Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012 2013 2014 2015 2016 2017 2018

Details for Mechanism ID: 10389
Country/Region: Namibia
Year: 2010
Main Partner: Management Sciences for Health
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $2,869,294

The Management Sciences for Health/ Strengthening Pharmaceutical Systems (MSH/SPS) program in Namibia is a continuing implementing mechanism from FY09. In COP09, this IM funded activities under HTXS, PDTX, HVTB, HVSI and OHSS. In COP10, HVTB is no longer being funded.

MSH/ SPS has four objectives: 1) improve governance in the pharmaceutical sector, 2) strengthen pharmaceutical management systems to support priority public health services and interventions, 3) contain the emergence and spread of antimicrobial resistance (AMR), and 4) expand access to essential medicines. These objectives will be achieved through partnership, capacity building, and coordination with partners to ensure efficiency and sustainability of interventions.

To improve governance in the pharmaceutical sector, SPS implementing mechanism will enhance the registration, inspection, quality assurance and post marketing surveillance units of the Namibia Medicines Regulatory Council (NMRC), resulting in more efficient and effective regulatory system for timely registration of antiretroviral and essential medicines. SPS will also continue to support review of the National Medicines Policy (NMP), and the development and implementation of the National Pharmaceutical Master Plan.

To strengthen pharmaceutical management systems to support priority public health services and interventions, SPS will develop and implement strategies that strengthen systems, human resources and institutional capacity at various levels for the delivery of pharmaceutical services. This involves supporting the Pharmacy Management Information System (PMIS); the facility level patient Electronic Dispensing Tool (EDT); supporting pharmacy human resources; and strengthening of pre and in-service training of pharmaceutical personnel. These activities will gradually be transitioned to the MoHSS as PEPFAR resources declines.

To contain the emergence and spread of AMR, SPS will support MoHSS in enhancing rational use of medicines by strengthening therapeutic committees and training at facility level. The Program also ensures institutional systems strengthening and the development of cost-effective and sustainable interventions for the containment of spread of antimicrobial resistance. Interventions include monitoring HIV drug resistance early warning indicators (EWIs), adherence interventions, and implementing infection control activities.

ARVs are essential medicines in Namibia that should be continuously available in all health facilities. SPS provides technical assistance to MoHSS and other partners to improve access to essential medicines by strengthening systems for managing pharmaceuticals in the public sector and supports decentralization and interventions aimed at reducing the cost of ART in the private sector.

In line with the partnership framework agreement, MSH/SPS program will focus on key priority areas of treatment, care and support by contributing to expanding ART services, and on key area of coordination and management as it relates to pharmaceutical services. SPS focuses on leadership and governance in the pharmaceutical sector, community systems strengthening, human resources for health capacity development, and strengthening monitoring and evaluation systems.

SPS has a national coverage and the target population is the entire population of people living with HIV/AIDS in Namibia.

SPS contributes to Health Systems Strengthening by using the adapted capacity building pyramid model as a conceptual framework for building capacity of pharmaceutical services. Key components are: • Operationalization of structure, systems, and roles through development and implementation of policies, regulations, procedures guidelines and other governance structures • Strengthen Human Resources for Health capacity and provision of equipment and requisite infrastructure including in-service and pre-service training at the National Health training centre (NHTC) and the University of Namibia to increase supply, skills and competence of personnel • Deployment of essential tools and information systems for strengthening health systems at facility and national level

Cross -cutting Issues: Increasing gender equity in HIV/AIDS activities and services.

SPS has developed and supports systems that ensure that patient data on ART is disaggregated by gender and age, appropriately analyzed and shared with decision makers.

In order to build efficiency and sustainability, SPS will support scale-up and increased access to ART through decentralization and public-private partnerships. Increasing focus will be on transitioning activities to MoHSS, particularly with regard to the newly recruited pharmacy personnel.

