Namibia Country Report FY17

Transcription

1 USAID ASSIST Prject Namibia Cuntry Reprt FY17 Cperative Agreement Number: AID-OAA-A Perfrmance Perid: Octber 1, 2016 September 29, 2017 SEPTEMBER 2017 This annual cuntry reprt was prepared by University Research C., LLC fr review by the United States Agency fr Internatinal Develpment (USAID). The USAID Applying Science t Strengthen and Imprve Systems (ASSIST) Prject is made pssible by the generus supprt f the American peple thrugh USAID.

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3 USAID ASSIST Prject Applying Science t Strengthen and Imprve Systems Namibia Cuntry Reprt FY17 Cperative Agreement Number AID-OAA-A Perfrmance Perid: Octber 1, 2016 September 29, 2017 SEPTEMBER 2017 DISCLAIMER This cuntry reprt was authred by University Research C., LLC (URC). The views expressed d nt necessarily reflect the views f the United States Agency fr Internatinal Develpment r the United States Gvernment.

4 Acknwledgements This annual cuntry reprt was prepared by University Research C., LLC (URC) fr review by the United States Agency fr Internatinal Develpment (USAID) under the USAID Applying Science t Strengthen and Imprve Systems (ASSIST) Prject, which is funded by the American peple thrugh USAID s Bureau fr Glbal Health, Office f Health Systems. The prject is managed by URC under the terms f Cperative Agreement Number AID-OAA-A URC's glbal partners fr USAID ASSIST include: Encmpass LLC; FHI 360; Harvard T. H. Chan Schl f Public Health; HEALTHQUAL Internatinal; Initiatives Inc.; Institute fr Healthcare Imprvement; Jhns Hpkins Center fr Cmmunicatin Prgrams; and WI-HER, LLC. Fr mre infrmatin n the wrk f the USAID ASSIST Prject, please visit r write assist-inf@urc-chs.cm. Recmmended citatin USAID Applying Science t Strengthen and Imprve Systems (ASSIST) Prject Namibia Cuntry Reprt FY17. Published by the USAID ASSIST Prject. Chevy Chase, MD: University Research C., LLC (URC).

5 Table f Cntents List f Figures... i Abbreviatins... ii 1 INTRODUCTION PROGRAM OVERVIEW KEY ACTIVITIES, ACCOMPLISHMENTS, AND RESULTS... 3 Activity 1. Prvide cntinuus quality imprvement supprt fr VMMC, HTC, PMTCT, ART, and TB-HIV care... 3 Activity 2. Prvide CQI training fr HIV and AIDS prgrams... 8 Activity 3. Supprt US Gvernment-led VMMC external quality assessment (cre-funded) SUSTAINABILITY AND INSTITUTIONALIZATION GENDER INTEGRATION... 9 List f Figures Figure 1. Namibia: Summary f baseline assessment acrss 7 VMMC sites, Windhek (Oct 2016)... 3 Figure 2. Summary f baseline assessment acrss 3 VMMC sites, Khmas District, Windhek (May 2017)... 4 Figure 3. Individual site cmpliance t the quality standards, baseline assessment f 10 VMMC sites, Khmas District, Windhek (Oct 2016 and May 2017)... 5 Figure 4. Gap in key ppulatins receiving HIV cunseling and testing (target vs actual), Khmas, Oshikt, Zambezi districts (Oct 2015 Jun 2016)... 6 Figure 5. Percent f pregnant wmen tested fr HIV r with knwn HIV status at entry t care, 8 sites (Odib sub-district) Jan 16 Mar Figure 6. Percent f infants wh had a virlgic HIV test within 12 mnths f birth, 8 sites, Odib subdistrict (Jan 16 Mar 17)... 7 USAID ASSIST Namibia Cuntry Reprt FY17 i

