Phase 2 Funding Approved for Two HIV Grants in Namibia
The Global Fund Board has approved funding for Phase 2 of two HIV grants to Namibia. In so doing, the Board was acting on the recommendations of the Grant Approvals Committee (GAC).
The principal recipients (PRs) for the two grants are the Ministry of Health and Social Services (MOHSS) and the Namibia Network of AIDS Service Organizations (NANASO). The GAC said that both PRs made significant progress in Phase 1 of the grants, but that they also faced some challenges.
The GAC said that in Phase 1, the MOHSS improved access to HIV treatment, care and support services, including coverage of antiretrovirals (ARVs) and HIV counselling and testing for children and women. However, the GAC said, little progress was made in addressing TB/HIV co-infection. In 2011, although 84% TB patients were known to have HIV, only 54% of HIV-positive TB patients were on ARVs.
The grant managed by NANASO was rated B1 at the cut-off date. However, the GAC said, the interventions implemented by sub-recipients (SRs) in several areas were poorly defined. The areas included comprehensive care and support for orphans and vulnerable children; prevention interventions for youth; home-based care for chronically ill; and care and support for persons living with HIV. In addition, the GAC said, the weak monitoring system in place in Namibia was able to capture only the number of contacts rather than the number of individuals reached with interventions.
During Phase 2, the National HIV Programme will focus on five high-impact interventions: (1) treatment, care and support; (2) prevention of mother-to-child transmission (PMTCT); (3) scaling-up of voluntary male medical circumcision (VMMC); (4) basic prevention packages for men who have sex with men, and sex workers; and (5) cross-cutting activities such as strategic and targeted behavioural change communication, HIV counselling and testing, and condom promotion and distribution.
By 2015, Namibia is expected to reach 144,989 adults and 16,759 children on ARVs. This represents 95% coverage according to current World Health Organisation eligibility criteria. At that point, the Global Fund will be contributing about 25% of the ARV budget. In addition, by 2015, Namibia is expected to reach universal coverage of PMTCT with Option B+. (Option B+ refers to life-long antiretroviral treatment for all HIV-infected pregnant women regardless of CD4 count.)
VMMC was not part of Phase 1 of the Global Fund grants, but was implemented through regular MOHSS services and with support from the (US) President’s Emergency Plan for AIDS Relief (PEPFAR). Over the next three years, Global Fund investments are expected to contribute to reaching 56% coverage of VMMC in Namibia.
The GAC provided some guidance for Phase 2 and beyond. In particular, the GAC stressed the need for big picture reflection on HIV epidemic trends in Namibia, and on what is required for complete control of HIV given the significant progress that has been made. (The GAC said the same thing about TB and malaria). The GAC added that it was important for the National HIV Programme to examine where HIV incidence remains high. In Phase 2, the GAC said, Namibia should have a country dialogue on high HIV transmission areas using a district-by-district approach and focusing on the most vulnerable groups.
The GAC also emphasised the need to expand TB/HIV activities in Phase 2, and to ensure that issues such as gender-based violence, empowerment of women – and better integration and linkages of health system strengthening and community systems strengthening – are better reflected in interventions.
Finally, the GAC recommended that discussions be held with the Government of Namibia on increasing domestic levels of investment in civil society as well as ensuring funding for key population networks.
The Global Fund Board approved incremental funding in the amount of $52 million for the grant managed by the MOHSS; and in the amount of $12 million for the grant managed by NANASO.
Information for this article was taken from Board Decision B28-EDP-22 and from B28-ER-17, the Report of Secretariat Funding Recommendations for May 2013. These documents are not available on the Global Fund website.