Scaling up what works: replicating models on community service delivery and advocacy Jennifer Gatsi Mallet Namibia Women’s Health Network / ICW

Community Mobilization  The process of engaging communities to identify community priorities, resources, needs and solutions.  Using these resources to promote representative participation, good governance, and accountability.  Leads to increased awareness and knowledge of HIV prevention, treatment, care and support of HIV and AIDS.

ARV Rollout  Goal: All HIV positive people accessing ARV  In 2008 ARV supplied at 13 Hospitals across all regions  PMTCT services at 6 State and 4 Church Hospitals  55,000 of 100,000 people living with HIV accessed ARV treatment. More than 75,000 by March 2010 (MoHSS and UNAIDS, 2011), and 50,000 on pre-ART.  Hospitalisation rates decreased from 9,465 in 2006 to 1,597 in 2009, while the number of deaths declined from 2,622 to 359. (MoHSS, 2010)  By ART and 89 outreach sites were established

ARV Rollout  The ARV Rollout is considered a success case  successful through community advocacy, education, and mobilization of resources and information to the people.  Included traditional and community leaders, and to integrated home based care.  ARV Rollout included CBOs & HBC orgs.

Community and Home Based Care (CHBC) and Patient Experts  20,000 volunteers, HBC to over 70,000 with primary healthcare services  Community and individual support groups  Testing, adherence to ART  Patient experts: trained by Ministry of Health, women who are living with HIV.

WHO Guidelines  2010: All infants who have known exposure to HIV or unknown; virological testing at 4 to 6 weeks of age.  If initial positive virological test they should start ART immediately.  Namibia experienced a 50% decline in MTCT between 2009 and 2012.

Prevention of Mother to Child Transmission  Implemented in 2002  2010 had achieved 77% coverage, with a complete course of ARV for women in need of PMTCT.  package of HIV-testing, ARV prophylaxis, counseling for nutrition and infant feeding, as well as family planning counseling services.  Namibia was the most successful in regards to PMTCT implementation in all of Africa.

Elimination of Mother to Child Transmission  Piloted by the Government of Namibia in 2012 with the goal to have zero babies born HIV positive by  4 Prong Approach: 1.HIV prevention among women of childbearing age 2.prevention of unintended pregnancy 3.prevention of MTCT (ARV provision to pregnant women and ensure safe delivery) 4.Family-Centered HIV Care, Treatment and Support, ARV provision, cotrimoxazole prophylaxis.

Namibia Women's Health Network  Elimination of Mother to Child Transmission Support Groups in the communities.  Encouraging people living with HIV to adhere to treatment through nutritional programs and support groups.  The Support Groups provide the women with an outlet to discuss barriers to treatment and testing.  EMTCT Project and Field officers educate the women about interacting with the healthcare system in order to understand their rights and adhere to treatment. Namibia Women's Health Network & ICW

Namibia's National Strategic Framework  informed by mutli-stakeholders and WHO Guidelines  Two aims of the NSF: 1. Preventative measures and testing 2. Improved quality of life for PLWHA through community based care and access to treatment for all.  2013 Recommendation: Advocacy to be strengthened at the community level to the most vulnerable population groups, in particular (young women and mobile populations).  Policy formation included NWHN but needs translators and more support for women from the community.

Workplace Programs WPP  Deliver health support inputs with a focus on HIV prevention benefit employees directly at their place of work.  In 2013, awareness-raising inputs and HIV tests at the workplace were made available for some 45,000 company employees  Namibia takes multi- sectoral approach

IMPACT: IMPACT: Impact: 1)Strengthens collaboration and partnerships between government, civil society and communities 2) Endorses the importance of creating smart partnerships with communities 3) Creates Policies which responds to community needs and ensures national budgets are tailored to support communities and civil society programs in scaling up access to testing, treatment and support 4) Promotes meaningful involvement of WLHIV, key affected groups and communities in all stages of developing policy, promoting and scaling up access to testing and treatment 5) Puts WLHIV and key populations at the forefront of policy development

We need to care, with empathy and dignity, for those who are living with HIV, their families and communities. We need to remember that although individually, we are like grains of sand, together we are the majestic dunes of the Namib. We can be powerful and majestic, together. -President Pohamba