6 Abbreviatins ART Antiretrviral therapy AIDSFree USAID Strengthening High Impact Interventins fr an AIDS-free Generatin Prject ASSIST USAID Applying Science t Strengthen and Imprve Systems Prject CDC U.S. Centers fr Disease Cntrl and Preventin CQI Cntinuus quality imprvement EQA External quality assurance HC3 USAID Health Cmmunicatin Capacity Cllabrative Prject HIV/AIDS Human immundeficiency virus / acquired immundeficiency syndrme HTC HIV testing and cunseling IPs Implementing partners KNCV Kninklijke Nederlandse Centrale Vereeniging Tuberculse Fnds KP Key ppulatin MOHSS Ministry f Health and Scial Services MTCT Mther-t-child transmissin f HIV PEPFAR U.S. President's Emergency Plan fr AIDS Relief PMTCT Preventin f mther-t-child transmissin QI Quality imprvement TB Tuberculsis URC University Research C., LLC UTAP USAID Clinical Services Technical Assistance Prject USAID United States Agency fr Internatinal Develpment VMMC Vluntary Medical Male Circumcisin WHO Wrld Health Organizatin ii USAID ASSIST Namibia Cuntry Reprt FY17

7 1 Intrductin The USAID Applying Science t Strengthen and Imprve Systems (ASSIST) Prject started prviding quality imprvement supprt fr vluntary medical male circumcisin (VMMC) in Namibia in Octber Initially ASSIST s aim was t imprve VMMC services in the cuntry thrugh public-private partnerships invlving the gvernment and private health practitiners in 10 sites in ne ut f the 13 regins in the cuntry (Khmas). Fr VMMC, prject activities included: Supprting sites t cnduct cntinuus quality imprvement assessments t identify gaps in care quality Supprting the implementing partner (AIDSFree/Abt Assciates) and sites t implement imprvement strategies aimed at infectin preventin and cntrl t reduce the rate f cmplicatins fllwing circumcisin Maintaining accurate and cmplete data sets fr prgrammatic planning and budgeting Facilitating skills transfer t private health practitiners and Ministry f Health staff Strengthening linkages and integratin f VMMC services within the mainstream health system After the initial visit, USAID Namibia requested that ASSIST, drawing n staff based in the prject s Suth Africa ffice, als prvide supprt in the imprvement f HIV care and treatment and antiretrviral therapy (ART) and preventin f mther-t-child transmissin (PMTCT), HIV testing and cunseling (HTC), and TB/HIV services t the Ministry f Health and Scial Services (MOHSS) and PEPFAR implementing partners (IPs) prviding HIV/AIDS and TB services in the cuntry. ASSIST prvided this supprt t five public sites lcated in fur regins: tw ART/PMTCT sites (ne in Oshikt Regin and ne in Ohangwena Regin), three TB/HIV sites (tw in Katima Mulil District in Zambezi Regin and ne in Windhek District in Khmas Regin). Technical supprt included: Cnducting baseline assessments at PEPFAR IP-supprted sites: AIDSfree/Abt; Kninklijke Nederlandse Centrale Vereeniging Tuberculse Fnds (KNCV TB Prgram); Key Pp Sciety fr Family Health (SFH); USAID Clinical Services Technical Assistance Prject (UTAP)/IntraHealth; and MCSP/Jhpieg) Invlving all the IPs, MOHSS, and reginal staff in generating/reviewing the baseline findings Categrizing the sites per the type f supprt needed based n the baseline findings Prviding mnthly, quarterly, and annual CQI supprt based n the need t ensure that the services are prvided t the WHO standards ASSIST activities in Namibia clsed in September Cntinued CQI supprt fr VMMC services in Namibia will be prvided by the AIDSFree Prject in FY18. Scale f USAID ASSIST s Wrk in Namibia MOHSS, 5 IPs 4 ut f 13 regins (Khmas, Ohangwena, Oshikt and Zambezi) 10 ut f 120 private facilities (VMMC); 2 PMTCT/ART (MOHSS) and 3 TB/HIV (MOHSS) 4 IP QI teams and 10 facility QI teams 536,879 ut f 2.2 millin USAID ASSIST Namibia Cuntry Reprt FY17 1

