This mechanism supports the NHTC to train health care workers in the public and private sectors. Current training courses focus on PMTCT, Early Infant Diagnosis, HIV prevention, male circumcision, nutrition, HIV treatment, TB diagnosis and care, HIV counseling and testing, and nursing. Strengthening NHTCs capacity to provide in-service training and continuing medical education to healthcare workers in the public and private sectors contributes to GHI country ownership and access to quality health services goals. The NHTC trains healthcare workers nationwide. In-service trainings are provided through the NHTC headquarters and four regional training centers, as well as via Digital Video Conferences. Training schedules have been adapted to attract more private providers nationwide. I-TECH has successfully transitioned several project staff to the NHTC payroll, and has formed a joint Transition Technical Working Group with MOHSS (NHTC) and UNAM. In COP11, PEPFAR shifted a portion of funds from I-TECH to directly support the NHTC. Activities supported under this mechanism are integrated with CDCs direct technical assistance to the MOHSS. Supporting training activities through NHTC avoids duplicative training efforts and reduces costs associated with training abroad. Hiring of trainers, tutors, and other key staff is coordinated with MOHSS and CDC through Potentia. I-TECH maintains a robust M&E system to measure progress towards national targets. A detailed work plan and M&E plan is developed each year and is reported to CDC and HRSA on a quarterly basis. I-TECH is committed to transferring operational control over these systems to its Namibian counterparts.

Activities supported through I-Tech in this budget code include;

Training of HCWs in HIV/AIDS related Nutrition, OIs and STIs: Support for revision of the curriculum on HIV/Nutrition Management and will conduct two regional trainings, of 25 participants each. I-TECH will conduct regional trainings on Nutrition Assessment and Counseling and Support (NACS), STI surveillance and management of opportunistic infections. I-TECH will also support the procurement of supplies and equipment for training.

Capacity Building of MOHSS/Nutrition unit: Capacity development for staff in the MOHSS nutrition unit with the aim of transitioning the work of the I-TECH Nutrition Advisor to MOHSS staff. To transition these functions to MOHSS staff, I-TECH will support capacity building activities including but not limited to short courses of 3-4 weeks for nurses in the nutrition unit. The courses will include topics such as: Infant/breast feeding, nutrition and HIV, HIV and non-communicable diseases, growth monitoring, nutrition surveillance, M&E and basic nutrition.

Printing of Materials: I-TECH will print copies of guidelines and the strategic plan developed in 2011. I-TECH will also print IEC materials in an effort to address the information gap identified in a 2011 landscape analysis among clients accessing nutrition services.

Clinical Mentoring for Nurses: Tutors from the Regional Health Training Centers will conduct quarterly clinical support visits to facilities providing nutrition services in the regions to ensure transfer of learning and to provide on-site mentorship. During these visits, 2-3 tutors will assess the facility, supplies, and quality of service provision in nutrition. The Nutrition Advisor will also join the tutors from NHTC during these visits.

Distance Learning Training: To complement the training and mentoring, I-TECH will provide distance learning opportunities for health care workers to enhance their knowledge about all aspects of treatment of patients with HIV including cervical cancer screening and provision of ARV services. This will include digital video conferences as well as internet-based distance learning opportunities.

I-TECH continues to work with NHTC to implement an HR and programmatic transition plan. Support for human capacity development in Namibia will contribute to the integration of support activities, such as nutrition, into HIV/AIDS and primary healthcare services. The expansion of access to integrated services is a primary objective of the Namibia GHI Strategy. CDC and I-TECH will continue to coordinate with USAID-funded nutrition programs.

Curriculum review/development: In response to Namibias growing number of patients with MDR and XDR TB, the National TB and Leprosy Program (NTLP) developed Drug Resistant TB management guidelines in COP11. ITECH, with its partners, will develop a Programmatic Management of DR-TB training curriculum. In addition, ITECH will revise a basic TB curriculum for public sector nurses.

Pilot testing and training in Programmatic Management of DR-TB: The MDR-TB curriculum will be piloted tested in COP12 with 25 participants; one course will be conducted.

Training of public and private sector nurses in TB: In collaboration with the Global Fund, ITECH will continue to train public and private nurses in TB/HIV and will conduct one training for 20 private nurses. This training will focus on the new TB guidelines. ITECH will support four trainings for 100 public sector nurses.

TB training materials: ITECH will continue to provide training materials for HIV/TB training courses offered to public sector nurses. This includes trainer and participant manuals, and relevant handouts and teaching aides. Training for public sector nurses is funded by the Global Fund; ITECH will continue to collaborate with Global Fund to provide training materials for 250 nurses.

