The African Palliative Care Association (APCA) is dedicated to applying lessons learned from other African

countries to scale-up cost-effective, culturally-appropriate palliative care for Namibian persons living with

HIV/AIDS (PLWHA) and their families. This continuation from COP07 relates to other Basic Care services:

USAID, MOHSS, I-TECH and PACT grantee links.

Palliative care technical expertise in Namibia is increasing and has expanded beyond the cancer centre to

doctors, nurses and community volunteers through palliative care training provided in FY 2006 and FY

2007. The development and expansion of palliative has been limited by the lack of expertise to support not

only provision of palliative care but efforts to advance programs. In FY 2006/2007, the USG and its

partners, including the Ministry of Health and Human Services (MoHSS) received technical assistance from

APCA and its members. This included support for the Catholic AIDS Action (CAA) community and home-

based care (CHBC) program to pilot a program to integrate key palliative care strategies and training into

their efforts within Anamulenge & Rehebooth. Sensitization of the MoHSS, other key stakeholders and USG

care and treatment partners about the palliative approach to HIV/AIDS care and effective bi-directional

referrals has also been carried out. Initial work has begun in conjunction with I-TECH to review the

Namibian adaptation of the IMAI palliative care module, along with I-TECHS HIV/AIDS modules for the

University of Namibia School of Nursing. Mobilization for Namibian leadership in palliative care training,

service delivery and policy development has been key through the initial development of a National Task

Force for Palliative Care and the later establishment of a Namibian Palliative Care Association.

While significant program accomplishments are underway, continued technical support is needed to build

on program successes, address existing gaps and develop dedicated in-country expertise. In COP 2008,

APCA will support the MoHSS, USG partners and other stakeholders with to roll out HIV-related palliative

care services, including continued support for the national Integrated Management of Adult Illnesses (IMAI)

palliative care program and the development and piloting of a national palliative care training program for in-

service training, training of trainers (ToT) and supportive supervision. In 2008, the IMAI palliative care

module will be completed and implementation will begin in selected health centers and clinics. APCA will

support the MoHSS and ITECH with implementation through ongoing review of training materials and

essential drug lists, and technical assistance with on the current policy environment for ensuring availability

and accessibility of essential palliative care drugs. While initial work during FY 2006 resulted in palliative

care being included in the national policy on HIV/AIDS, APCA will advocate and support the MoHSS in the

development of further palliative care policies and guidelines; the development and implementation of

standards of care; monitoring and evaluation of palliative care and movement towards the development of a

national palliative care policy that allows nurses to prescribe narcotics and other symptom-relieving

medications. Technical assistance will follow for nurse training and the possible integration of this topic into

the University of Namibia's Advanced Nursing Diploma. Building on successes to date of APCAs Regional

Drug Availability Workshops in Entebbe (2006) and Accra (2007), APCA will work with the National

Palliative Care Task Force to ensure Namibian follow-through on the work plan to be developed by

Namibian stakeholders at the drug availability meeting set for Windhoek in February 2008.

During COP 2007 APCA supported the National Palliative Care Task Force and the MoHSS to develop a

detailed plan for palliative care leadership and integration at policy, service delivery and education/training

levels. This was informed through a study tour for key MoHSS and NGO personnel to share lessons learned

and best practices across Africa. In FY COP 2008 APCA will support the development of a functional

national palliative care association out of the task force, with clear terms of reference, strategic plan and

work plan.

The CAA/APCA pilot program to integrate palliative care into select sites in the CAA home-based care

program was completed in COP 2007 and lessons learned along with implementation challenges are being

disseminated. In COP 2008, this program will be expanded to additional sites that selected in partnership

with the MoHSS and CAA. APCA will train a further 20 health care professionals to receive ToT in palliative

care and also directly train up to 200 community volunteers. APCA will also provide refresher training and

on-going support and mentorship for persons previously trained. APCA will ensure gender-sensitive

approaches, including equitable training and support of male and female health care workers with the goal

of equitable access to HIV/AIDS services for PLWHA and their families throughout USG-supported

programs. APCA will also build upon its programs in other countries looking at men as care givers for

PLWHA and will integrate the lessons learned into its program in Namibia.

The USG supports a tremendous range of palliative care activities in Namibia. Some palliative care is

provided by partners and subpartners under the "palliative care" program areas; other palliative care is

provided by partners in other program areas, such as prevention, counseling and testing, and HIV

treatment. Care-related activities extend from clinical interventions focused on the patient (e.g. infection

prophylaxis and pain management) to psychological, spiritual and social care interventions for the patient

and the patient's family. More information is needed on the range, levels and quality of activities being

supported. In FY 2006/2007 APCA conducted a palliative care public health evaluation (PHE) in Kenya and

Uganda. During COP 2007, lessons learned from this PHE will be disseminated and applied to the

Namibian context. APCA will then conduct a similar PHE which was supported in COP 07 in Namibia. The

results will be finalized in COP 2008 and will help develop: 1) an inventory of PEPFAR-supported palliative

care activities in Namibia; 2) a practical framework for categorizing these activities including the levels of

palliative care provided; 3) a set of process indicators that can be used to evaluate the quantity, quality and

levels of palliative care provided; 4) a model that estimates the demand for and supply of palliative care by

select PEPFAR-supported palliative care partners in a specified geographic area including an appraisal on

implementation of elements of the preventive care package, and strategies that support treatment

adherence and management of symptoms and pain; and 5) a situational analysis as requested by the

MoHSS on the status of palliative care in Namibia. The results will be used to inform program planning by

the USG/NAMIBIA team and Namibian Government, expand palliative care service delivery in under-served

areas, and identify priorities for monitoring and evaluation. The results will also help APCA support the

MoHSS to develop a framework for palliative care monitoring and evaluation for Namibia and APCA will

provide technical assistance in the developing tools for ongoing monitoring and evaluation of palliative care.

This activity will be undertaken in consultation with USG-supported palliative care partners, including the

MoHSS.

Throughout COP 2008 the work of APCA in Namibia will be co-ordinated by an in-country project co-

ordinator supported by the Southern Africa Regional Co-ordinator who will make quarterly supervision visits

Activity Narrative: and provide, alongside other APCA staff, technical assistance as required.

This activity was erroneously entered into the South Africa Regional Associate Award of Pact, Inc.

All targets and narrative, as well as funding should have gone to Pact TBD Leader with Associate

Cooperative Agreement.