HIV Clinicians Society in facilitating palliative care management training for staff by covering travel and per diem expenses. Palliative care training will be integrated in the training curriculum of the National Health Training Center (NHTC).

NACS will continue to be strengthened through training, clinical mentorship, supportive supervision and kitchen corner initiatives. Assessments include weights, heights and MUAC (for pregnant women). Onandjokwe and Oshikuku district hospitals are amongst the supported pilot sites for the NACS. The kitchen corner is implemented in three FBOs and IH will extend it to three remaining sites, including equipment and training.

IH will support the integration of all its programs into existing facilities, through training and support, capacity building of the MoHSS/Regional Medical Team (RMT) through joint quarterly support visits and also support the integration of programs into the NHTC and Regional Health Training Centers. Facilities across the country implement policies and guidelines differently. IH will support the operationalization of care through training and dissemination of standards of practice (SOP).

Sustainability of all services and quality of care will be supported through technical assistance and mentoring of supervisors at national, RMT, and FBO to provide supportive supervision and monitoring and evaluation, ensuring national guidelines are followed and local SOPs are developed.

IH will collaborate with the MoHSS to ensure partners implement the mother-to-mother activities to ensure mothers living with HIV are effectively linked to HIV care and treatment services.

Activities will be implemented in Rundu, Omusati, Oshikoto and Ohangwena Regions and at the national level.

Activities are linked to activities funded in MTCT, HVCT, CIRC, HTXS, PDTX, PDCS, HVSI and OHSS.

Under this budget code in COP12, The Capacity Project, through IntraHealth International, Inc. (IH) will work with its sub-partners to ensure continuation of routine pediatric care for HIV infected and affected children. Areas of focus will be strengthening early infant diagnosis for HIV exposed infants by DNA-PCR testing available in all faith-based hospitals; registration of HIV positive children into care; strengthening the follow up of pre-ART children; strengthening nutritional assessments counseling and support (NACS) screening for opportunistic infections (OI); provision of OI prophylaxis for eligible patients; and provision of psychological and spiritual support to children and their caregivers.

The close follow up of pre-ART patients will ensure the children will be initiated on ART as soon as they are eligible for treatment. IH will continue to promote and monitor integration of services that will support prompt management of co-morbidities, management of diarrheal diseases, tuberculosis (TB) and malaria. Integration of the services will be strengthened including primary health care for under-fives, maternity wards, maternal and child health, and inpatient and outpatient services.

Spiritual support will be strengthened through faith-based hospital (FBH) clergy services. IH will work with its sub-partners to strengthen adolescent prevention messages for those who visit the hospital for different services, as well as for positive health dignity and prevention and support groups through the prevention officers available in the sites. IH sub-partners will continue regular evaluation of HIV positive children through TB, malaria, CD4 and other tests. Linkages to community activities through the bi-directional referral system will be strengthened after being piloted during COP11.

Under this budget code, The Capacity Project, through IntraHealth International, Inc. (IH)) will continue to support the national research, monitoring and evaluation (RM&E) partners to improve and strengthen their monitoring and evaluation (M&E) systems. IH will ensure that processes promote national ownership and national capacity development.IH will support RM&E to improve the electronic patient management system (ePMS) in faith-based and non-faith-based facilities in the country. To expand the knowledge in ePMS, IH will assist the Ministry of Health and Social Services (MoHSS) to train all national RM&E staff, and senior data clerks at the regional level on the system as facilitators. The MoHSS will update user and training manuals.During COP12, the MoHSS, with support from an IH consultant, will continue developing the national ePMS system based on the new uptake forms. As ART guidelines change from time to time, the electronic system and paper tools will also be revised. In collaboration with the MoHSS and the USG CDC, IH will support the updating of monthly reporting tools and systems for prevention of mother to child transmission and ART programs.IH will continue to support the development of the national M&E system by: attending quarterly MOHSS M&E committee meetings; contributing to the effectiveness and efficiency of the national internal review board; training sub-partner organizations on data quality, use and dissemination, and specific M&E skills; and aligning and integrating sub-partners data reporting requirement with MOHSS reporting systems (tools, channels).IH will assist the MoHSS to integrate sub-partners reporting for the National System for Program Monitoring (SPM) and continue strengthening collaboration between sub-partner organizations, the Regional Councils and the National M&E Office.IH will conduct an end-of-project evaluation to identify lessons for each of the program areas/key results areas. The evaluation will include document review and selected interviews with key informants and a field mission to relevant regions.Activities will be implemented in Rundu, Omusati, Oshikoto and Ohangwena Regions and at the national level.

