Detailed Mechanism Funding and Narrative

Years of mechanism: 2012 2013 2014

Details for Mechanism ID: 14371
Country/Region: Namibia
Year: 2013
Main Partner: Johns Hopkins University
Main Partner Program: JHPIEGO
Organizational Type: University
Funding Agency: USAID
Total Funding: $1,146,453

The Maternal and Child Health Integrated Program (MCHIP) IM aims to provide technical assistance on the institutionalization of the new health extension worker cadre and the strategic integration of HIV/AIDS into the broader health care system. These goals directly link to the GHI intermediate results and principles of transition, sustainability, and access.

The IM will address the governance, operational, and capacity issues associated with formalizing the health extension worker cadre and HIV/AIDS integration into primary health care and other relevant fields as appropriate. This IM will build upon other COP12 activities relating to task shifting and integration. MCHIP activities will support the National Health Extension Worker (HEW) Steering Committee to develop needed policies, protocols, budget estimates and plans for approval of a new cadre by the Government of Namibia (GRN) (including the Public Service Commission and the Ministry of Finance). MCHIP will also support the Ministry of Health and Social Services to operationalize its new structure for service delivery, including HIV/AIDS, in accordance with its revised minimum district service package, integration goals and GRN decentralization principles.

This approach will strengthen the GRN capacity to access underserved populations and sustain service delivery, including those relating to HIV/AIDS. A monitoring and evaluation plan will be developed jointly with the GRN in alignment with its own performance management system targets for the health sector.

No vehicle purchases envisaged.

Funding for Care: Orphans and Vulnerable Children (HKID): $163,027

This is a new budget code supports transition. Under the HKID budget code, JHPIEGO, an international partner, under the Maternal and Child Health Integrated Program (MCHIP) field support mechanism, will build the capacity of the Kavango Teenage Pregnancy Task Force (KTPTF). The KTPTF is chaired by the Ministries of Health and Education and includes two co-secretariats, which are the Ministry of Gender Equality and Child Welfare and Lifeline/Childline. The overall objective is for stakeholders to implement a comprehensive, multi-partner strategic plan to reduce teen pregnancy in the region.

COP13 resources the KTPTF has identified following key areas to be addressed with COP13 resources: 1) Gender-based violence prevention; 2) and operational plan to institutionalize bidirectional referral between schools, clinics and CSOs; 3) mobilization plan to leverage technical and financial support for adolescent friendly services. JHPIEGO will provide direct technical assistance (TA) to KTPTF in developing a multi-partner and multi-faceted strategic plan for the prevention of teen pregnancy, including increase efforts to engage men in sexual and reproductive health services. This activity will provide TA to programming in Kunene and Kavango regions.

JHPIEGO role is to provide direct TA to the KTPTF to develop local ownership and build the capacity of the KTPTF members to meet its objectives. MCHIP will work closely with the Teen Pregnancy Task Force members, the MOHSS, Ministry of Youth and Education, NGOs such as NAPPA and Life Line/ Child Line, schools, and other relevant stakeholders in the region. Given the high number of Peace Corps volunteers in Kavango, coordination with the volunteers and their participation in KTPTF will be important to explore.

A 2011 US International Development (USAID) funded an assessment that examined the high teen pregnancy rate (36.7%) in the region; which was three times the national average. Despite the promising progress in HIV prevention efforts in the area, teenage pregnancy rates remain high; demonstrating the need for an integrated and comprehensive approach that addressed both HIV and pregnancy prevention among young people. Additionally, the survey results reported key drivers of the high teenage pregnancy rate were related to poverty, traditional cultural beliefs and behaviors, and lack of access to services.

More specifically, under the HKID budget code, JHPIEGO will support the KTPTF to target specific groups or sectors, e.g., teens in schools, teachers and parents, health provider, community leaders and local authorities, and regional health authorities to encourage their discussion about the severity of the teen pregnancy problem in the region, its causes and consequences, and the possible solutions. JHPIEGO will work with the KTPTF to develop an organizational structure and Terms of Reference and to affiliate with one of the line ministries that are present in the region. Currently, there are 30 members on the KTPTF. Membership will be updated periodically in consultation with CSOs, Ministry of Health, Youth and Education offices in the region. JHPIEGO will contribute to an integrated package of adolescent care services, including TA to healthcare providers in selected Kavango facilities in providing adolescent friendly reproductive health service delivery (counseling and testing, family planning, screening for STIs, etc.). This activity builds on ongoing work by JHPIEGO in t

Funding for Care: TB/HIV (HVTB): $54,342

This is a new budget code which supports transition. Under the HVTB budget code, JHPIEGO, an international partner, will utilize COP13 resources to achieve the following objectives: (1) Provide TA to the MOHSS to transition from an emergency/ vertical program mode to an integrated approach is appropriate at this moment in time: (2) Support GRN to establish national guidelines and procedures to implement a coordinated response for HIV integration in MNCH, including integration with TB; and (3) Pilot an integrated HIV/PHC service delivery approach in at least two hospitals in one region.

