Namibia FY 2007 Country Operational Plan (COP)


NAMIBIA

Project Title: Namibia Fiscal Year 2007 Country Operational Plan (COP)

Budget Summary:

  Field Programs Funding by Account  Central Programs Funding by Account  
   Notified as of March 2007 Notified as of June 2007 Notified as of November 2006   
Implementing Agency GAP GHAI Subtotal: Field Programs Funding GAP GHAI New Subtotal: Field Programs Funding GHAI Central Programs Total Dollars Allocated: Field & Central Funding
DOD 0 1,650,000 1,650,000 0 2,233,000 2,233,000 0 2,233,000
DOL 0 0 0 0 0 0 0 0
HHS 1,500,000 35,719,731 37,219,731 1,500,000 41,762,028 43,262,028 1,600,000 44,862,028
Peace Corps 0 985,300 985,300 0 985,300 985,300 0 985,300
State 0 1,170,090 1,170,090 0 2,695,090 2,695,090 0 2,695,090
USAID 0 36,673,682 36,673,682 0 39,254,582 39,254,582 1,158,901 40,413,483
TOTAL Approved 1,500,000 76,198,803 77,698,803 1,500,000 86,930,000 88,430,000 2,758,901 91,188,901

HIV/AIDS Epidemic in Namibia:
Estimated Population: 2,031,000*
HIV Prevalence rate: 19.6*
# of HIV infected: 230,000*
Estimated # of OVCs: 85,000*�
*Figures are from the 2006 Report on the Global AIDS Epidemic, UNAIDS
Prevalence is in adults only (15-49 years)
Orphans aged 0-17 due to AIDS

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

Namibia

Total # Individuals Receiving Care and Support

Total # Individuals Receiving ART

End of Fiscal Year 2004 *

96,900

4,000

End of Fiscal Year 2005 **

146,300

14,300

End of Fiscal Year 2006 ***

142,700

26,300

End of Fiscal Year 2007 ****

195,133

45,300

End of Fiscal Year 2008 ****

227,996

53,500

* 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
*** Results. �Power of Partnerships: The President�s Emergency Plan for AIDS Relief.� Third Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, February 2007
**** Fiscal Year 2007 Country Operational Plan targets

Program Description

Namibia has a severe, generalized HIV epidemic, with an estimated 230,000 HIV-infected individuals. The country�s HIV prevalence of 19.7% in pregnant women is one of the five highest prevalence rates in the world. HIV transmission is almost exclusively through heterosexual contact or through mother-to-child transmission. Social, economic, and cultural factors, such as population migrations, disempowered women, alcohol, stigma, ignorance, and lack of male circumcision, help drive the epidemic.

In addition, the tuberculosis (TB) case rate of 813 cases per 100,000 in Namibia is the highest in the world (MoHSS 2004), with HIV co-infection estimated at 60%. Also, there is anecdotal evidence that multi-drug resistant TB (MDR-TB) is increasing. TB continues to be the leading cause of death for people with HIV/AIDS, even with the availability of antiretroviral therapy (ART). Additionally, Namibia has the world�s highest rate of unequal income distribution (Gini index 70.9), high levels of poverty, and a lack of economic opportunity. Human capacity development, quality of services, and sustainability will be important considerations in fiscal year 2007.

Emergency Plan activities in fiscal year 2007 will focus on supporting behavior change activities that emphasize delaying sexual debut, changing male norms to reduce the incidence of cross-generational sex and concurrent partners, increasing faithfulness, conducting prevention with positives programs in health care settings, and increasing access to condoms for high-risk individuals. Emergency Plan activities also will foster developing staff capacity within the public health services sector; supporting human resource development efforts in order to ensure that Namibia has the human resources necessary to fight HIV/AIDS in the long term; promoting access to treatment and care in rural settings; and employing community counselors to provide comprehensive services involving prevention, counseling and testing, and care in health care settings.

Additional Funding: In June 2007, an additional $8,130,000 was allocated to expand on existing activities in treatment, counseling and testing, HIV/TB (especially for laboratory support), and OVC. The additional funding will build on prevention initiatives related to gender and alcohol, and will expand PMTCT activities. Additional funding will also support medical male circumcision activities and a PMTCT activity between Namibia and Angola.