Training of doctors, and pharmacists on TB/HIV co-infection: ITECH will strengthen the abilities of public and private sector clinicians to prevent, diagnose, and manage TB, including DRTB. In COP12, ITECH will conduct four basic TB courses using the updated curriculum, with 30 participants each. A course called Updates in TB management will be provided to 50 public sector doctors and pharmacists in two trainings.

Training in Clinical HIV Care and OIs: ITECH will enhance doctors and pharmacists capacity to appropriately diagnose and manage OIs, assess and manage pain and provide other appropriate care. ITECH, with MOHSS, revised the curriculum for Clinical Care of HIV, AIDS and Opportunistic Infections to correspond to guidance given in the Namibia Standard Treatment Guidelines launched in 2011. ITECH will conduct two training courses with 25 government doctors and pharmacists each.

Clinical Mentoring: Clinical mentors provide daily in-service training for healthcare staff and will provide mentoring support to clinicians following the training in TB/HIV and OI management. Tutors from the Training Networks will conduct quarterly visits to the facilities for skills transfer, on-site mentorship and to identify gaps and make recommendations for improvement.

Activities supported in this budget code include;

Training of HCWs in pediatric HIV treatment: ITECH will train HCWs in comprehensive pediatric HIV care using a curriculum that includes clinical pre-ART and ART care, management of common clinical conditions, opportunistic infections, nutrition and growth monitoring, psychosocial challenges, and other palliative care issues. In COP12, part of the curriculum will be updated to align with the new Essential Services for Adolescents Living with HIV (ALHIV) Strategy.

ITECH will conduct two training courses on comprehensive pediatric HIV care, each with 25 people, for public sector doctors and pharmacists.

An advanced ART curriculum addressing the use of ARVs in adults and children, as well as the management of TB/HIV co-infection will be regularly revised and updated, and used to conduct training for doctors and pharmacists already trained in the basic courses (See HTXS).

HIV Clinical Mentoring: Four HIV physician clinical mentors will provide mentoring support on the management of pediatric HIV care and treatment primarily to doctors in 8 of the 13 regions of Namibia, reaching 94 clinicians in 36 sites (NB: see links to HTXS and PDTX). Clinical mentors provide on-site support to health workers in health facilities in managing OIs, malnutrition and providing ART, and work with the sites to assess quality of HIV care provided (link to HIVQUAL).

Clinical mentors will also assess training needs and routinely provide didactic and hands-on training as well as regular DVC case discussions co-hosted with mentees from the field, thus promoting sustainability. They will also promote a multi-disciplinary approach to HIV care, and strengthen mechanisms to address site specific patient retention and referral issues including the use of outreach, bi-directional referral systems and defaulter tracing.

Support of Community Based Child Growth Monitoring and Promotion: ITECH will support the initiation of Community Based Growth Monitoring and Promotion (CBGMP), which will assist in early identification of children with poor growth as a result of HIV infection and related illness. This will coincide with support and promotion of exclusive breastfeeding with appropriate complimentary feeding for up to two years and beyond. Five courses on Nutrition assessment counseling and Support will be conducted with 25 participants each, for a total of 125 people trained

Distance Learning Training: To complement training and mentoring, ITECH will provide digital video conferences and internet-based distance learning.

Investments in human capacity development through ITECH and, increasingly, through its local partners, the NHTC and the University of Namibia, contribute to the USG Namibia teams transition objectives. Increasing the availability of trained healthcare workers in the field also contributes to the access objectives described in the Namibia GHI strategy.

Funding in this budget code includes the following activities:

Training workshops in various health sector tools: Continuing capacity building for the MOHSS Response Monitoring and Evaluation (RM&E) unit to implement monitoring, data collection, and analysis, and reporting of health sector data. The RM&E unit will train its regional staff, including data clerks, to improve data collection, entry, data cleaning, analysis, and use.

System for Program Monitoring training: Support for the System for Program Monitoring (SPM), the system through which all non-health sector HIV/AIDS related activities are reported by the Ministry of Regional and Local Government to the National AIDS Commission. This activity will support one M&E training for the 13 Regional M&E officers; two SPM trainings for regional implementers; one report-writing training and TOT for regional M&E officers and community liaison officers.

Support for Health Information Systems capacity building and training support: Support to the MOHSS HIS through capacity building for regional HIS officers in data entry, analysis, use, and quality. One training on DHIS for new recruits will be held, along with two Data Review and Analysis workshops.