SPS will partner with the National Medicines Policy Coordination, Response Monitoring and Evaluation and Quality Assurance units of MoHSS in implementing national pharmaceutical related M&E systems for pharmaceutical care. Support will also be provided to MoHSS staff to conduct annual data quality audits in 20 sites and facilitate supportive supervision visits, a crucial element in data quality assurance (DQA). SPS will also strengthen data feedback and dissemination mechanisms with quarterly feedback to sites and annual feedback during the pharmacy forum. SPS will conduct two Public Health Evaluations in COP10.

Funding for Treatment: Adult Treatment (HTXS): $1,575,230

This is a continuing activity from FY09.

Strengthening Pharmaceuticals Systems (SPS) will work to consolidate previous achievements and

transition efforts to the MoHSS, who is increasingly assuming ownership per the partnership framework agreement (PFA). This activity has six components: 1) increase access to ART, 2) support treatment guidelines, 3) support the development and implementation of adherence interventions, 4) support monitoring of Anti-microbial Resistance (AMR), 5) strengthen sustainable human resource capacity for delivery of pharmaceutical services, and 6) improve infection control (IC) and environmentally safe disposal of pharmaceutical waste.

1. Increase access to ART through decentralization and public-private partnership activities as follows: • Support 15 additional ART clinics and provide dispensing equipment (pill cutters, counting trays, measuring cylinders and computers); • Strengthen inventory and dispensing practices in all ART sites; • Roll out Electronic Dispensing Tool (EDT) mobile to 35 additional sites; and • Develop interventions in collaboration with Medscheme (Namibia Health Plan), to train 30 practitioners to improve guidelines compliance and other cost drivers, and enhance data reporting mechanisms from the private to the public sector.

2. Support standard treatment guidelines (STG) development and technical committees. • Support MoHSS implement STG, monitor its use and set up systems for regular STG updates. • Support MoHSS in updating Namibia's next edition of the essential medicines list. • Support the Essential Medicines Committee secretariat to ensure transparency and good governance; and enhance evidence-based selection of essential medicines.

3. Support the development and implementation of adherence interventions. This will be achieved through scale up of adherence interventions implemented in COP08/09 to the national level, including treatment literacy activities, enhanced patient follow-up, and adherence monitoring and reporting activities in all ART facilities.

4. Support monitoring of Antimicrobial Resistance (AMR). • Train 30 prescribers and 30 dispensers in AMR risk minimization strategies. • Support interventions to reduce AMR risk and ensure ART cost effectiveness. • Support Therapeutic Committees (TC) to improve rational use of medicines and mitigation of AMR, and enhance TC functioning and prepare for long term sustainability in COP11.

5. Strengthen sustainable human resource capacity for delivery of pharmaceutical services through: • Support to MoHSS strategy development for sustaining increased enrollment, training and retention of pharmacist's assistants at NHTC; • Technical assistance and support to finalize and implement UNAM Pharmacy competency framework

and curriculum initiated in COP09; • Support the local chapter of the International Network for improving Rational Use of Drugs (INRUD); and • Continue funding 21 MoHSS pharmacy positions while continuing discussion on strategies to transition the salaries and related costs to the MoHSS by 2011.

6. Improve IC and environmentally safe disposal of pharmaceutical waste through improving awareness and enhancing good IC practices, including ensuring availability of IC commodities in all 34 hospitals in Namibia and implementing strategies for prevention of nosocomial infections.

Quarterly Systems Strengthening (SS) and monitoring visits will ensure program implementation conforms to standards and that pharmaceutical performances are enhanced. During these visits, data quality assessments will be done and validated with other pharmaceutical and ART data sources in the districts.

The current capacity building program and system strengthening with regards to training and retention of pharmaceutical staff, database development and transfer of skills will enable the MoHSS to sustain the services beyond SPS support.

Sustainability/ SS: This activity builds sustainability through rational ARV prescription practices, AMR and transitioning SS roles to the MOHSS. The private sector will be instrumental in increasing access to affordable ARV services. Quality assurance will be provided through standardized tools and EDT integration.

Funding for Treatment: Pediatric Treatment (PDTX): $385,405


Funding for Strategic Information (HVSI): $164,500


Funding for Health Systems Strengthening (OHSS): $744,159