The following programmatic areas will be included in fiscal year 2007 to mitigate the impact of the epidemic in Namibia:

Prevention: $19,332,019 ($17,653,594 Field and $1,678,425 Central) (26.1% of prevention, care and treatment budget)

Prevention activities will focus on increasing abstinence and faithfulness, with programs that encourage partner reduction and the delay of sexual debut, and also address: harmful male norms; the role of alcohol abuse in HIV transmission in Namibia; partner reduction; delaying age of sexual debut; and risk factors contributing to cross-generational sex. Key prevention activities include: communication of HIV/AIDS prevention messages by HIV-positive individuals; targeted interventions in health facilities and community counseling and testing (CT) centers, which include disseminating information on alcohol-related risk factors, promotion of faithfulness, and correct and consistent condom use for HIV-positive patients; and targeted programs for most-at-risk populations. In addition, population-based door-to-door educational programs will expand, in coordination with programs supported by the Government of Namibia and the Global Fund.

Resources will support prevention of mother-to-child transmission (PMTCT) services in all clinics. The antiretroviral (ARV) prophylaxis regimen for HIV-positive mothers will be strengthened by the possible addition of a second ARV drug to the current regimen. The USG will support the medical facilities providing PMTCT, with rapid test kits, ARV drugs, laboratory testing, personnel, training, management support, and technical assistance.

Principal Partners: Catholic AIDS Action (CAA), Catholic Health Services (CHS), Development Aid People to People (DAPP), Family Health International (FHI), International Training and Education Center on HIV/AIDS (I-TECH), Johns Hopkins University/Health Communication Partnership (JHU/HCP), Lifeline-Childline (Ll/Cl), Lutheran Medical Services (LMS), Ministry of Health and Social Services (MoHSS), Namibia Institute of Pathology (NIP), Pact Inc., Potentia Namibia Recruitment Consultancy (Potentia), Project Hope, Public Health Institute, Regional Procurement and Services Office (RPSO), Social Marketing Association of Namibia (SMA), University Research Corp. (URC) and the Walvis Bay and Sam Nujoma Multipurpose Centers.

Care: $25,949,908 ($24,869,432 Field and $1,080,476 Central) (35.0% of prevention, care and treatment budget)

Care activities will focus on supporting Namibia�s dissemination of Integrated Management of Adult Illness (IMAI) practices; increasing CT services; ensuring that orphans and vulnerable children (OVC) are identified and provided with a full package of services; expanding access to palliative care; and increasing linkages between TB and HIV testing and care services. Partners will strategically locate CT services, based upon local assessments and government guidance. Health facilities will promote routine, provider-initiated CT for HIV/AIDS-related conditions, in order to improve access to prevention, care, and treatment services for people living with HIV/AIDS (PLWA).

All partners will continue to strengthen linkages among non-ART care, CT, and referral services. Health care providers will focus on improving the quality of palliative care and ART, including the preventive care package. TB activities will focus on increasing HIV testing of TB patients and improving linkages to HIV care and treatment, when necessary. TB/HIV activities will expand provision of routine CT, help improve diagnosis and increase DOTS service points. With a population of 135,180 OVC attributable to HIV, identification of OVC and the delivery of a minimum package of high quality services will continue to be a focus. The USG team and its partners will support income-generating and educational activities for OVC.

Principal Partners: Academy for Educational Development (AED), CAPACITY Project, Catholic AIDS Action (CAA), Catholic Health Services (CHS), Church Alliance for Orphans (CAFO), Council of Churches in Namibia (CCN), Development Aid People to People (DAPP), Evangelical Lutheran Church in the Republic of Namibia - AIDS Program (ELCAP), Evangelical Lutheran Church in Namibia (ELCIN), Family Health International (FHI), International Training and Education Center on HIV/AIDS (I-TECH), Johns Hopkins University/Health Communication Partnership (JHU/HCP), Lutheran Medical Services (LMS), Ministry of Education (MOE), Ministry of Health and Social Services (MoHSS), Ministry of Gender Equality and Child Welfare, Namibia Institute of Pathology (NIP), Organization for Resources and Training (ORT), Pact, Inc., Partnership for Supply Chain Management, Philippi Namibia, Potentia Namibia Recruitment Consultancy, and Social Marketing Association of Namibia (SMA).