8 2 Prgram Overview What are we trying t accmplish? At what scale? 1. Prvide cntinuus quality imprvement supprt fr VMMC, HTC, PMTCT, ART, and TB-HIV care 1.1 Reduce mrbidity and mrtality thrugh prvisin f quality and safe VMMC services Imprve the quality and ensure safety and effectiveness f VMMC services thrugh applicatin f CQI methdlgy Capacitate MOHSS, reginal, private practitiners, and PEPFAR partner staff n CQI t ensure prvisin f CQI in VMMC services and strengthen the health care system Supprt develpment, validatin, evaluatin and assessment f the prgrams 1.2 Imprve and strengthen HIV cunseling and testing services Increase the number f peple living with HIV wh knw their status and are enrlled in the wellness prgram Regins: 1 ut f 13 (Khmas) Facilities in regin: 10 ut f 120 private practitiner facilities IP QI teams: 2 (the tw teams versee all 10 facilities) Regins: 4 ut f 13 (Khmas, Zambezi, Ohangwena and Oshikt) QI teams: 2 internal IP and 5 facility-based teams 1.3 Imprve the quality f care and treatment services (ART/PMTCT/TB-HIV care) Imprve the quality f life fr peple living with HIV Reduce transmissin f the virus t uninfected peple Decrease the rates f TB/HIV c-infectin 2. Prvide CQI training fr HIV and AIDS prgrams Prvide supprt t MOHSS, AIDSFree/Abt Assciates t develp standardized VMMC CQI training curricula and standardize HTC, ART/PMTCT and TBHIV curricula in cllabratin with IntraHealth, Prject Hpe, and SFH. Regins: 4 ut f 13 (Khmas, Zambezi, Ohangwena and Oshikt) Facilities in regin: 2 PMTCT/ART sites (1 in Oshikt, 1 in Ohangwena), 3 TB/HIV sites (2 in Katima Mulil District in Zambezi Regin, 1 in Windhek District in Khmas), and 7 HTC sites (Oshikt Regin) QI teams: 5 Regins: 4 ut f 13 (Khmas Zambezi, Ohangwena and Oshikt) 80 IP, MOHSS, and private practitiners staff 3. Supprt US Gvernment-led VMMC external quality assessment (cre-funded) Supprt the VMMC external quality assessment (EQA) rganized by USAID in August 2017 with clinical, mnitring & evaluatin, and knwledge management persnnel Supprt reprting f findings t the MOHSS and the sites regarding the quality f the VMMC services being delivered. Imprvement Activity Regin: 19 private sectr sites in the Khmas Regin Crss-cutting Activity 2 USAID ASSIST Namibia Cuntry Reprt FY17

9 3 Key Activities, Accmplishments, and Results Activity 1. Prvide cntinuus quality imprvement supprt fr VMMC, HTC, PMTCT, ART, and TB-HIV care BACKGROUND The VMMC cntinuus quality imprvement (CQI) assessments were cnducted in seven f the private sectr sites in Octber 2016 and in the ther three private sectr sites in May All the sites were given feedback n their perfrmance by standard and were prvided with an Actin Matrix t develp quality imprvement plans based n the gaps identified. ASSIST led a CQI training in Namibia in February 2017, where all the districts were represented, as well as the MOHSS and implementing partners. Participants were seated by district t allw them t wrk tgether n challenges facing sites. ACCOMPLISHMENTS AND RESULTS Baseline quality assessment cnducted at seven VMMC sites in Windhek (Oct 2016) and then an additinal three sites in Windhek (May 2017). The assessment was cnducted with the VMMC implementing partner, AIDSFree/Abt Assciates. It assessed facility cmpliance t standards arund seven areas f quality based n the WHO VMMC Quality Assessment Tlkit. The assessment included reviewing patient recrds and bserving prviders. Three f the 10 sites t be assessed were riginally pstpned due t the unavailability f physicians; they were assessed during a secnd rund in May When sme physicians were nt available fr the baseline assessment, registered nurses wrking with the physicians were available. Sme quality standards were nt applicable in Namibia and were therefre nt included in the assessment. The main findings f the assessment included: All sites implemented the best practice f using an electrnic register that shws adverse events, if any, fllw-ups, HIV testing results and fllw-up, and type f surgical prcedure All sites had slid infrastructure, including sufficient space fr a waiting area and the infrastructure necessary t maintain infectin cntrl All sites had emergency trlleys with drugs althugh they did nt have a daily checklist fr stck cntrl Quarterly peer review meetings amngst dctrs prvided a platfrm fr imprved perfrmance Sites were mtivated t mve frm relying n lcums t hiring permanent staff nurses Figures 1 and 2 shw the results f the VMMC site assessments the first seven cmpleted in Octber 2016, and the final three cmpleted in May The verall perfrmance was 83.9% fr the first seven sites and 77.3% fr the final three sites. Of the 10 sites, nly three were assessed fr individual HIV cunseling and testing, and perfrmed prly at 47.7%. Figure 1. Namibia: Summary f baseline assessment acrss 7 VMMC sites, Windhek (Oct 2016) N. Quality Standards Areas Scre N. f sites assessed Ttal number f sub-standards Number f substandards assessed 1 Management systems 80.4% Mnitring and Evaluatin 84.9% Registratin, grup educatin and IEC Individual HIV cunseling and testing 47.7% Infrastructure, supplies, equipment, and 93.6% envirnment 6 Male circumcisin surgical prcedure 86.4% Infectin preventin 80.2% Overall Perfrmance 83.9% USAID ASSIST Namibia Cuntry Reprt FY17 3