This activity was developed based in coordination with Directorates within the Ministry of Health and Social Services (MOHSS) around technical capacity and assistance needs. These activities fit within the Partnership Framework (PF), the Global Health Initiative (GHI), and the principles of transition outlined in both matrixes. As described above, JHPIEGO will utilize COP13 funds to support HVTB activities which support GRN National Health Policy Framework (NHPF) and the National Development Plans. The NHPF describes a strategy to expand and promote the delivery of accessible, sustainable, and equitable quality healthcare through an integrated, multi-sectoral, primary healthcare (PHC) model including HIV/AIDS and TB.

TB is a major contributor to HIV-related mortality. Namibia has a TB notification rate of 598 cases per 100,000 population (of which 50% are co-infected with HIV), and is one of the largest national TB epidemics in the world. Given the great need for strengthening both HIV and TB services, under the HVTB budget code, JHPIEGO will expand access to HIV testing and counseling (HCT) and TB detection through the HEP strategy. JHPIEGO will strengthen the implementation of the HEP under the current pilot. The HEP has at its core, the HEW (Health Extension Worker) as a key cadre at the community level, linking the community to the broader health systems. The HEW will provide integrated prevention education (including HTC promotion), illness detection (including TB screening) and referral services and facilitate better linkages between health facilities and the communities. In addition to implementation support, JHPIEGO will also provide policy and operational support for the HEP to include HEP stewardship and management under the Human Resource Development Plans, and updating the key policies, strategies and guidelines for HEP expansion. JHPIEGO support related to integration of HIV and TB into the PHC will also include activities in this budget code. As the MOHSS supports the Option B+ roll out, HCT will be integrated at different levels acre within the PHC.

This activity will develop a comprehensive program which complements other activities under both MTCT and HKID. No motor vehicle, construction, or renovation envisaged.

Funding for Strategic Information (HVSI): $217,369

This is a new budget code which was developed based on assessments and meeting with Directorates within the Ministry of Health and Social Services (MOHSS) around technical capacity and assistance needs. These activities fit within the Partnership Framework (PF), the Global Health Initiative (GHI), and the principles of transition outlined in both matrixes.

MCHIP will sub-contract with Survey Warehouse, a local Namibian company, to support the MOHSS to implement program evaluations around the Health Extension Worker (HEW) program as it expands to additional regions. MCHIP will also provide focused support to MOHSS to strengthen and institutionalize a number of M&E related skills in the following areas: (1) Geographic Information Systems (GIS) mapping and training of staff for future needs; (2) Support development of essential standardized set of hospital indicators. These activities will contribute to expanding MOHSS capacity to utilize data for decision making, GIS mapping for resource allocation decision making and data standardization.

PEPFAR M&E support in Namibia has been utilized to strengthen routine M&E systems; enabling these systems to meet the needs of the national HIV/AIDS response, including designing data reporting and monitoring systems for such program areas, e.g. HIV care and treatment, Antiretroviral pharmacy dispensing systems, Human Resources and District Health Information Systems. However, there is still a gap in the capacity of MOHSS staff to interpret, disseminate and utilize data for decision making. In addition, there is also a gap within the MOHSS to generate evidence around program effectiveness, identify best practices and optimal program models, and evaluate the impact of programs on key health outcomes. These activities are designed to begin to bridge this gap and create internal MOHSS capacity to meet these needs. The HEW program is viewed as a critical platform by both the GRN and stakeholders as an effective approach for bridging the gap between health facilities and hard-to-reach communities. It is essential that rigorous evaluations to better understand and identify best practices for the design and scale-up of the program are identified and use data to demonstrate the impact of the HEW program on health outcomes at the community level.

Within HVSI, JHPIEGO will provide TA to the MOHSS with oversight and support from USAID that are based on the principles of transition. Additionally, JHPIEGO will ensure activities align with standards, policies and guidelines dictated by MOHSS research activities, data standards and norms. JHPIEGO will utilize COP13 funding to complete the following objectives: 1) Work with Survey Warehouse around the design of operations and program evaluations for the expansion of the HEW program; 2) Implement a GIS library and produce GIS library based on a number of national data sources and; (3) support the development and standardization of an essential hospital indicator set. Activities will be implemented and coordinated with existing and other US Government supported efforts including Health Systems 20/20 and activities under the Office of the Global AIDS Coordinator, Strategic Information Proposal fund.

