SHOPS/Namibia aims to catalyze private sector investment to increase sustainability for the HIV/AIDS response and health care system. This addresses the GHI principles of systems strengthening, transition and improving access. The project will work nationally to strengthen the capacity of the Government of Namibia and civil society to develop public private partnerships (PPP), to motivate private employers to provide health benefits for the formal sector and to support private health providers to deliver quality services to help achieve national health goals. SHOPS will work on: 1) Health Financing: Work with the Ministry of Health and Social Services (MOHSS) and medical aids to expand access to low-cost insurance for the formally employed; 2) NGO sustainability: Strengthen the ability of local NGO to market their competencies and other assets to private firms and providers; 3) Quality improvement: Work with local institutions and other USG partners to provide training opportunities, incentives and modalities tailored for private health providers; and 4) Enabling policy environment and innovative partnerships: Support the MOHSS to partner with the private sector through a new MOHSS PPP unit. Additionally, SHOPS will assess and complete a pilot to develop a sustainable PPP mechanism for primary health care mobile clinics and continue to identify and facilitate new PPP. SHOPS will add to the evidence-base to show how private sector involvement can lead to greater cost-efficiencies, cost-saving and accessibility of health care. The project will work with a number of local partners, including the MOHSS, PharmAccess and the Namibian Medical Aid Fund. Monitoring and evaluation will entail data collection from the private sector, NGO and MOHSS. No vehicle purchase envisaged.

This continuing activity, implemented by the Strengthening Health Outcomes through the Private Sector (SHOPS) project will continue activities to 1) Promote non-governmental organization (NGO) sustainability; 2) Facilitate public-private partnerships (PPP) and help support an enabling policy environment for the provision of private health services; 3) Expand access to low-cost health insurance and promote the financing of ART through the private sector; 4) Expand access to training opportunities and promote quality improvement for private providers; and 5) Strengthen private sector reporting to the Ministry of Health and Social Services (MoHSS) on health information, including that related to HIV/AIDS services.

In COP11, SHOPS developed a sustainability strategy for NGO providing HIV/AIDS services after conducting market research about possible demand and willingness to pay for NGO services by corporations and public institutions. In COP12, SHOPS will focus on training a selected number of NGO in developing and implementing individualized sustainability strategies, and will help to establish a network of potentially sustainable NGO that can help train other NGO reliant on donor funding on how to improve prospects for financial sustainability. Additionally, SHOPS will conduct a cost benefit analysis of potential private sector support to the Social Security Development Fund (SS DF) to support both civil society organizations and bursaries for human resources for health.

SHOPS will continue to identify and facilitate promising public-private partnerships (PPP) and will provide technical assistance to the MoHSS in contracting and partnering with the private sector. SHOPS will help guide private sector involvement in the upcoming National Health Insurance effort to promote universal health coverage. As the new PPP unit comes on board in the MOHSS, SHOPS will support the unit (jointly with GIZ) with developing needed justifications, legal landscape analyses, and the development of a private sector policy.

Increasing private contributions to fund HIV treatment will reduce the public burden to pay for ART. SHOPS will build on the analytical work conducted in COP11 for a basic package for low cost insurance as well as lessons learnt from primary health care mobile clinics to work with the medical aid industry to develop and market low cost insurance products to employers and employees.

SHOPS will continue to provide technical assistance (TA) to local training institutions on adapting curricula for private providers to expand access and will work to link Continuing Professional Development credits for private providers with the uptake of these training courses. This includes demand creation for preventive services among insurance and private provider stakeholders.

In COP12, SHOPS will work to support the MOHSS to routinely link in private sector information. They will work closely with both the public and private sector to determine the parameters of data needs, raise private sector awareness, allay fears, promote understanding of why the data submission is needed and how it will be used and the scheduling and format of data submissions to the MOHSS. SHOPS will work with Namibian Medical Aid Fund and medical aid schemes to develop a health sector database and provide TA to support private sector. SHOPS will also continue to provide to support reporting to MoHSS on workplace HIV programs.