Evaluation of HIV Disclosure to Children Program: ITECH will conduct an evaluation to 1) assess the implementation fidelity of the MOHSS child disclosure intervention at nine high patient volume sites; 2) determine benefits of the program to HCWs in increasing their knowledge, confidence and stress reduction with disclosure; 3) determine the benefits of the program to caregivers in improving their ability to care for children living with HIV; and 4) compare patient outcomes for children in the disclosure program with those who are not in the program.

Evaluation of MOHSS/ITECH Distance Learning Program: MOHSS and ITECH implement the Distance Learning (DL) and Digital Video Conferencing program. In COP12, ITECH will conduct an evaluation of the program to simultaneously assess the impact that the program has made to HCWs throughout the country and to inform the transition plan to the MOHSS moving forward.

M&E of transition to the National Health Training Center (NHTC): ITECH collaborates with NHTC and has been transitioning activities and staff to this MOHSS unit. As part of the transitioning activities, ITECH will promote and monitor processes and outcomes associated with this transition.

Conducting a national research dissemination workshop: ITECH and the MOHSS will organize a national research dissemination conference in 2013 focusing on program data, surveillance data, and operational research across multiple program areas. No such dissemination activity exists in Namibia; this workshop responds to a mandate in the National HIV Research Agenda.

Assist MOHSS to develop its capacity to assume management and use of the Digital Video Conferencing (DVC) system: An assessment was conducted with COP11 funds to evaluate MOHSSs capacity to take on responsibility of DVC. In COP12, comprehensive plans will be developed to transition operation of DVC to MOHSS. In COP12 ITECH will continue to work with MOHSS, UNAM, and partners to expand the use of DVC. ITECH will intensify training of MOHSS and UNAM staff to operate and maintain equipment, and to organize and manage DVC sessions and programs.

Curricula review/development of community counselor training in MC: Community counselors (CC) play a key role in recruitment, health education and providing HIV counseling services to men enrolled in Namibias national MC program. I-TECH will continue to ensure that training curricula and other materials are updated regularly to ensure standardization and continuity in the CC cadre.

Training of regional and district managers on the Namibian MC policy and its implementation: In this activity, regional and district managers will be oriented on the Namibian Policy for MC and its implementation. In COP12, I-TECH, in collaboration with the MOHSS, will conduct two training courses for 40 regional and district managers.

Training of Trainers: Roll-out of MC requires provision of services by clinicians who are highly trained on the theory and practice of the MC procedure. Skilled clinical trainers will form a crucial part of the MOHSS MC Strategy and Implementation plan. I-TECH will identify clinicians who have demonstrated competence in performing MC and who show potential as future MC training facilitators. In COP12, I-TECH will revise its TOT program and conduct two MC TOT training courses.

Training of Service Providers: Training of doctors, nurses, and community counselors will continue to support the national MC programs efforts to scale-up to meet the National Strategic Framework (NSF) goal of circumcising 450,000 men by March 2016. The MC training curriculum covers technical skills and infection control. Non-consumable surgical equipment and consumable commodities will be procured to support these training courses. Five training courses will be conducted for doctors, nurses and CC, targeting 150 staff.

MC Quality Assurance and Certification: Several months following the training for MC providers, I-TECH MC trainers (a physician and a nurse) will track the progress made by clinical trainees and will conduct 1-2 day visits to the sites where clinicians, who have received MC training, are operating. The WHO Quality Assessment toolkit will be used to evaluate each clinical providers proficiency in the MC operative procedure and to assist in additional skills transfer where necessary. A certificate of MC proficiency will be issued to individual providers meeting all the set requirements. It is anticipated that 60 providers in 30 sites will be assessed for proficiency.

Neonatal Circumcision: The NSF sets a goal of circumcising 167,900 newborn males by March 2016. In COP12, I-TECH will collaborate with the MOHSS to: 1) Develop a neonatal MC providers curriculum; 2) Support one neonatal MC TOT training for 16 people; 3) Conduct one pilot training for 16 participants; and 4) Conduct one roll-out training for 16 participants.

Distance Learning Training: To complement the didactic and practical training, as well as the mentoring support described above, I-TECH will continue to provide distance learning opportunities for HCW to enhance their knowledge about MC. DVC will be used for continuing education and refresher courses on the Namibian MC Policy, neonatal MC and other relevant topics.

Support for training and expert supervision will support expanded access to MC services in high-need areas of Namibia. A successful rapid roll-out of MC services will also accelerate the transition of the MC program from a time-limited program focused on adult males to an MOHSS-led routine program focused on neonatal MC.

