I-TECH's work with the Namibian defence force
From 2007-2016, I-TECH worked with the Namibian Ministry of Defence/Namibian Defence Force (MOD/NDF), funded by the U.S. Department of Defense, to strengthen the military’s capacity to provide comprehensive antiretroviral therapy and HIV counseling and testing services to soldiers, their families, and communities. During this time, I-TECH supported establishment of the MOD/NDF’s first and largest ART clinic, as well as both mobile and fixed HTC sites. To read more about this work, see this article in the Namibian Defence Force Journal: "Successful Partnership in Fighting HIV and AIDS."
Other PAST PROGRAM HIGHLIGHTS
- I-TECH maintains a strong partnership with the University of Namibia to promote teaching excellence among lecturers and tutors, and strengthen clinical training curricula, simulation laboratories, and other resources used to train key health cadres. Between 2009 and 2014 I-TECH promoted graduate-level education in public health at the University of Namibia (UNAM) to sustain the cadre of public-health professionals in Namibia, and to expand the type and expertise of people available to work in public health. This support included development of a strategic plan for the development of a small, part-time MPH degree program into the core of a future school of public health. With strong leadership and committed support from UNAM management, an independent school of public health was opened at UNAM in 2016.
- I-TECH conducted patient education and empowerment trainings with HIV-positive patients in antiretroviral therapy clinics to increase patient engagement during patient-provider interactions. I-TECH evaluated the effectiveness of the trainings finding that the training could increase the engagement of patients in their own care and treatment.
In Namibia, the Ministry of Health and Social Services (MoHSS) is leveraging the country’s relative prosperity to address key health challenges, which include high HIV prevalence, and a shortage of skilled health care workers. These efforts are providing quality care to a greater number of Namibians and steadily improving health outcomes. Since 2003, I-TECH Namibia has served as a key training partner to the MoHSS in building a strong health workforce, and has provided direct service delivery and technical assistance to support the improvement of health outcomes.
Based out of Namibia’s capital city Windhoek, I-TECH Namibia draws on expertise from I-TECH’s global network, including the University of Washington, the University of California, San Francisco, and Namibian partner organizations to implement a wide-reaching portfolio of health programs. I-TECH and partners support the MoHSS to create robust and sustainable health care systems, train health care providers, and build the health workforce. I-TECH places an emphasis on assessment, monitoring and evaluation, and continuous quality improvement, and prepares programs for transition to Namibian ownership.
Together, I-TECH Namibia and dedicated local partners are supporting an effective and sustainable health care system—an enduring step toward meeting the country’s health goals and supporting the future of its people.
current program priorities
Strengthen the HIV Care Continuum
- I-TECH currently supports direct service delivery and on-site technical assistance along the HIV Care Continuum to 30 facilities (Jan 2017) in four regions in Namibia. On-site activities are implemented by multidisciplinary teams consisting of HIV Clinical Nurse Mentors (registered nurses experienced in HIV care and treatment), Physicians, and a Lab Specialist, Health Assistants (healthcare workers providing HIV testing and counseling services), M&E Officers (staff supporting data analysis and visualization to improve data use), and Program Assistants (staff conducting routine data quality improvement activities). To support efforts to achieve HIV epidemic control, I-TECH supports key MoHSS strategies such as provider initiated HIV counseling and testing, and decentralization of HIV care and treatment of pregnant women and others to peripheral clinic and community levels.
- I-TECH addresses emerging concerns in HIV care and treatment through innovation projects. The MoHSS is releasing new “Treatment for All” guidelines for antiretroviral therapy in accordance with the June 2016 Word Health Organization guidelines. Under these guidelines, as soon as a person is tested HIV-positive they will be put on antiretroviral medication for life. There is concern that starting asymptomatic people on treatment with little time between diagnosis and initiation could result in poor adherence and poor engagement in care. In response to these concerns I-TECH developed an interactive education and counseling intervention in the form of a colorful 5-chapter book titled “ARVs and Healthy Me” for healthcare workers to support HIV-positive patients in having good adherence and engagement in care. I-TECH is planning an evaluation of the intervention’s effectiveness and the MoHSS plans to incorporate it into the routine HIV-patient management and care with the “Treatment for All” guidelines.
