Namibia FY 2006 Country Operational Plan (COP)


NAMIBIA

Project Title: Namibia FY 2006 Country Operational Plan (COP)

Budget Summary:

 
Field Programs Funding by Account
Central Programs Funding by Account
 
 
Notified as of May 2006
Current Notification August 2006
Current Notification August 2006
 
Implementing Agency

GAP

GHAI

Subtotal:
Field Programs Funding by Account

GHAI

GAP

New Subtotal: Field Programs Funding by Account

GHAI Central Programs

Total Dollars Allocated: Field & Central Funding

DOD

-

1,361,000

1,361,000

-

-

1,361,000

-

1,361,000

DOL

-

-

-

-

-

-

-

-

HHS

1,500,000

24,469,500

25,969,500

-

-

25,969,500

1,676,440

27,645,940

Peace Corps

-

843,300

843,300

-

-

843,300

-

843,300

State

-

175,000

175,000

-

-

175,000

-

175,000

USAID

-

24,651,200

24,651,200

-

-

24,651,200

2,612,438

27,263,638

TOTAL Approved

1,500,000

51,500,000

53,000,000

-

-

53,000,000

4,288,878

57,288,878

HIV/AIDS Epidemic in Namibia:

Adult HIV Prevalence Rate: 19.6% [8.6-31.7%] (UNAIDS 2006)
Estimated Number of HIV-infected People: 230,000 [110,000-360,000] (UNAIDS 2006)
Estimated Number of AIDS Orphans: 85,000 [42,000-120,000] (UNAIDS 2006)

Country Results and Projections to Achieve 2-7-10 Goals:

Namibia Total # Individuals Receiving Care and Support Total # Individuals Receiving ART
End of FY 2004* 96,900 4,000
End of FY 2005** 146,300 14,300
End of FY 2006*** 122,790 22,000
End of FY 2007*** 203,030 34,500

*Results. "Engendering Bold Leadership: The President's Emergency Plan for AIDS Relief." First Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, March 2005
**Results. "Action Today, a Foundation for Tomorrow: The President's Emergency Plan for AIDS Relief." Second Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, February, 2006
***Projections from FY 2006 Country Operational Plan

Program Description:

Namibia has a severe, generalized HIV epidemic, which has expanded rapidly, with an HIV prevalence of 19.6% [8.6-31.7%], making it one of the most severely affected countries. The first AIDS case was reported in 1986, and ten years later AIDS became the leading cause of death. Namibia, one of the most sparsely populated countries in Africa with a total population of 1.826 million, has an estimated 200,000 HIV-infected individuals. There is no significant difference between rural and urban antenatal sero-prevalence rates (22% vs. 25%). HIV transmission is almost exclusively through heterosexual contact or through mother-to-child transmission, and most at-risk populations include migrant workers, truckers, the military, young women and girls along transportation routes, commercial sex workers, those who have sex after abusing alcohol, sexually active youth, out-of-school youth, and orphans and vulnerable children (OVC). The tuberculosis (TB) case rate of 813 cases per 100,000 in Namibia is the highest in the world (Namibia Ministry of Health and Social Services [MoHSS] 2004), with HIV co-infection estimated at 60%. TB continues to be the leading cause of death for people with HIV/AIDS, even with the availability of antiretroviral therapy. Additionally, in spite of per capita GDP of $1,173, Namibia has the world�s highest rate of income disparity (Gini index 70.9), high levels of poverty, and a lack of economic opportunity. Human resource development, quality of services, and sustainability will be important considerations in FY 2006. The following programmatic areas are included in the FY 2006 Country Operational Plan (COP) to mitigate the impact of the epidemic in Namibia:

Prevention: $12,064,454 as of August 2006 ($8,491,613 Field and $3,572,841 Central) (26.4% of prevention, care, and treatment budget)

