Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011

Details for Mechanism ID: 10381
Country/Region: Namibia
Year: 2011
Main Partner: Abt Associates
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: USAID
Total Funding: $874,655

COP 2010 Overview Narrative

Health Systems 20/20 is a continuing Implementing Mechanism.

The Health Systems 20/20 project (HS 20/20) is a Leader with Associates Cooperative Agreement awarded by USAID's Global Health Bureau to Abt Associates and its partners. The goal of HS 20/20 is to increase the use of priority population, health, and nutrition (PHN) services, especially by the disadvantaged. Towards this goal, it implements activities to improve health system performance in four key areas (1) health financing, (2) governance, (3) operations, and (4) local capacity. The project team brings together an exceptional pool of professionals with depth and experience in capacity building, governance, finance and operations.

Health system strengthening related to HIV/AIDS is a key element of the Partnership Framework. HS20/20 is committed to country ownership and the development of local capacity to ensure sustainability of activities initiated under the agreement. Furthermore, HS20/20 will continue its ongoing efforts in Namibia to strengthen human resources for health (HRH) planning, governance, and financial management of HIV/AIDS related activities, three important components of the Partnership Framework.

HS 20/20 will work at the national level with government officials and civil society stakeholders. The key ministry partners will include the Ministry of Health and Social Services, the Ministry of Finance and the proposed new National HIV/AIDS Council. By supporting the GRN in its development of a national costed HRH plan, HS20/20 will also target the cross-cutting issue of HRH strengthening.

The HS 20/20 vision for both strengthening health systems and making them more efficient over time relies on the project's success in its core intervention areas, which include strengthening of financial systems, operations, and governance and building capacity. The project's results framework calls for improvements in these areas.

HS 20/20's work aligns with PEPFAR's cost-efficiency principles by strengthening GRN leadership. Through this approach, HS 20/20 is able to save resources needed to lead, implement, and champion each activity. Instead, the GRN will lead each activity and this allows for HS 20/20 funds to be maximized across a number of activities through the provision of strategic technical assistance provided at key phasesinitiation and design, data analysis and interpretation, and in some cases report writing.

At its onset, HS 20/20 drafted a set of program indicators to benchmark its performance. HS 20/20 will apply them to each of the activities proposed for Namibia in order to both monitor and evaluate performance and create opportunities for learning. In addition, HS 20/20 will partner with the MOHSS to collect information on the COP10 core indicator activities and report on targets that have been met. The data quality for program monitoring will be ensured through data validation exercises undertaken in conjunction with implementing partners in the MOHSS and the Monitoring and Evaluation Officer at USAID. HS20/20 will also strengthen data feedback loops and dissemination mechanisms by working with our implementing partners in the MOHSS to widely share health finance information, final resource allocation criteria, and results from HRH situation assessments, planning workshops, and gap estimations. These dissemination efforts will involve district, regional and national level health system administrators and managers.

Funding for Health Systems Strengthening (OHSS): $874,655

1.Organizational support for the establishment of a new directorate on health information systems at the MoHSS that will build and sustain information systems that make data easier to maintain, access, and use for policy purposes.

Continuing Activity

Estimated Budget = $195,000

2. Technical support to the MoHSS to implement its recently developed (by COP 11) HRH plan, including related support to the Public Service Commission and Ministry of Finance, to ensure a robust health care workforce that meets the health needs of the population, including HIV-related needs.

New Activity

Estimated Budget = $200,000

3. Technical support to the MoHSS to conduct costing studies and to develop a process/system for conducting and updating future costing exercises within the Ministry (one that builds upon the expenditure tracking systems). Strengthening MOHSS's capacity in costing will enable them to ensure that new policies and guidelines can be sufficiently financed and effectively implemented.

New Activity

Estimated Budget = $354,655

4. Technical support to the MOHSS to complete its institutionalization process of expenditure tracking and the National Health Accounts Framework. This will equip MOHSS with necessary data to advocate for more GRN health investments during budget negotiations.

Continuing Activity

Estimated Budget = $125,000


The USAID/Health Systems 20/20 (HS 20/20) project has provided support to the Ministry of Health and Social Services in the areas of health financing (including National Health Accounts, resource tracking, and costing), human resources for health, and health information systems. The project will build upon these areas in COP 11 and focus on strengthening local institutions to be fully equipped to lead systems strengthening efforts. In so doing, local institutions will not only be the target of its activities but where relevant and possible, the project will also work through local firms and consultants to deliver its technical support. Finally, work will be coordinated with WHO's technical support for health systems strengthening in Namibia.