Activities are also linked to MTCT, OHSS, HKID, HVCT, and HTVB. Cross-cutting attribution for HRH is estimated at the amount of$300,000. No motor vehicle, construction, or renovation envisaged.

Funding for Health Systems Strengthening (OHSS): $298,883

This is a new activity, implemented by the Maternal Child Health Integrated Program (MCHIP), that will provide technical assistance on the institutionalization of the new health extension worker (HEW) cadre and the strategic integration of HIV/AIDS into the broader health care system.

As defined in the Ministry of Health and Social Services (MOHSS) systems review, there are major systems barriers associated with providing needed health care services in the community; the public health care system is largely facility based with no existing government health care cadre based in the community. To address this issue, the MOHSS plans to introduce a new cadre of HEW, which in addition to increasing access, will support task shifting and increased efficiencies in the delivery of care. In addition to this service delivery issue, the Minister of Health has stated that HIV/AIDS services need to be integrated within the broader health care system. This is in keeping with the Health Systems Review recommendation to streamline fragmented and parallel systems. Strategic integration of this magnitude has not been done before so it is important that this process be informed to minimize disruption during transition.

This mechanism will draw upon its international expertise as one of the leading technical assistance providers on integrated maternal child health care, to support the following targeted leveraging activitiessome of which are complemented by human resources for health activities supported by UNICEF.

Support the institutionalization of the HEW Cadre: MCHIP will support the development of needed policies and plans for approval of the new cadre by the Government of Namibia (GRN), such as a HEW policy, capacity building strategies for HEW (both to become a HEW and to be promoted within HEW cadre), management plans, employment plans and health professional licensing. In addition, the mechanism will support the development of viable recruitment and retention strategies, including an appropriate benefit package. Finally, support will be provided to define and formalize the relationship of HEWs with non-governmental organizations (NGO) volunteers (particularly, in face of declining NGO resources). MCHIPs activities will complement other COP12 activities relating to HEWs that are focused on defining the scope of practice for the cadre (e.g. developing the training curriculum).

Support the MOHSS with its strategic integration of HIV/AIDS into primary health care and other related fields as appropriate: MCHIP will support the MOHSS to determine how the new minimum district package will be delivered. In addition, MCHIP will support the MOHSS to operationalize its new organizational structure, including its goal of strategic HIV/AIDS integration, at the facility and community level (e.g. the health care facility patient flow and arrangement of rooms may need to be altered). Strategic integration of an HIV/AIDS program has not been done before to this extent and it will be important to determine what services should and perhaps should not be integrated; this decision process should be well-informed to minimize disruption during transition. The MCHIP activity will build upon other COP12 activities that will support implementation relating to integration and some human resource and costing analyses to inform the path chosen for integration.

Funding for Prevention: HIV Testing and Counseling (HVCT): $81,513

This is a new budget code that supports transition. Under the HVCT budget code, JHPIEGO, an international partner, will utilize COP13 resources to achieve the following objectives: 1) Institutionalize the Health Extension Worker (HEW) cadre and Health Extension Worker Program (HEP); 2) Develop strategic models for integrating HIV/AIDS into Namibias broader health care system and primary health care (PHC) system (specifically within MNCH); and 3) Develop a teenage pregnancy prevention program in the Kavango Region.

Namibia has high coverage of care and treatment, but is also classified as a generalized HIV epidemic, and an estimated national prevalence of 13.2%. Activities will specifically focus on HEW pilot regions; in particular, the high HIV prevalence and teenage pregnancy in the Kavango region. This activity will focus on integrating family planning (FP) and HIV counseling and testing (HCT) efforts, which are critical for women in girls in the Kavango region. COP13 funding for this HCT activity will utilize a capacity building approach in line with the within the Namibia Global Health Initiative (GHI) and Partnership Framework (PF). JHPIEGO will provide technical assistance (TA) to existing services, building Health Extension Worker (HEW) capacities, increasing access to HCT, but not the provision of direct service delivery.

Support for this activity is related to the routinization of HCT through integrating HIV care into PHC services. As the Ministry of Health and Social Services (MOHSS) supports the Option B+ roll out, JHPIEGO will support the integration of HCT at different levels within the primary health care system. JHPIEGO will provide TA in the integration of services to increase HCT opportunities and overall uptake.

Under the HVCT budget code, access to HCT will be expanded through the Health Extension Program (HEP) strategy. In particular, JHPIEGO will focus on the implementation of the HEP pilot. Within the HEP, the HEW cadre operates at the community level, linking the community to the broader health system. The HEW package of functions will include HCT, at the community level, as part of prevention and health promotion goals. This activity will enhance coordination and linkages to existing HCT services through the HEW cadre; and increase the uptake of HCT services. JHPIEGO will build the capacity of HEW to provide active referrals and linkages to improve linkage-to-HIV care, retention to care, and adherence to care and treatment. HEW will follow-up with PLWHA who have not enrolled in care to reduce loss-to-follow-up.