Treatment: $28,816,255 (Field funded) (38.9% of prevention, care and treatment budget)

Treatment activities will focus upon decentralization to expand coverage to more rural sites, quality of service and patient retention, ensuring adequate human capacity for now and in the future, support for the procurement and supply chain management of ARV drugs and related commodities, and building laboratory capacity to provide quality assurance and testing. Recruitment of contracted doctors, nurses, and pharmacists will be paired with expansion of scholarships for training of new professionals; in addition, the implementation of both human resource planning and twinning programs will foster development of local human capacity. The USG will continue to provide technical assistance for national program management, pharmaceutical management and logistics, training, senior health care personnel, funding for laboratory services, infrastructure improvements, and information system development.

Principal partners: CAPACITY Project, Catholic Health Services (CHS), Development Aid People to People (DAPP), International Training and Education Center for HIV (ITECH), Johns Hopkins University/Health Communication Partnership (JHU/HCP), MoHSS National Health Training Center, Lutheran Medical Services (LMS), Management Sciences for Health/Rational Pharmaceutical Management Plus (MSH/RPM+), Ministry of Health and Social Services (MOHSS), Namibia Institute of Pathology (NIP), Partnership for Supply Chain Management and Potentia Namibia Recruitment Consultancy.

Other Costs: $17,090,719

Technical and financial support will expand and strengthen the USG-supported national health management information systems (HMIS), to make it more relevant to service providers and policy makers while ensuring its sustainability over the long-term. USG support will also expand HIV surveillance for transmission of drug-resistant HIV in the general population and MDR-TB. With the consensus of the MoHSS, and in line with the host government�s priorities, the USG will help build capacity for public health evaluation of programs in order to document impact at the population level.

Principal Partners: Academy for Educational Development (AED), Comforce, Family Health International (FHI), Johns Hopkins University Health Communications Partnership (JHU/HCP), Measure Evaluation, Measure DHS, Ministry of Gender Equality and Child Welfare, Ministry of Health and Social Services (MoHSS), the National Planning Commission�s Central Bureau of Statistics and Potentia Namibia Recruitment Consultancy.

Programs addressing cross-cutting issues in both government and civil society will continue to provide training on human resource development, organizational capacity building, community mobilization and advocacy, and education on available benefits. In an effort to sustainably address Namibia�s severe human resource shortages in medical professions, USG will support scholarships for Namibian students. The integration of HIV/AIDS into existing pre-service training programs for health care workers, as well as the continued use and expansion of digital video conferencing, will reduce the human resource burdens of providing training; this also will facilitate the expansion of skills among new and existing health care providers. Community Action Forums will help bring HIV initiatives into the mainstream, and will support a full range of HIV/AIDS services at the community level. Government and business partners will initiate and expand workplace HIV/AIDS programs, in an effort to fight stigma and bring HIV/AIDS issues to a broader audience.

Principal Partners: International Training and Education Center for HIV (ITECH), Family Health International (FHI), Johns Hopkins University Health Communications Partnership (JHU/HCP), Legal Assistance Center/AIDS Law Unit, Lifeline-Childline (CL/LL), Ministry of Information and Broadcasting (MIB), Ministry of Health and Social Services (MoHSS), MoHSS National Health Training Center, Namibia Institute of Pathology (NIP), Potentia Namibia Recruitment Consultancy, and University of Namibia.

Funds for management and staffing will support in-country personnel needed for DOD, DOS, HHS/CDC, Peace Corps, and USAID. Travel, management, and logistics support in country will be included in these costs.

Other Donors, Global Fund Activities, Coordination Mechanisms

The Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund) is the second largest donor (after the USG) in the fight against HIV/AIDS, and Namibia is currently utilizing a Round Two grant of $26 million, with a Round Two, Phase Two proposal under review. Other development partners include the European Union and UN agencies, including the World Health Organization (WHO), UNAIDS, UNICEF, UNFPA, and UNDP. Global Fund money supports ART and care services, OVC programs, workplace HIV programs, support for community-based care, TB control, CT, 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 Namibian 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, non-governmental organizations, faith-based organizations, trade unions and private sector organizations. The USG team will continue to work with the Namibian government and other development partners to ensure coordination of HIV policy and to promote sustainability of programs.

Program Contact: Emergency Plan Coordinator Dennis Weeks and Ambassador Joyce Barr

Time Frame: Fiscal year 2007 � fiscal year 2008

Approved Funding by Program Area: Namibia

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