Training in HIV Counseling and Testing: HCT is the entry point for Prevention and for PLHIV to access care and treatment. Accordingly, there is a great need to train nurses and community counselors (CC) throughout the country in order to increase service coverage through different service delivery methods. Health Care Workers (HCW) will be trained in HCT. The counseling component involves training in HIV individual counseling, couples HIV counseling and testing (CHCT) using either the client-initiated or provider-initiated testing and counseling (PICT) approaches. In 2009 MOHSS integrated PICT into the HCT course in an effort to increase PICT coverage. With COP11 funds ITECH reviewed the HCT curriculum in line with the revised HCT guidelines. In COP12, a total of 120 HCW will be trained in HCT (VCT and PICT). In addition, ITECH will conduct PICT courses via the digital video conferencing (DVC) for nurses in out- and various in-patient departments. This is in line with the MOHSSs goal of increasing the number of persons receiving HCT, and to rapidly refer a greater number of infected persons to ART services for treatment. Five additional trainings in CHCT will be conducted to train a total of 120 health workers. Overall, a total of 240 HCW will be trained in HCT.

Distance Learning (DL) Training: To complement the didactic training, ITECH will continue to provide distance learning opportunities for health care workers to enhance their knowledge about management to provide effective and quality HCT. This will include digital video conferences as well as internet-based distance learning opportunities. In addition, in line with the ITECH transition plan, with FY12 funds, ITECH will begin training NTN resource persons to operate, manage and operationalize the DL component of the training including DVC equipment.

ITECH continues to implement a transition plan with the NHTC. ITECH activities to build human capacity in the healthcare field will contribute to MOHSS efforts to expand access to HIV and primary healthcare services throughout the public health care network. The increased focus on PICT is designed to improve uptake of services by populations (e.g., men) who have historically not accessed HCT or benefitted from rapid referral to treatment.

ITECH will support the national roll out of the training of Prevention for PLHIV curriculum. The core framework of this course is based on CDCs Prevention with PLHIV evaluation intervention and includes: Prevention messaging (e.g., disclosure, partner testing, condom use, and an intervention on alcohol use); syndromic screening for STIs as well as the provision of family planning counseling. The prevention course will also include a brief overview of TB and nutrition screening. Four trainings will be conducted, with 40 participants each, for a total of 160 health workers trained.

To complement the didactic training and information dissemination support, ITECH 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. In addition, in line with the ITECH transition plan, ITECH will begin training GRN staff to operate and manage the distance learning component, including the DVC system.

Curriculum review/development and training of nurses in the provision of PMTCT and EID services: In 2010, the Ministry of Health and Social Services (MOHSS) revised the Prevention of Mother to Child Transmission (PMTCT) regimen to align with the World Health Organization (WHO) recommendations. In 2009, the Early Infant Diagnosis (EID) course was integrated into the PMTCT course in order to harmonize training, reduce vertical training, and to ensure that Health Care Workers (HCW) were trained in all components of PMTCT. In addition, in COP12 the MOHSS plans to embark on a strategy to eliminate MTCT. In FY 2012, ITECH, in partnership with technical experts from the MOHSS, will revise the training curriculum in accordance with the new guidelines. In line with ITECHs transition plan with COP12 funds, ITECH will begin supporting and providing technical assistance for National Training Network to establish the Curricula Unit within the National Training Center. ITECH will use the funds to train a total of 225 HCW. Funds will also be used to procure training materials and supplies.

Clinical mentoring for doctors and nurses: To support the national efforts to eliminate MTCT through effective and quality PMTCT services, ITECH will use the current structured clinical support visit assessment tools and tutors from the Regional Health Training Centers to conduct quarterly clinical support visits to facilities providing PMTCT/EID services in the regions in order to ensure transfer of learning and to provide on-site mentorship. During these visits, two to three tutors will work as a team to assess the facility, supplies, and quality of service provision in PMTCT/EID. In COP12, through this support, the National Training Network (NTN) tutors will visit 50 sites mentoring a total of 200 HCW. To ensure sustainability and transfer of activities, ITECH will train regional tutors as Nurse Mentors. In addition, four HIV expert physician clinical mentors will continue to provide mentoring support primarily to doctors in 8 of 13 regions of Namibia in their management of pregnancy and delivery of HIV-infected pregnant women and their HIV-exposed infants. Clinical mentors will also assess training needs and routinely provide didactic and hands-on training and mentorship as needed in the PMTCT.

Distance Learning Training: To complement the didactic training and information dissemination support, ITECH will continue to provide distance learning (DL) 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. In addition, in line with ITECH transition plan, it will begin training NTN resource persons to operate, manage and operationalize the DL component of the training including Digital Video Conferencing equipment.