1) Organizational development (OD) support to the upcoming and new HIS (Health Information System) Directorate within MoHSS. This activity is critical to the Ministry's efforts to streamline, link, and integrate the many currently fragmented health information systems. In doing so, the Directorate will be strengthened so it may build and sustain information systems that are easier to maintain, access, and use for policy purposes.

In COP 10, HS 20/20 facilitated and solicited stakeholders input and buy-in to inform the development of a Ministry-owned concept of an HIS directorate.

In COP 11, HS 20/20 will:

o work with the MOHSS to operationalize this concept: finalize the organizational design of the directorate; develop planning and review mechanisms; establish and support an effective management team for the directorate; establish mechanisms to coordinate with other MOHSS directorates and implementing partners; support Ministry to meet any other additional requirements needed to obtain approval for such a directorate by the GRN (for example, by the Public Service Commission and Ministry of Finance); and

o build capacity of a local management consultancy firm to support the roll out of the Directorate.

2) Support to MOHSS to implement its HRH plan: By COP 11, the MOHSS will have developed its new HRH plan. This plan is critical to providing guidance for ensuring a robust health care workforce to meet the needs of the HIV/AIDS response along with the health needs of the population. HS 20/20 will support the operationalization of this plan in the following ways:

Support the MOHSS to design and roll out retention strategies including

o developing a implementation plan,

o drafting manuals and other communication materials to disseminate details of the plans to employees, and

o undertaking workshops to increase awareness about the new retention strategies among employees.

Working with faith-based providers (many of whom are supported by USAID) through targeted training programs to ensure compliance with the new plan

Providing technical support to the MOHSS on the revision of its staff establishment, particularly to accommodate any currently USG supported staff

Supporting Ministry to meet any other additional requirements needed to obtain approval for Plan and staff establishment by the GRN, including the Public Service Commission and Ministry of Finance.

Developing a Monitoring and Evaluation (M&E) framework to assess the programmatic strengths and weaknesses of the new HRH plan

It should be noted that USG COP 11 funds, through PACT, will also be used to support the Ministry of Gender Equality and Child Welfare to role out its new HR strategy. Because both the MGECW and MOHSS include social workers in their staff establishments, PACT and HS 20/20 will work with their respective Ministries to better coordinate relevant areas of overlap in the Ministries' staff establishments for maximum impact.

3) Costing: When introducing new policies and guidelines, it is critical that the costs associated with these changes be considered to ensure that they can be sufficiently financed and effectively implemented. However, this is not always done and the need for costing has been highlighted in the recent MoHSS health policy (draft). In addition, costing studies are often conducted by outside consultants and with an inadequate focus on ensuring that the datasets are stored at the Ministry and where relevant, updated in master costing spread sheets (like the resource needs estimation model). In addition, there has not been a focus on ensuring that Ministry staff themselves are able to routinely update, analyze, and conduct such studies. In this regard, HS 20/20 will conduct the following specific activities:

Provide technical support to the Ministry to conduct selected costing studies (to be selected and prioritized by the MOHSS), such as the costing implications of the new male circumcision policy, or the new ART guidelines. HS 20/20 will involve local institutions (e.g. UNAM, Polytechnic of Namibia) and GRN staff in these efforts

Conduct trainings to build capacity of government staff to conduct, analyze and interpret costing data along with instituting quality assurance safe guards

Support the Ministry to develop a process whereby routine expenditure information (such as that mentioned in activity #4) informs costing efforts (i.e. what has been spent forms the basis for unit costs) and there is a mechanism for updating costing estimates by MoHSS staff

4) Expenditure tracking institutionalization efforts

In COP 10, HS 20/20 makes a concerted effort to institutionalize the process for collecting expenditure data, such that it is done on a regular basis as part of routine information systems and not as a separate study each time.

In COP 11, the project will focus on the following specific activities:

o Operationalize the new online donor-NGO resource tracking database (designed in COP 10) for the next NHA effort

o Train the Ministry-based NHA team on the new international classification of health accounts (ICHA), which OECD and WHO are currently developing, and assist them to make the relevant changes that will need to be made to the country's NHA process.

o Link the public, donor/NGO databases to the development of a private sector M&E database that would be financed under the GFATM Round 10, should this proposal be successful.

o Institutionalize the use of expenditure data in budget negotiations and advocacy efforts with Ministry of Finance, such that the GRN is invests more funds in health.

Subpartners Total: $0
Aga Khan Foundation: NA
Bitrán y Asociados: NA
BRAC University: NA
Broad Branch Associates: NA
Deloitte Consulting Limited: NA
Forum One Communications: NA
Forum One Communications: NA
RTI International: NA
RTI International: NA
Training Resources Group Inc.: NA
Tulane University: NA
Cross Cutting Budget Categories and Known Amounts Total: $245,000
Human Resources for Health $245,000