10 Figure 2. Summary f baseline assessment acrss 3 VMMC sites, Khmas District, Windhek (May 2017) N. Quality Standard Areas 1 Management systems 2 Mnitring and Evaluatin 3 Registratin, grup educatin and IEC 4 Individual cunselling and HIV testing 5 Infrastructure, supplies, and envirnment 6 Male circumcisin surgical prcedure 7 Infectin preventin Scre Overall Perfrmance 77.3% N. f sites assessed Ttal number f sub-standards Number f substandards assessed 60.3% % % % % % 3 10 LEGEND Level f supprt Cllabrative Light Intensive Scre GOOD FAIR POOR Standards 1-5 >80% 80% - 50% <50% Standards 6-7 >85% 85% - 70% <70% Figure 3 shws results f the VMMC site assessments fr each f the 10 sites in Windhek in the Khmas District. Three sites shw pr perfrmance in Standard 7: Infectin, preventin and cntrl, which, tgether with Standard 8: Surgical Prcedure, frms the cre f VMMC; these tw standards are measured n a separate assessment scale (see legend abve) t reflect this. Overall perfrmance f the 10 VMMC sites was fair at 81.9%%. This CQI baseline assessment pinted t the need fr these facilities t be supprted with CQI t imprve the quality f VMMC services ffered t clients. 4 USAID ASSIST Namibia Cuntry Reprt FY17

11 Figure 3. Individual site cmpliance t the quality standards, baseline assessment f 10 VMMC sites, Khmas District, Windhek (Oct 2016 and May 2017) Dr Aneni Med. Center Circle Med. Center Grace Med. Center Dr Jna Med. Center Maerua Med. Center Wanaheda Med. Center Wellcare & Aesthetic Center Dr. CR Gawachab Family Medical Practice Management systems Mnitring and Evaluatin Registratin, Grup educatin and IEC Individual Cunselling fr VMMC and HCT Infrastructure Surgical prcedure Infectin Preventin and Cntrl Overall perfrmance 89% 97% 92% 93% 74% 89% 73% 81% 100% 88% 86% 96% 78% 48% 96% 68% 89% 79% 79% 88% 97% 95% 78% 87% 85% 76% 98% 85% 86% 80% 92% 92% 90% 67% 84% 60% 83% 82% 81% 76% 58% 83% 88% 87% 79% Best Practice 64% 70% 55% 94% 95% 97% 79% Nrth Lands Medical Practice 59% 68% 87% 81% 74% Ttal 74% 81% 55% 48% 92% 88% 83% 82% LEGEND Level f supprt Cllabrative Light Intensive Scre GOOD FAIR POOR Standards 1-5 >80% 80% - 50% <50% Standards 6-7 >85% 85% - 70% <70% Cnducted qualitative and quantitative baseline gap analysis fr HTC data (Q1-3). Implementing partners prvided data frm three districts, Khmas, Oshikt, and Zambezi, that ASSIST analyzed. This included an analysis f key ppulatins (KPs) receiving HIV cunseling and testing, which fund large gaps between targets and actual perfrmance (see Errr! Nt a valid bkmark self-reference.). This baseline analysis infrmed plans fr site-level mentrship and caching. Sites were supprted t develp an actin plan matrix and dcument changes tested and prgress n clsing gaps identified by the baseline analysis. The gap analysis als included KP clients wh enrlled in care and enrlled in treatment, amng thse wh received HTC. The analysis shwed that the prprtin f KPs wh tested psitive and were enrlled n ART varied widely between the three districts, frm 8% t 82%, and f thse enrlled, all were eventually lst t fllw-up. Issues identified included nt meeting HTC targets amng key ppulatins, high numbers f clients lst t care acrss the three regins, lw enrllment in care, and pr initiatin n treatment. Because the data did nt identify the types f KPs invlved, IPs need t clarify whether KPs include all f the fllwing KP grups (which is USAID s definitin f KPs): peple wh inject drugs, men wh have sex with men, transgender persns, sex USAID ASSIST Namibia Cuntry Reprt FY17 5

