Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012

Details for Mechanism ID: 11572
Country/Region: Namibia
Year: 2012
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Implementing Agency
Funding Agency: HHS/CDC
Total Funding: $896,253

This mechanism supports technical assistance projects implemented by CDC technical and administrative staff based in Namibia and in Atlanta. CDCs Global AIDS Program office in Namibia provides direct technical assistance and capacity building to technical and administrative partners within the MOHSS, the Namibia Institute of Pathology, local training institutions, and local NGOs. This direct TA contributes to the continuum of care, access to services and transition objectives described in the PF and GHI Strategy for Namibia. CDC Namibia has offices in Windhoek and Oshakati, Namibia. From these two sites, CDC technical and administrative staff may provide technical assistance to all 13 regions. CDC is committed to a technical assistance model that focuses on direct support to the Ministry of Health and Social Services and other partners directly involved in human capacity development, biomedical prevention, and community-based activities that provide HIV counseling and testing and link HIV-infected patients to ART services, or contribute to TB case finding and drug adherence. CDC is heavily engaged in the USG-GRN HRH technical working group and has successfully shifted away from direct salary support for medical officers. CDC technical advisors will remain involved in transition planning for HRH, commodities and other programmatic activities. Providing direct financial and technical assistance to the MOHSS is less costly than providing similar support via US-based implementing partners. CDC technical assistance contributions are linked to MOHSS and other partner work plans, which are monitored and evaluated by PEPFAR, the GRN, and often, other donors (e.g., Global Fund, WHO).

Funding for Strategic Information (HVSI): $589,798

In her November 8, 2011 address to NIH, Secretary Clinton laid out a strategy for a combination prevention of HIV based on preventing mother to child transmission (PMTCT), expanding voluntary male circumcision (VMC), and scaling up antiretroviral (ARV) programs. The secretary noted that this strategy will rely on strong health systems and country ownership. When national and sub-national health departments take ownership of health strategies and participate in their design and management success is more likely.

Secretary Clinton signaled a broad global interest in strengthening health systems. Yet there is still a lack of consensus of how best to measure the impact of such efforts. Several of the largest multilateral health donors and technical agencies (World Bank, GFATM, GAVI, and WHO) have recently committed to developing a common funding platform for HSS, associated with a common approach to measuring the impacts of HSS. USG and PEPFAR have not been partners in the actual common HSS funding platform per se, but in recent months have committed to participate in the development and use of a global set of metrics for HSS that would be adopted by those organizations and by PEPFAR. Discussions with those partners in the summer 2010 led to the concept that an especially useful role for PEPFAR in this process would be in assisting countries with the implementation of emerging HSS indicators and related processes. This project will help CDC Namibia monitor and evaluate the impact of its investments in health systems strengthening, which currently account for more than 40% of the annual COP budget.

Funds in this area will support technical assistance (TA) for data collection, a quality audit, analysis, and validation of priority health systems strengthening indicators. Deliverables from this TA will include: Reports, scientific manuscripts, and revised or adapted protocols, which will be produced in collaboration with technical staff from the CDC Namibia office. This collaboration will build local capacity to conduct future health systems evaluations, and to use health systems metrics for ongoing monitoring and evaluation. This technical assistance (from CDC Atlanta and an expert partner to be selected by Atlanta) will contribute evidence to inform a mutual understanding by the USG and GRN of emerging concepts such as country ownership and sustainability.CDC will also support technical assistance for the MoHSS to conduct analyses for epidemic and lab systems strengthening, including;

Epidemic modeling to estimate the relative impact of prevention interventions on incidence: Given the new information on the prevention impact of treatment from HPTN 052, Namibia may have better insight into the impact of its programs where treatment has reached coverage of 80% and has also seen a decline in incidence. This activity would collect retrospective data and work closely with the government of Namibia to build capacity to conduct epidemic modeling to better understand the dynamics of the epidemic.

Measuring the impact of lab system strengthening : Focus to include assessment of impact of MEDITECH (LIS), HRH, Equipment and other commodities on LSS.

Funding for Prevention: HIV Testing and Counseling (HVCT): $150,000

To support the MOHSS strategy of identifying new HIV infections and rapidly referring infected patients to ART services, the MOHSS is shifting focus to increase efforts to identify sero-discordant couples. CDC will facilitate the identification of a specialist partner from the southern African region (either Zambia (ZEHRP) or Rwanda (PSF)) to provide south-to-south technical assistance to the MOHSS on couples HCT. This TA will consist of training of HCT service providers and promoters, follow up support visits, extended TDY support from the TA providers to establish implementing sites, ensuring quality and M&E. An exchange visit for Namibian staff to visit Zambia or Rwanda to learn from their programs is envisaged.

Support for south-to-south Technical Assistance will play an increasingly important role in CDC Namibias sustainability strategy.

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $156,455

PMTCT is one of PEPFAR Namibias most important points of engagement with the Primary Healthcare Directorate. As such, PMTCT will play an increasingly important role in PEPFAR Namibias work to expand the impact of PEPFAR investments to primary healthcare objectives described in the Namibia GHI Strategy. For instance, PEPFAR investments in PMTCT continue to have positive ripple effects on the integration of and access to non-HIV services offered in antenatal clinics and on task-shifting for nurses who are implementing the governments IMAI/IMCI strategy.Therefore these funds contribute to the expansion of support and technical assistance for PMTCT services within the regions. In addition, efforts will be made to enhance integration with primary health care to strengthen maternal-child health care. Support will include technical assistance, supervisory visits, equipment, supplies and office running costs, especially for CDCs field-based work in northern Namibia.

Key Issues Identified in Mechanism
Addressing male norms and behaviors
enumerations.Impact/End-of-Program Evaluation
Increasing gender equity in HIV/AIDS activities and services
Child Survival Activities
Mobile Populations
Safe Motherhood
Tuberculosis
Family Planning