Activities are linked to activities funded in MTCT, HVCT, CIRC, HTXS, PDCS, HBHC, PDTX and OHSS.

Under this budget code, The Capacity Project, through IntraHealth International, Inc. (IH) will continue to support faith-based sub-partners and the HIV Clinicians Society to address identified capacity challenges and to conduct final Organizational Capacity Assessments (OCA) to assess progress and phase-out activities.During COP11, IH conducted OCAs to identify gaps and the priority capacity areas for the three sub-partner FBOs and the HIV Clinicians Society. These organizations need to be strengthened to enable them to operate independent of USG support. The tool assessed the following organizational capacity areas: 1) Purpose and planning; 2) Programs and services; 3) Governance and program management; 4) Organizational sustainability and integration planning; 5) Financial and operational management; 6) Human resources; 7) Monitoring, evaluation and reporting; and 8) Advocacy and networking. A comprehensive institutional strengthening plan (CISP) was developed after the OCA for each institution.IH will continue to be an active participant in the Ministry of Health and Social Services (MOHSS) Human Resource for Health (HRH) Technical Working Group (TWG) to identify solutions to absorb donor supported staff into the GRN. This will involve estimating workloads and finding innovative solutions to integrate HIV services into primary health care activities to increase the efficiency of service delivery while ensuring quality of care without losing critical data. The transition will be monitored by setting benchmarks and advocating for integrated data collection tools. Beginning in COP11 and continuing in COP12, IH is collaborating with the MoHSS and faith-based organizations to ensure the availability of data for HRH planning and management at the central, regional and facility level, while ensuring data security. IH will support the MoHSS to ensure that the Human Resource Information Management System (HRIMS) data are cleaned before uploading into the Oracle-based system at the Office of the Prime Minister. IH will build the needed capacity for the MOHSS at the national regional levels to ensure they are receiving and using HR reports to improve HR management and planning. The National Health Training Center and Health Professional Council through will continue to receive IH support to have quality data available for tracking training (pre-service and in-service) of student health professionals and registration/licensing of health professionals after training completion. IH will support building capacity of faith-based organizations and national partners systems to function independent of IH.IH, together with the MoHSS, faith-based partners and other stakeholder will continue conducting several operational studies/evaluations during the financial year. These will assist the various faith-based facilities, regional management teams, and the MoHSS to use evidence based approaches to assess and test different ways to deliver patient care, manage their staff and their facilities and gain critical information about the actual or potential results using qualitative and quantitative data credibly.

Activities will be implemented in Rundu, Omusati, Oshikoto and Ohangwena Regions and at the national level.

Activities are linked to activities funded in MTCT, HVCT, CIRC, HTXS, PDCS, HBHC, HVSI and PDTX.

Activities under this budget code, through IntraHealth International, Inc. (IH), will support the MOHSS to operationalize the MC strategy, including provision of MC through approved mixed service delivery models.

The National Strategic Framework (NSF) has set ambitious targets for MC by 2015/16 - to circumcise 450,000 men and 167,000 male newborns. To meet these goals IH supported the Ministry of Health and Social Services (MOHSS) to develop a five year MC strategy and implementation plan during COP10. IH will continue to support the MOHSS to operationalize the MC strategy through the following activities: 1) Training of healthcare workers; 2) Quality assurance and support and supervisory visits; 3) MC campaigns; and 4) support of in-country (through implementation of a roaster of MC providers on clinical consultant basis) and international volunteer programs and task shifting activities. IH will advocate for more sustainable training approaches including incorporation of MC in the University of Namibia and the National Health Training Centers curricula.