In addition to implementation support, JHPIEGO will also provide policy and operational support for the HEP to include stewardship and management under the Human Resource Development Plans, and updating the key policies, strategies and guidelines for HEP expansion.

This activity will be monitored and evaluated. In particular, HCT will be monitored and evaluated, including essential/ not reported and recommended PEPFAR indicators and linkages from HCT to care, treatment, and other prevention services.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $93,843

This is a new budget code that supports transition. Under the HVOP budget code, JHPIEGO, an international partner, will utilize COP13 resources to achieve the following objectives: 1) Integrate HIV prevention services into primary health care (PHC) ; and 2) Support the scale-up of voluntary medical male circumcision (VMMC) in health facilities and outreach service delivery models in selected regions.

Namibia has high coverage of care and treatment, but is also classified as a generalized HIV epidemic, and an estimated national prevalence of 13.2%. Activities will specifically focus on HEW pilot regions, in particular, the high HIV prevalence and teenage pregnancy in the Kavango region. This activity will focus on integrating HIV prevention into primary health care and support VMMC in health facilities. COP13 funding for these HVOP activities will utilize capacity building approaches in line with the within the Namibia Global Health Initiative (GHI) and Partnership Framework (PF).

Under the HVOP budget code, access to HIV prevention services including VMMC will be expanded in selected regions. In particular, JHPIEGO will focus on supporting the scale up of VMMC services and to strengthen linkages between HIV prevention-related biomedical interventions and social and behavioral change services. JHPIEGO will promote quality assurance and provide supportive supervision in the form of TA to HEW in the scale-up of VMMC integration of services.

This activity will be monitored and evaluated including essential/ not reported and recommended PEPFAR indicators and linkages from social and behavioral change activities, VMMC and HIV counseling and testing (HCT) activities.

This activity narrative is linked with other activities under HVCT, MTCT and HKID. Cross-cutting attributions in HRH for $50,000. No vehicle for this activity envisaged.

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $237,476

This is a new budget code which supports transition. Under the MTCT budget code, JHPIEGO, an international partner, will continue its technical assistance (TA) on national policy and governance processes that support the integration of HIV programs and activities, including prevention-of-mother-to-child-HIV-transmission (PMTCT) and operational roll out of Option B+ within the broader context of primary health care (PHC). This activity is aligned with the Government of Namibia (GRN) elimination of mother-to-child transmission plan.

Under the MTCT budget code, JHPIEGO will support the MOHSS health reform agenda by addressing issues of staffing, capacity building and improved coverage of basic health services. Core objectives linked to PMTCT include defining the national policy and operational framework for the Health Extension Worker Program (HEP). The HEP will contribute to expanding access and coverage of PMTCT services along the facility to community continuum of care. JHPIEGO will provide TA to scale up evidence-based, high impact and integrated maternal, newborn, child health (MNCH) and PMTCT, interventions.

This activity will enhance PMTCT and HIV integration by developing integrated PMTCT standard operating procedures (SOP), along the different levels of care; from the primary health care (PHC) clinics to district hospitals. JHPIEGO efforts will complement the national efforts as part of the Option B+ roll out to increase healthcare providers offerings of HIV counseling and testing (HCT) to pregnant women, in order to improve uptake of PMTCT services. JHPIEGO will provide TA in integrating HIV service components into PHC service delivery to reflect the National Policy and Guidelines on integration. JHPIEGO will work closely with providers, supervisors, and managers to reorganize client flow to maximize provision of integrated services in line with the SOP and operations guidelines developed under this activity. This activity will be evaluated on a quarterly basis, and a detailed monitoring and evaluation plan will be developed with JHPIEGO.

JHPIEGO will also coordinate with existing USG supported efforts including community-based PMTCT efforts in collaboration with the IntraHealth supported M2M (Mother to Mothers) Initiative, and LifeLineChildLine youth prevention efforts. Additionally, the activitys Senior Technical Advisor will serve as an active member of the HIV Integration Technical Working Group, providing support to the PHC and DSP directorates.

Cross-cutting attributions in HRH for $150,000. No motor vehicle envisaged.

Subpartners Total: $0
Broad Branch Associates: NA
ICF International: NA
John Snow, Inc: NA
Population Services International: NA
Program for Appropriate Technology in Health: NA
Survey Warehouse: NA
Key Issues Identified in Mechanism
enumerations.Malaria (PMI)
Child Survival Activities
Safe Motherhood
Tuberculosis
Family Planning