12 wrkers, and prisners. Figure 4. Gap in key ppulatins receiving HIV cunseling and testing (target vs actual), Khmas, Oshikt, Zambezi districts (Oct 2015 Jun 2016) 3,000 2,500 2,000 1,500 1, Windhek Walvis Bay Katima Mulil (Khmas) (Oshikt) (Zambezi) # KP Clients receiving HTC Q 1-3 Target # KP Clients receiving HTC Actual perfrmance Cnducted qualitative and quantitative baseline gap analysis fr PMTCT f data (Q2-3). This included an analysis f pregnant wmen wh are tested fr HIV r with knwn HIV status at entry t care in eight sites in Odib sub-district (Figure 5). It als included an analysis f early infant diagnsis f HIV in Odib sub-district, which shws that mst health centers are perfrming under the 80% target (Figure 6). Issues identified include: Impssible t knw hw many f the pregnant wmen came in with a knwn HIV status and the actual number tested, because data were nt disaggregated in this way. Thus, ne cannt determine f thse tested at the health center, hw many tested HIV-psitive and hw many were admitted with HIV-psitive status. Testing rate at referring clinics ranges frm 36% t 100%, with nly fur clinics registering testing rates f 84% t 100%. Stck-uts f rapid kits with health centers subsequently using ELISA TAT f 5-7 days. Sme wmen were discharged pst-delivery withut HIV results and n interventins. Mst mthers were nt hnring appintments fr results and pst-natal fllw-up, leading t mther-t-child transmissin (MTCT) risk. Misplacement f results due t lack f prper filing and dcumentatin in the registers MTCT risk as eligible infants will nt receive interventins. Lw early infant diagnsis f HIV thrugh virlgy HIV test. SPREAD OF IMPROVEMENT ASSIST prvided direct service delivery supprt at ne site per prgram t ensure creatin and existence f an envirnment fr benchmarking fr ther public and private sites in the fur regins thrugh establishment f Centers f Excellence. Lessns learned frm the Centers f Excellence will be scaled up by the fur implementing partners t the pilt sites and beynd. ASSIST supprt helped ensure that all stakehlders were expsed t the CQI prcess, including site and reginal QI teams, and were capacitated in the applicatin f CQI methdlgies and tls fr scaling them up t ther regins and sites. 6 USAID ASSIST Namibia Cuntry Reprt FY17