IH will, in conjunction with MOHSS and other USG partners, continue to build the capacity of its partners to offer medical MC as an element of the national prevention strategy and ensure provision of a full package which includes sexually transmitted infection screening and management, behavioral counseling, provider-initiated counseling and testing and condom promotion and distribution.

Traditional circumcisers conduct a significant number of circumcisions particularly in communities known to circumcise their male children. To ensure safe MC by traditional circumcisers, IH, in collaboration with the MOHSS and stakeholders, will support advocacy, communication, information and training of traditional circumcisers in areas such as infection control, biohazard waste disposal, messaging and monitoring and evaluation of these activities.

IH will continue to support local partners to use counseling and testing services as an entry point for medical MC services (information and education), with counselors referring clients as appropriate. All counselors will be trained to provide medical MC counseling as well as ensure referrals of male clients testing HIV negative for medical MC services. In addition, the clients seeking medical MC services who test HIV positive will be referred to care and treatment in the same facility. Partners will be supported to ensure availability of Information Education and Communication (IEC) materials in HCT centers which provide information on MC.

IH will support its partners to create MC demand in their localities through community mobilization activities, use of local radios, involvement of community leaders, councilors and church leaders, and campaigns to increase the number of men demanding medical MC services. The number of people reached with MC messaging will be monitored routinely.

IH will support revision and implementation of the MC M&E systems, including training for the users. During the COP11, IH supported the partner organizations to integrate reporting for MC into the overall MOHSS system. During COP12, IH will continue supporting the training of staff in the data collection tools and electronic system.

Activities will be implemented in Rundu, Omusati, Oshikoto and Ohangwena Regions and at the national level.

Activities are linked to activities funded in MTCT, HVCT, CIRC, HTXS, PDTX, HBHC, HVSI and OHSS.

In COP11, IntraHealth International Inc. (IH) transitioned HIV counseling and testing (HCT) Quality Assurance (QA) to local partners as well as to the Ministry of Health and Social Services (MOHSS). During COP12, IH will continue providing limited technical assistance (TA) for HCT. Partner organizations and MOHSS Regional Management Team (RMT) staff will continue providing support for monitoring and evaluation (M&E) and QA to all the sites.

The performance improvement approach will continue to be utilized to ensure that local teams develop strategies or interventions to close gaps identified during these support visits.

IH will support partners to increase access to testing and encourage uptake of HCT while advocating for integration of New Start stand-alone centers into government funding. This includes scaling up outreach and mobile testing services to hard-to-reach communities (with focus on men and couples). Emphasis will be on positive yield and linking clients testing HIV positive to care and treatment services using a bi-directional referral system. This includes referral for sexually transmitted infections, tuberculosis, male circumcision and alcohol.

IH, in collaboration with the MOHSS, will continue to support its partners to roll-out provider-initiated HCT (PICT) activities. During FY2010, only 30% of HCT clients in faith-based organizations (FBO) sites were reported as PITC.

Since the average out-patient visits per person in FBO districts are 0.5 to 1.0 there is a huge opportunity to ensure cost-effectiveness of PICT. The following activities will be undertaken to ensure success: District Coordinating Committees to sensitize, advocate, promote and coordinate PICT activities in their facilities; community awareness and demand creation for communities and out- and in-patients; provision of in-room testing; support whole team approach training of staff on PICT; ensure proper inventory control systems for rapid test kits and timely ordering from central medical stores; and quality assurance by the partners and supported by RMTs.

IH will continue supporting partners to implement couples HCT. During FY2010, only 12% of individuals counseled and tested in New Start Centers were tested as couples with variation between 10-25%.

IH will continue to support partners to develop and utilize strategies to increase uptake of counseling and testing services (e.g. promotional activities, special opening times for couples). Partners will conduct male only testing days to try and increase the uptake of HCT services by men.

During COP11, IH collaborated with the MOHSS to integrate M&E into the MOHSS existing system in order to standardize the information for reporting purposes. The standalone New Start centers will move away from anonymous HIV testing to shared HIV testing and clients seeking HCT services will be handled the same way as in public health facilities. In addition, New Start centers will use the MOHSS HCT registers and report directly to the MOHSS on a monthly basis.