Investments in human capacity development through ITECH and, increasingly, through its local partners, the NHTC and the University of Namibia, contribute to the USG Namibia teams transition objectives. Increasing the availability of trained healthcare workers in the field also contributes to the access objectives described in the Namibia GHI strategy.

Doctors ART Training: ITECH will conduct three basic ART courses and advanced ART and TB management trainings for the public and private sector for doctors and pharmacists.

Clinical Mentoring for Doctors: Clinical mentors will provide on-site support to Health Care Workers (HCW) in ART facilities, using MOHSS and HIVQUAL tools and work with the sites every 6 months to assess the quality of HIV care provided by mentees.

In COP12, ITECH task-shifting courses for nurses and doctors will support MOHSS plans to implement findings of the task-shifting study.

Training of Trainers will provide training skills to clinicians already proficient in delivering ART care. This will encourage sustainable training for HCW.

ITECH will support the Integrated Management of Adult Illnesses (IMAI) training program targeting 60 nurses and community counselors. 10 ART trainings for nurses will be conducted.

Curriculum review/development: Revise three curricula: 1) Task Shifting; 2) IMAI; and 3) Training of Trainers. ITECH will support and provide technical assistance for National Training Network to establish a Curricula Unit.

Clinical mentoring and training of 34 nurses in ART clinics will be focused on in COP12. Nurses will provide mentoring and will work closely with IMAI facilities.

Training of Nurses in Medicine Adherence Counseling (MAC): Train nurses in MAC, print training materials, and procure training supplies and equipment. In COP12, ITECH will conduct 5 regional trainings targeting 125 HCW.

Distance Learning Training: Provide HIV-related distance learning (DL) to HCWs through digital video conferences (DVC) as well as internet-based DL. ITECH will train NTN resource persons to manage the DVC equipment.

Strengthen National Health Training Network (TN): Trainings in Leadership and Management, Curriculum Development, Training Delivery, Distance Learning, and M&E and Research. ITECH will support the revision of nursing curricula, skill and competency development, and integration of the Leaders in Health (LIH) course.

UNAMs School of Nursing (SoN): Support professional development for UNAM SoN faculty and initiate twinning relationships of UNAM with nursing schools in South Africa. The curricula and Lecturers Resource Guide will also be revised.

School of Medicine (SoM): Support to the SoM to review curricula to address the content gaps relating to HIV within the medical student curriculum.

Training of Health Care Workers (HCW) in pediatric HIV treatment: ITECH will train HCW in comprehensive pediatric HIV care using a curriculum that includes clinical pre-ART and ART care, management of common clinical conditions, opportunistic infections, nutrition and growth monitoring, psychosocial challenges, and other palliative care issues. In COP12, parts of the curriculum will be updated to reflect the new Essential Services for Adolescents Living with HIV (ALHIV) strategy. ITECH will conduct two training courses on pediatric HIV care, each with 25 people, for public sector doctors and pharmacists.

Training in HIV Disclosure to Children: ITECH and the MOHSS developed a course focusing on psychosocial and practical aspects of HIV disclosure to children in COP11. Practical tools were also developed and provided as starter packs to sites trained for implementation. This interactive and practical course was piloted and conducted in COP11. In COP12, ITECH will conduct six training courses with 27 participants (at least 3 participants from each ART site). The Why I take my medicines book will be translated into three additional local languages.

Supporting the dissemination of Essential Services for Adolescents Living with HIV (ALHIV) Strategy: A new MOHSS strategy for ALHIV is expected in 2012. To facilitate timely dissemination and implementation of the new strategy, ITECH will incorporate information from the strategy into module-relevant curricula such as: Comprehensive Pediatric HIV Care, ART guidelines courses for doctors, pharmacists and nurses, IMAI, HCT and PMTCT.

Clinical Mentoring for Doctors: Clinical Mentors will continue to assist facilities to focus on increasing access to early infant diagnosis and enrolment of HIV-infected patients into HIV care and treatment. Clinical mentors will also assist facilities to address psychosocial issues such as HIV disclosure for children, and addressing the needs of adolescents living with HIV.

Supportive Supervision and quality improvement: Using structured clinical support visit assessment tools, tutors will conduct quarterly clinical support visits to facilities providing pediatric care and treatment. During these visits, two to three tutors will assess the facility, supplies, and quality of service provision. To promote sustainability, ITECH will also train regional tutors as Nurse Mentors.

Investments in human capacity development through ITECH and, increasingly, through the University of Namibia, contribute to the USG Namibia teams transition objectives. Increasing the availability of trained healthcare workers in the field also contributes to the access objectives described in the Namibia GHI strategy.