13 Figure 5. Percent f pregnant wmen tested fr HIV r with knwn HIV status at entry t care, 8 sites (Odib sub-district) Jan 16 Mar % 100% 80% 60% 40% 20% 0% Odib Hamukt wa Kapa Edundja Ohangwena Ohaukel Onamukul Ondbe Okatpe Q2FY16 Q3FY16 Q4FY16 Q1FY17 Q2FY17 Denminatr: Number f new antenatal care and labr and delivery clients Odib Hamukt wa Kapa Edundja Ohangwena Ohaukel Onamukul Ondbe Okatpe Q2FY16 Q3FY16 Q4FY16 Q1FY17 Q2FY17 Figure 6. Percent f infants wh had a virlgic HIV test within 12 mnths f birth, 8 sites, Odib sub-district (Jan 16 Mar 17) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Odib Hamukt wa Kapa Edundja Ohangwena Ohaukel Onamukul Ondbe Okatpe 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Q2FY16 Q3FY16 Q4FY16 Q1FY17 Q2FY17 Target USAID ASSIST Namibia Cuntry Reprt FY17 7

14 Activity 2. Prvide CQI training fr HIV and AIDS prgrams BACKGROUND ASSIST wrked twards strengthening the implementatin and quality f VMMC, HTS, ART, PMTCT, and TB-HIV services in an integrated and patient-centred manner in Namibia t enable the MOHSS t mve twards the achievement f the gals. T facilitate this, USAID identified the need fr CQI supprt in HIV and AIDS services prvided thrugh public-private partnership in particular, the need t develp and prvide cmprehensive and cnsistent CQI capacity building / training fr MOHSS and private sectr prviders invlved in VMMC, HTS, ART, PMTCT, and TB-HIV service prvisin. ACCOMPLISHMENTS AND RESULTS Cnducted fur-day (Feb 2017) and tw-day (May 2017) CQI trainings fr dctrs, nurses, USAID/Namibia s Health Systems Strengthening and Quality Team, and staff frm implementing partners, the Namibia HIV Sciety, and the MOHSS. The training was designed t help trainees apply the principles f the science f imprvement t health care imprvement. The curse was designed arund a real-life VMMC case study in Suth Africa. It tk the participants thrugh a simulatin exercise f a VMMC imprvement jurney. The fundamentals f imprving health care, as well as the methds, were illustrated thrugh a series f imprvement mdules. The training aimed t develp knwledge and skills t enable participants t: Define an imprvement aim Frm imprvement teams Analyze prcesses f care Test and implement changes t enable the implementatin f interventins in everyday wrk Mnitr and evaluate results f tested change Implement prgrams quality standards and & use recrds During the CQI training, each district develped quality imprvement plans based n their real challenges using the CQI methdlgies. These quality imprvement plans integrated gender. Each grup fcused n their actual prgram s challenges and were supprted in develping changes t test t imprve the quality f care. CQI tls were reviewed and aligned t address the natinal cuntry cntext. A schedule f CQI supprt was shared with partners. The UTAP and KNCV partners frm Ohangwena District in the Nrth requested t be supprted n the quality imprvement plans they develped. The CQI supprt was based n the way frward frm the meeting f implementing partners which was held fllwing the training, in March ASSIST was requested t supprt the ART/PMTCT and TB/HIV prgram in the Nrth, thrugh its Suth Africa-based staff. Participants in the February training were frm seven districts and included partners fr VMMC, PMTCT, ART, and TB/HIV. Partners frm UTAP, KNCV, and HTC attended. Unfrtunately, Prject Hpe and SFH culd nt attend. The participants were taken thrugh the prcess f CQI, including the Plan-D-Study-Act cycle, use f Fishbne diagrams fr rt cause analysis, use f dcumentatin jurnals t track imprvement wrk, and pltting results using time series charts. During the training, the qualitative and quantitative gap analysis reprt (baseline) n HTC, ART/PMTCT, and TB/HIV was shared with participants, wh then develped site-specific quality imprvement plans based n their respective challenges in their cntent areas. Participants in the May 2017 training n CQI were frm Omuthiya and Engela hspitals and included KNCV and UTAP partners. It was bserved that cmpletin f viral lad assessments was a challenge, but the facilities have taken n sme f the best practices shared with them, including using stickers t serve as a reminder n client s recrds. The sites were taken thrugh CQI prcesses: identifying, analyzing, testing changes, and making decisins t adapt, adpt, r abandn and are being encuraged t develp QI teams. It was agreed after the training that IP staff wuld use the CQI supprt and mentring and guidance tl as a guide t mentring during CQI visits. In additin, use f the QI team dcumentatin jurnal was encuraged t track each site s prgress. Pre- and pst-training knwledge tests shw an average scre increase f 11%. 8 USAID ASSIST Namibia Cuntry Reprt FY17