- I-TECH participates actively in National MoHSS technical working groups and advisory committees, providing technical advice and support in the development of HIV-related guidelines and policies, as well as the first National AIDS conference held in November 2016.
- I-TECH continues to focus efforts on the improvement of data quality and use of data to improve clinical decision making. I-TECH works at the site-level to build awareness and buy-in for data quality and use among site-level management and health care workers. On-site I-TECH M&E Officers and Program Assistants monitor completeness and accuracy of service delivery documentation from the point of patient encounter to the point of final data capture in an electronic database. M&E Officers promote the use of data by clinicians and facility management for systems improvement and performance enhancement.
Support Paediatric HIV Care and Treatment
- I-TECH works to strengthen quality of paediatric HIV care and treatment in Namibia, through developing a “model” Paediatric HIV clinic and supporting decentralization of quality paediatric care to other facilities
- In collaboration with the MoHSS, I-TECH developed an innovative, structured intervention to help guide healthcare workers and caregivers through the process of disclosing an HIV-positive status to children. An evaluation of the disclosure program showed that it increased healthcare worker and provider confidence and communication in pediatric disclosure. The MoHSS adopted the program and included it in the 2014 Namibian National Guidelines for Antiretroviral Therapy, as well as incorporating it into routine monitoring systems including HIVQUAL.
- I-TECH clinicians work at the site-level to support the development, implementation, and monitoring of strategies to improve adolescent HIV services and transition of adolescents from paediatric to adult care.
Voluntary Medical Male Circumcision for HIV Prevention
- In accordance with the World Health Organization and the Joint United Nations Program on HIV and AIDS recommendations, I-TECH assists the MoHSS in expanding provision of voluntary medical male circumcision as an HIV prevention option amongst target populations in Oshana and Zambezi regions.
- Since January 2016, I-TECH provides demand creation support to the MoHSS through the establishment of a network of community-based mobilizers and recruiters, as well as active engagement of local and regional stakeholders critical in the facilitation of demand generation.
- To ensure the development of adequate skills, experience, and preparation of healthcare workers to deliver quality male circumcision services, I-TECH provides training for doctors, nurses (registered ad enrolled), and community counselors.
- I-TECH provides technical assistance in the formulation of national guidelines and SOPs, most recently related to the newly included target group of 10-14 year olds.
- I-TECH is working to institutionalize a routine and systematic review process of male circumcision services to continuously improve the quality of our activities and maintain rates of adverse events under 2%.
Strengthening National Health Systems
- I-TECH plans, assesses, and positions programs for transition to MoHSS ownership in concurrence with the I-TECH operating principles. I-TECH began implementing a clinical mentoring program in 2006. In 2015 the program was fully transitioned the MoHSS.
- I-TECH continues to promote evidence-based program and strategic planning through assessments, operational research, and continuous quality improvement at national, regional and at site levels.
- In an effort to expand access to ART, the MoHSS implemented a task shifting demonstration project in 2009 to determine if nurse-initiated management of antiretroviral treatment (NIMART) was a feasible alternative to doctor-led models. I-TECH supported an evaluation of this project leading to its adoption and scale-up by the Ministry. I-TECH continues to hold NIMART trainings, five were held in 2016 with 125 healthcare workers trained.
- Project ECHO (Extension for Community Healthcare Outcomes) is a unique tele-health platform that connects HIV specialists (in a “hub” site) to distant clinicians (in “spoke” sites) to build healthcare worker capacity, share knowledge, and ultimately provide improved HIV care and treatment services to patients. I-TECH supported the Namibian MoHSS in a one-year pilot of the ECHO model, making Namibia the first country on the African continent to implement Project ECHO. An evaluation of the Namibian ECHO HIV pilot is currently underway, as is scale-up and expansion supported by I-TECH. I-TECH provides ICT support, and clinicians also participate actively as attendees, presenters and facilitators in the weekly sessions.
- I-TECH continues to focus efforts towards providing supportive supervision, mentoring, consultations, and on-site and off-site training to health care workers at supported sites.