IH will continue supporting the MoHSS to ensure that data quality is not compromised and that partners continue to report on the MOHSS HCT data collection tools. IH will also continue supporting the training of staff in HCT paper tools and electronic systems.

Activities will be implemented in Rundu, Omusati, Oshikoto and Ohangwena Regions and at the national level.

Activities are linked to activities funded in MTCT, PDCS, CIRC, HTXS, PDTX, HB.

Activities under this budget code, through IntraHealth International, Inc. (IH), will support the virtual elimination of mother to child transmission (eMTCT) by working through the Ministry of Health and Social Services (MOHSS) PMTCT Technical Working Group (TWG) to ensure implementation of the National eMTCT action plan. The plan focuses on strengthening prevention of HIV among women of reproductive age (prong one) and prevention of unintended pregnancies in women living with HIV (prong two) in addition to keeping mothers and their children alive. IH will collaborate with the MOHSS to strengthen synergies with existing programs for HIV, maternal, newborn and child health (MNCH) and family planning FP). Using the performance improvement approach, IH will support its partners to identify existing gaps in the eMTCT, including poor partner testing, and develop interventions to close these gaps. IH will contribute to the revision and finalization of PMTCT guidelines, possibly adopting option B+.

IH will support community systems strengthening to achieve virtual eMTCT. This includes leveraging funding from other donors to increase geographic coverage of the mother-to-mother (M2M) project. IH will collaborate closely with the MOHSS Directorate of Primary Health Care for this activity. In addition to providing peer support, M2M will ensure HIV positive mothers are more informed about a number of pertinent issues including MTCT, infant feeding, and the importance of adhering to treatment/prophylaxis in order to eliminate MTCT.

Activities will support the national eMTCT plan by focusing on gaps identified in prong one and two. IH will support partners to make sure that all pregnant women who tested negative receive HIV prevention packages and strengthen the HIV retest in the last trimester including male involvement.

IH, in collaboration with the MOHSS and the University of Namibia will facilitate a short course on the training of midwives on emergency obstetric care (EMOC) and neonatal resuscitation. IH will build on the training of trainers conducted by the MOHSS and WHO in COP10 and make sure all midwives at the clinic and health center level are trained.

Integrating FP, PMTCT, HCT, ART and MNCH: The majority of clients accessing PMTCT, HCT and ART services in all the faith based hospitals are women. This creates a huge opportunity to reach these clients with FP messaging and commodities on site. FP messaging that is sensitive to the teachings of the Catholic Church will be developed and implemented.

IH will support partners to strengthen the tracking system for HIV exposed babies using a unique identifier. Tracking of these babies and testing them at six weeks or soon after would enable early identification of HIV+ babies and early treatment to improve their survival.

PMTCT data is currently being collected through the health information system and reported through the district and regions. At the district level PMTCT data is entered into a computerized database and forwarded to the regional and national levels.

In COP11, IH supported the MOHSS to integrate data collection for EMOC into the overall MoHSS system. During COP12, IH will continue supporting the training of staff in the revised data collection tools and system.

Activities will be implemented in Rundu, Omusati, Oshikoto and Ohangwena Regions and at the national level.

Activities are linked to activities funded in HVCT, PDCS, CIRC, HTXS, PDTX, HBHC, HVSI and OHSS.

Under this budget code in COP12, The Capacity Project, through IntraHealth International, Inc. (IH) will improve quality of life for people living with HIV/AIDS by continuing support of integrated and comprehensive HIV care and treatment services for adults in hospitals, health centers and outreach services. The strategy will focus on capacity building of sub-partner organizations to implement and sustain quality HIV treatment services for adult patients. Through mentorship, in-service and on-the-job training, IH will ensure adherence to the national ART guidelines and maintain high quality of care for patients on ART. By the end of COP 12, IH expects the program will be under the leadership of the Ministry of Health and Social Services (MOHSS).

IH will support the expansion of outlets offering ARV services, through outreach and integrated management of adult & adolescent illnesses (IMAI). Under MOHSS support, faith-based hospitals (FBH) will continue expanding outreach services and support staff at these facilities. A total of 20-25 registered nurses (RN) will be trained in IMAI in COP12. Training for health professionals on IMAI is already integrated into the MOHSS system.