15 Held partners meeting (Mar 2017). After the CQI training, ASSIST held a meeting fr all partners t share their different prgrams, challenges, and hw their tls can be aligned based n the baseline reprt, and strengthen what is already happening with the MOHSS. We als planned ur CQI supprt. The fllwing areas were discussed: Areas f supprt needed per partner Intrductin t the prcess f CQI Pilting a few sites then scaling up The need t align tls and t strengthen what is already happening at MOHSS The gaps that were identified during Site Imprvement thrugh Mnitring System (SIMS) assessment and the need t incrprate CQI. Activity 3. Supprt US Gvernment-led VMMC external quality assessment (cre-funded) BACKGROUND In late June 2017, the VMMC team at the Office f HIV/AIDS (OHA) requested ASSIST supprt fr an external quality assessment f the private sectr VMMC sites in the Khmas Regin f Namibia. The gals f the EQA were t: 1) ensure that the PEPFAR-supprted sites were prviding VMMC services accrding t recmmended natinal and Wrld Health Organizatin (WHO) guidelines and PEPFAR plicy directives cntained in the 2017 Technical Cnsideratins; and 2) prvide infrmatin t the MOHSS and the sites regarding the quality f the VMMC services being delivered. Funding fr ASSIST s EQA supprt was prvided thrugh the VMMC cre funds frm USAID OHA. ACCOMPLISHMENTS AND RESULTS The USAID-led Namibia VMMC external quality assessment (EQA) was carried ut at 19 private sectr sites in the Khmas Regin (Aug 2017), by three teams (A, B, and C) cmpsed f MOHSS, USAID, CDC, USAID ASSIST, AIDSFree, and HC3. ASSIST prvided the fllwing staff frm Suth Africa and Uganda t supprt the EQA implementatin: Ms. Vilet Manthata, Dr. Jhn Byabagambi, Dr. Raymnd Mabuse, Mr. Hulisani Matakanye, and Mr. Manasa Allan Ayami. Supprted EQA reprting (Aug-Sept 2017). Fllwing the EQA implementatin, ASSIST headquarters and Suth Africa ffice prvided supprt fr cmpletin f the verall Namibia EQA reprt and the 19 site-level reprts. Fllwing the EQA, USAID Namibia requested tw weeks technical supprt frm Dr. Jhn Byabagambi f ASSIST Uganda, t wrk with AIDSFree t prvide CQI supprt t a number f the assessed private sectr sites (Sept 2017). This CQI supprt was funded by the Office f HIV/AIDS under ASSIST s VMMC transitin plan. 4 Sustainability and Institutinalizatin ASSIST wrked t build the capacity f private sectr health practitiners, implementing partners, and MOHSS staff in Namibia t incrprate CQI in VMMC, HTC, ART/PMTCT, and TB/HIV services thrugh prviding quality imprvement training sessins, mentrship, and technical assistance. In additin, the prject wrked with ther PEPFAR partners invlved with HIV/AIDS and TB services that supprt the MOHSS in Namibia, private sectr health practitiners, and the MOHSS t ensure utilizatin f CQI methdlgies and prgrammatic data t identify pririty areas, gauge perfrmance, and plan fr scaleup f services. ASSIST als supprted the standardizatin f tls and develpment f QI indicatrs accrding t the needs f specific prgrams supprted with CQI. By ensuring buy-in and capacitatin f key stakehlders at all levels, we believe that cnditins fr ensuring sustainability fr CQI wrk are being created. 5 Gender Integratin Gender integratin was included as part f the QI training sessins in February and May 2017, including a discussin f the rle f gender integratin in all different HIV prgrams (including VMMC). Site-specific quality imprvement plans integrated gender cncerns. USAID ASSIST Namibia Cuntry Reprt FY17 9

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