Prevention activities in Namibia include prevention of mother-to-child transmission (PMTCT), abstinence and faithfulness programs, condom promotion and distribution, targeting of most-at-risk populations, and blood and injection safety. Approximately 33% of pregnant women currently receive PMTCT services compared with less than 25% in 2004. With FY 2006 funding support, the Emergency Plan goal is to increase coverage to 70% or reach 37,500 women with PMTCT services and to provide 7,000 HIV-positive pregnant women with a full course of antiretroviral (ARV) prophylaxis. The ARV prophylaxis regimen will also be strengthened. FY 2006 fiscal resources will support technical assistance, infrastructure improvements, rapid test kits, ARV drugs, laboratory testing, personnel, counseling facilities, information systems, educational materials and equipment, training, transport, and management to support the current 35 hospitals and 15 clinics providing PMTCT services and to expand to remaining clinics. Abstinence and faithfulness programs will be further expanded in all regions, including the incorporation of alcohol and substance abuse into prevention messages. The Emergency Plan will increase the capacity of school, faith and work based programs for youth and families to provide prevention education including delay of sexual debut, abstinence, faithfulness to a partner of known HIV status, and promotion and distribution of condoms for sexually active and most-at-risk populations. Population-based door-to-door educational programs will be consolidated in four high-burden regions leveraging resources with the Government and the Global Fund to Fight AIDS Tuberculosis and Malaria (GFATM). HIV-positive patients in health facilities and community counseling and testing (CT) centers and their partners, which heretofore has been a missed prevention opportunity, will be a special target for intervention, including alcohol-related information, promotion of being faithful, and correct and consistent condom use. Utilizing FY 2006 funding, approximately 320,000 youth, parents, teachers, church leaders, and workers and their families will be reached with abstinence and faithfulness messages. Other prevention initiatives focus on HIV prevention education and increased condom use for most-at-risk populations, migrant workers, uniformed services, truckers, border officials and sex workers. 200,000 most-at-risk individuals will be reached with education on correct and consistent condom use and changing risk behaviors. Efforts will increase condom use among these populations and 33,000 military and police personnel.

In the May 2006 notification, an additional $419,500 was allocated for prevention activities. The additional funds will reach 10,000 people through community outreach that promotes HIV/AIDS prevention through abstinence and/or being faithful. 50 additional individuals will be trained to promote HIV/AIDS prevention through abstinence and/or being faithful. In August 2006, there was no change in the amount of funding allocated for prevention.

Principal Partners: Catholic AIDS Action, Catholic Health Services, Chamber of Mines, Change of Lifestyles (COLS), Development Aid People to People (DAPP), Family Health International, Fresh Ministries, Inc (Track 1), International Training and Education Center on HIV/AIDS (ITECH), Johns Hopkins University/Health Communication Partnership (JHU/HCP), Lifeline-Childline, Lutheran Medical Services, MoHSS, Namibia Institute of Pathology (NIP), Potentia Namibia Recruitment Consultancy, Regional Procurement and Services Office (RPSO), Social Marketing Association of Namibia, University Research Corp. (URC), Walvis Bay and Sam Nujoma Multipurpose Centers, and the World Lutheran Federation.

Care: $17,454,896 as of August 2006 ($16,738,859 Field and $716,037 Central) (38.1% of prevention, care, and treatment budget)

Care activities in Namibia include CT, clinical care, palliative care and support for OVC. Counseling and testing services outside of health facilities were not available in Namibia until 2003 when six freestanding centers were launched. In 2004, the USG supported the introduction of rapid HIV testing, capacity building in CT training, and running costs for 12 faith based and non-governmental organizations (FBO/NGO) centers, including five CT centers previously supported by the EU and seven new USG centers. In FY 2005, an additional three CT centers and two mobile outreach sites were established for a total of 17 sites (15 centers and two mobile sites). Counseling and testing services in health facilities will be expanded in FY 2006 by increasing the number of clinic-based community counselors from 100 in 42 facilities at present to 250 in 100 facilities, and rapid HIV testing will be expanded from the current 20 sites to 100 sites. Routine provider-initiated counseling and testing will be promoted for HIV/AIDS-related conditions, including sexually transmitted infections (STI), tuberculosis (TB) and other opportunistic infections, to improve access of people living with HIV/AIDS (PLWHA) to prevention, care, and treatment. With FY 2006 funds, USG assistance to CT will result in 133,000 new clients/patients knowing their HIV status.