IH will work with sub-partners to ensure family-centered approaches for same-day-visits for all family members. This approach will reduce the cost and inconvenience of multiple trips as well as facilitate disclosure and family support.

IH will support training cadres in collaboration with the HIV Clinicians Society, MoHSS and I-TECH. The HIV Clinicians Society will be supported to train through both didactic courses as well as quarterly continuing professional development meetings. Training for doctors, nurses and other health staff on ART, which is already integrated into the MoHSS system, will continue under the leadership and support from the MOHSS.

IH will participate on technical advisory committees, contributing to the development and updates of national guidelines and support development of standards of practice to improve implementation consistency. IH will conduct joint mentoring and supportive supervisory visits with MOHSS staff.

IH will continue providing technical assistance to support the MOHSS and partners in the implementation of the electronic patient management system (ePMS) throughout the country. During COP11, IH focused on building the key competencies of the MOHSS Research, Monitoring and Evaluation (RM&E) sub-division to use, modify and manage the ePMS and support the training for the revised monitoring tools for ART. Support was also provided to developing the user manual and other program specification documents. IH will continue support to the MOHSS in ePMS implementation, especially monitoring the transition of monitoring and evaluation (M&E) staff and integration of sub-partners M&E into the MOHSS. Support will also be provided to train the RM&E staff, senior data clerks, data clerks, doctors and nurses on the updated ePMS version and ART tools and to ensure that the training material is available for future use. To ensure country ownership, IH will also continue to train IT staff from the RM&E division on ePMS program skills to enable the RM&E division to make any future system changes required by the program.

Activities will be implemented in Rundu, Omusati, Oshikoto and Ohangwena Regions and at the national level.

Activities are linked to MTCT, HVCT, CIRC, HTXS, PDTX, HBHC, HVSI and OHSS.

Under this budget code, The Capacity Project, through IntraHealth International, Inc. (IH) will continue to support the Ministry of Health and Social Services (MOHSS) through membership on the Technical Advisory Committee (TAC) for national pediatric care and treatment updates. IH participates in national trainings offered by the National Health Training Center (NHTC) and serves as facilitators with I-TECH trainers. IH also provides in-service training for staff on updated guidelines during the supervisory and mentorship visits. Additionally, IH sits on the Maternal and Child Health Task Force in the Directorate of Primary Health care to ensure that pediatric HIV services are fully integrated into all child survival programming.

It is important to strengthen linkages of pediatric ART in-patient and out-patient services, primary health clinics and prevention of mother to child transmission (PMTCT) clinics and support efforts to integrate dried blood spot and maternal child health (MCH) services. Integration of these services will promote opportunities for pediatric treatment, minimize defaulting and decrease missed follow-up visits for infants.

IH will support and facilitate training of nurses, doctors and counselors in child and adolescent counseling skills for the faith-based hospitals, as many HIV positive children enrolled into care and treatment since the beginning of the ART program are now adolescents. Health workers need to be empowered to handle disclosure issues for children and adolescence as some of them will start asking questions about their status and may become sexually active, necessitating the importance to disclose their HIV status.

Facilities across the country implement policies and guidelines differently. IH will support the operationalization of treatment in partner faith-based facilities through training and dissemination of standards of practice. Analysis of cohort studies and electronic patient management system (ePMS) reports will enhance the quality of clinical services and in-time referral for laboratory investigation to detect treatment failure and its causes (adherence, drug resistance). IH will strengthen the sub-partners staff at their facilities and community-based activities with the bi-directional referral system, piloted during COP11.

IH will continue to mentor and build the capacity of staff to independently conduct supportive supervision using a structured tool. This will improve the probability of sustainability while ensuring adherence to national guidelines. As the program is transitioned to the leadership of the MOHSS, IH will participate in support visit with the MOHSS (National and Regional Management Teams) and provide them with feed-back for smooth transition. Local management teams will conduct in-service training for the staff in these departments.

Activities will be implemented in Rundu, Omusati, Oshikoto and Ohangwena regions and at the national level.

Activities are linked to activities funded in MTCT, HVCT, CIRC, HTXS, PDCS, HBHC, HVSI and OHSS.