This activity is linked to HVCT, CIRC and HTXS.

Using COP12 funding, this continuing activity, implemented by the Strengthening Health Outcomes through the Private Sector (SHOPS) project will focus on three medical male circumcision (MMC) activities as they relate to the private sector. Firstly, funds will be used for the Mister Sister initiative (described in the HVCT budget code narrative) to provide technical assistance to public-private primary health care (PHC) mobile clinics to promote the understanding of and access to MMC services in the communities serviced by the mobile clinics. This will include communities in remote rural areas. While the clinics themselves will not conduct MMC, they will create demand and link males requiring MMC to facilities and support follow-up of referrals.

Additionally, SHOPS Namibia will continue to work with the Workplace Wellness Network to facilitate MMC demand creation through the workplaces.

Finally, SHOPS will continue to work with medical insurance schemes to make sure that MMC as an explicit benefit is sustained and work with schemes that did not include it in COP11 to include it in COP12. Moreover, SHOPS will work with Namibian Medical Aid Fund (NAMAF) to collect information on MMC performed in the private sector; such that this information becomes routinely shared with the Ministry of Health and Social Services.

This activity is linked to HTXS and OHSS.

Using COP12 funding, this continuing activity will complete the proof of concept stage of a mobile primary health care (PHC) clinic to remote and farm areas of two more regions in Namibia. Mobile clinic initiatives in Namibia have traditionally offered singular interventions such as for immunization or HIV/AIDS counseling and testing (HCT). Preliminary results are showing that doing so reduces stigma and reluctance to receive services associated with mobile clinics that offer only HCT. Part of the services provided by the mobile clinic is HCT. However, through a new public-private Mister Sister initiative, a broader package of primary health care services will be offered in a mobile clinic setting. This activity aims to increase access to PHC to underserved populations. The premise of the public-private partnership is as follows: 1) A private corporate entity procures the mobile clinic vehicle; 2) Employers in remote locations (such as farms) pay for the clinic to offer health care services to their employees and dependents (these payments pay for the transport and operational costs); and 3) On route to these locations, the mobile clinic offers services to communities based on an agreement with the Government of Namibia, in which all commodities are provided by the Ministry of Health and Social Services and the National Institute of Pathology covers related services. The mobile clinic visits each point along its route once a month and provides basic PHC services through a registered nurse, including follow-up, referrals, and even picking up chronic medication for patients who would have to otherwise travel long distances to the clinic.

In this COP, Strengthening Health Outcomes through the Private Sector (SHOPS) will continue to support the Mister Sister initiative to promote awareness for HCT through education as well as providing HCT services in the farms and neighboring rural communities. Through support from SHOPS, Mister Sister will also continue to improve linkages and referrals between testing and treatment.

This activity is linked to work under OHSS, CIRC and PDTX.

Using COP12 funding, this continuing activity, implemented by the Strengthening Health Outcomes through the Private Sector (SHOPS) project, will continue to work with private distributors as well as the MOHSS to establish mechanisms to improve efficiencies and lower ARV prices for all ART patients in the private sector in order to realize sustainable ARV funding.

Findings from a SHOPS study have shown that the private sector pays twice as much for ARV as the public sector; this is largely due to the private sector providers ordering small volumes from a number of distributors. Interestingly enough, the principle payer of these higher-priced ARV is the GRN which runs the heavily subsidized civil servants insurance scheme (PSEMAS) that entitles beneficiaries to receive out-patient care (including ARV) in the private sector. Depending on the direction chosen by stakeholders in COP11, SHOPS support may include support to the GRN to procure ARV for the private sector, establishing mechanisms to charge the private sector for these ARV, supporting the procurement mechanism to meet private sector client volume requests, and conducting additional analyses on possible cost savings of procuring other public health related medicines through cheaper mechanisms.

SHOPS/Namibia will also continue to work with Workplace Wellness Network, to work on standards for workplace programs (WPP) that will ensure quality of care and services provided through the WPP.

This activity is linked to CIRC and OHSS.