Linkages between non-antiretroviral therapy (ART) care and counseling, testing, and referral services will be strengthened within and across the network, including the community. Extending and improving the quality of palliative care within the health network from hospitals to health centers and clinics and to community-based care will be an important priority in 2006. Training capacity will be expanded to strengthen the role of nurses in basic care, including the introduction of the Integrated Management of Adult Illness. FY 2006 funds will help support approximately 75,000 HIV-infected individuals who will be reached with palliative care services. Community-based programs managed by FBO will be strengthened by the addition of better supervision of community volunteers and development of standardized training curriculum and materials to increase technical and management capacity and to improve linkages. TB/HIV services will be supported comprehensively through routine CT, improved diagnosis, appropriate use of isoniazid preventive therapy, expansion of directly-observed therapy, short course strategy (DOTS) service points, accelerated training, linkages with ART services, and strengthening of monitoring and evaluation. Namibia�s population of OVC is primarily attributable to HIV. Namibia has a strong OVC program, with the Namibian Government recently developing and costing a National Plan of Action and funding an OVC Trust Fund for monetary grants to needy OVC. Currently, USG services provide care to approximately 27,000 OVC in nine regions and plan to develop the capacity of new partners to serve OVC. With FY 2006 funding support, a total of 48,000 OVC served by USG programs will be reached.

In the May 2006 notification, an additional $1,360,500 was allocated for care activities. The additional funds will support 10 additional service outlets providing counseling and testing and training in counseling and testing for 30 individuals; an additional 10,800 people will be counseled and tested for HIV and receive their test results. The funds will result in additional service provision to 10,250 OVC, including educational support for girls, as well as training 200 providers/caretakers in caring for OVC. In August 2006, there was no change in the amount of funding allocated for care.

Principal Partners: Academy for Educational Development (AED), CAPACITY Project, Catholic AIDS Action, Catholic Health Services, Church Alliance for Orphans (CAFO), Council of Churches in Namibia (CCN), DAPP, Evangelical Lutheran Church in the Republic of Namibia - AIDS Program (ELCAP), Evangelical Lutheran Church in Namibia (ELCIN), Family Health International, ITECH, JHU/HCP, Lutheran Medical Services, Ministry of Education, Ministry of Health and Social Services, Ministry of Gender Equality and Child Welfare, NIP, Urban Trust of Namibia, Organization for Resources and Training (ORT), Philippi Namibia, Potentia Namibia Recruitment Consultancy, and the Social Marketing Association of Namibia.

Treatment: $16,258,191 as of August 2006 ($16,258,191 Field and $0 Central) (35.5% of prevention, care, and treatment budget)

The USG supported expansion of ART services from 12 MoHSS and five faith-based hospitals in 2004 to 29 hospitals in 2005, increasing the number of patients started on ART from 4,000 to 11,000 in 2005. The remaining six small hospitals will start in late 2005 to early 2006 to reach a target of 35,200 by September 2007. The high demand for services continues to create considerable strain on the institutional and financial capacity of the MoHSS and establishing quality improvement systems for care and treatment is a MoHSS priority to be supported. The MoHSS is being funded to purchase FDA-approved ARV drugs. Support from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) for ARV drugs and services became available in mid-2005. A lack of health professionals remains an obstacle to accessing treatment and will be addressed through recruitment of additional contracted doctors, nurses, and pharmacists; expansion of scholarships for training of new professionals; and task migration from doctors to nurses. The USG is providing technical assistance for national program management, pharmaceutical management and logistics, senior health care personnel, funding for laboratory services, training, infrastructure improvements, information system development, quality improvement, targeted nutritional supplements for eligible ART patients, and ARV drug procurement. Funding support in FY 2006 will be increased to consolidate services at the existing sites and to explore expansion of treatment to selected high-burden health centers and clinics. The USG also provides training for the private sector, which provides ART to approximately 4,000 patients.

In the May 2006 notification, an additional $2,095,000 was allocated for treatment activities. The additional funds will support facility renovation to improve the quality of ARV services, contracting supplemental health workers, training nursing students and expanding viral load testing. The funding will enable an additional 2,000 people to begin ARV therapy. In August 2006, $75,000 was reprogrammed from treatment activities to a Management and Staffing activity to fund a Strategic Information Liaison and Deputy Emergency Plan Coordinator. Please note that pediatric AIDS funding that is attributed to OVC programs is included in the care program area total and is deducted from the treatment program area total.

Principal Partners: CAPACITY Project, Catholic Health Services, Development Aid People to People (DAPP), ITECH, JHU/HCP, MoHSS National Health Training Center, Lutheran Medical Services, Management Sciences for Health/Rational Pharmaceutical Management Plus (MSH/RPM+), Ministry of Health and Social Services, NIP, and Potentia Namibia Recruitment Consultancy.

Other Costs: $11,511,337 as of August 2006

Strategic information (SI) services in 2006 will focus on consolidating the USG-supported national health information systems in existing sites and expanding to new sites for PMTCT, ART, and CT, strengthening the HIV sentinel surveillance survey protocol for 2006 to include incidence testing, the Demographic and Health Survey, and a national health facility survey. With FY 2006 funding, the use of information from baseline and midterm surveys and program monitoring, e.g. PMTCT, ART, OVC, etc. will be used to improve reporting, dissemination of results, and to assist decision-making to improve overall program performance. SI interventions will improve both the capacity of the USG team to monitor progress towards reaching the 2-7-10 goals and of Namibian counterparts to monitor progress towards the achievement of national program goals.

Principal Partners: AED, Comforce, Family Health International, JHU/HCP, Measure Evaluation, Measure DHS, Ministry of Gender Equality and Child Welfare, Ministry of Health and Social Services, the National Planning Commission�s Central Bureau of Statistics and Potentia.

Crosscutting activities will focus on human resource development, organizational capacity building, community mobilization and advocacy and benefit education. Investments of FY 2006 funds in HIV/AIDS integration within pre-and-in-service training programs for health care workers and the use of technology for training and communication will result in immediate and longer-term human capacity building. The Ministry still has a vacancy rate of 40% for doctors, 25% for nurses, 58% for pharmacists, and 48% for social workers. Most existing medical technologists will be eligible for retirement in the next five years. To date, 102 Namibian students have received scholarships from the USG to study medicine, nursing, pharmacy, social work, and medical technology. Targeted work with NGO and FBO will strengthen organizational capacity and sustainability of HIV/AIDS prevention, care, and support efforts. Fourteen Community Action Forums have been formed and three more will be formed in FY 2006 as a result of ongoing community mobilization activities to increase advocacy, commitment, uptake of VCT, PMTCT and ART services and adherence and leveraging of resources.

In the May 2006 notification, an additional $875,000 was allocated for strategic information, policy analysis and systems-strengthening and management and staffing activities. The additional funds will support increased local capacity for financial management and information processing, and will provide technical assistance to the Namibian Government�s analysis of HIV/AIDS treatment costs. The funding will support an assessment and evaluation of the U.S. prevention strategy and will support full staffing of the DOD HIV/AIDS program office. In August 2006, $75,000 was reprogrammed to Other Costs to fund a Strategic Information Liaison and Deputy Emergency Plan Coordinator.

Administrative costs will support the program and the technical assistance required to implement and manage the Emergency Plan activities. DOD, DOS, HHS/CDC, United States Peace Corps and USAID personnel, travel, management, and logistics support in country will be included in these costs.

Principal Partners: ITECH, Family Health International, JHU/HCP, Legal Assistance Center/AIDS Law Unit, Lifeline-Childline, Ministry of Information and Broadcasting, Ministry of Health and Social Services, MoHSS National Health Training Center, NIP, Potentia, and the University of Namibia.

Other Donors, Global Fund Activities, Coordination Mechanisms:

A total of ten other development partners work on HIV/AIDS issues in Namibia. In addition to the GFATM, development partners range from the European Union (including Germany, Spain, Netherlands, Sweden, and Finland), the UN partners (WHO, UNAIDS, UNICEF, UNFPA, UNDP), to the private sector, including Bristol-Myers Squibb. While the USG is the largest donor, the GFATM has approved $26 million over two years for HIV/AIDS, with three years of additional funding expected but contingent on results achieved. GFATM money supports ART and care services, OVC programs, workplace HIV programs, support for community-based care, TB control, VCT, PMTCT plus and community outreach services. The USG has been asked to co-chair the UN Partnership Forum, which provides an HIV/AIDS partner coordination mechanism among development partners. The USG also sits on the National AIDS Executive Committee (NAEC), which coordinates implementation of Government of Namibia HIV/AIDS activities. The National Multi-Sectoral AIDS Coordinating Committee (NAMACOC), supported by the National AIDS Coordination Program (NACOP) as Secretariat, is responsible for multi-sectoral leadership and coordination. The membership of the committee consists of the Secretaries of all government ministries, major development partners (including USG representatives), NGO, FBO, trade unions and private sector organizations. The USG team will work with the Namibian government to ensure coordination of HIV policy and to promote sustainability of programs.

Program Contact: Ambassador Joyce Barr and Emergency Plan Coordinator, Aaron Daviet

Time Frame: FY 2006 � FY 2007

Approved Funding by Program Area: Namibia

August 2006 Operational Plan Main Page

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