Announcement of the New MoHSS-CDC 5 year Cooperative Agreement

Mrs. Anne-Marie Nitschke, Director of Special Programs, Mr.Benjamin Nangombe, Executive Director of the MoHSS, Hon. Dr. Shangula, Minister of Health & Social Services, U.S. Ambassador to Namibia, Ms. Lisa Johnson & Dr. Eric Dziuban, Director, CDC

Remarks by the U.S. Ambassador to Namibia, Ms. Lisa Johnson and CDC Country Director, Dr. Eric Dziuban at the announcement of the new MoHSS-CDC 5 year cooperative agreement

Hon. Dr. Shangula, Minister of Health & Social Services with U.S. Ambassador Lisa Johnson.

U.S. Ambassador to Namibia, Ms. Lisa Johnson

Good morning – I am thrilled to be here with you today. The U.S. Embassy and the Ministry of Health and Social Services have enjoyed a long and fruitful relationship. Today, I am pleased to have the opportunity to announce the launch of our next five-year cooperative agreement.

As a diplomat, I spend a lot of my time discussing deals, grants, agreements, and other forms of mutual understanding. Since I joined the Embassy last year, I have worked on a number of bilateral arrangements including the U.S-Namibia Air Services agreement, opening the U.S. market for exports of Namibian beef, and planning for the new U.S. Embassy compound.

However, “cooperative agreements” are special. They represent more than a transfer of money or goods. Cooperative agreements are also about the transfer of skills and technical assistance. They open a two-way transfer that benefits both sides.

The partnership between the Ministry of Health and CDC brings together an impressive and diverse skill set. The impact of the relationship is very clearly shown in the numbers. The Ministry of Health recently announced that Namibia, in terms of meeting the UNAIDS 95:95:95 targets, is currently at 94:96:95. This is an incredible achievement.

But there is also a qualitative impact that the numbers do not show. I am always pleased to observe how people change for the better when they work together. A U.S. technical advisor who begins work in Namibia is a very different person than the advisor who leaves three or four years later. I thank our Namibian counterparts for helping our advisors grow as much as our advisors have helped you grow. Working together works best when both sides are open to learning from one another. I am pleased to see that happening here.

This new agreement uses the term “substantial involvement.” I like that term because it does justice to what I have observed during the previous cooperative agreement between the Ministry and CDC.

Substantial involvement also means a shared responsibility for the outcomes of a project. We all know that the demands of PEPFAR funding are exacting. It is appropriate that the U.S. Government provides sufficient support to its partners, and takes on a shared responsibility, to ensure the successful implementation of the activities that are funded under these agreements.

When I joined the team in Johannesburg for the Country Operational Plan review in March, the main purpose of the discussion was to show what Namibia is planning to do from October 2019. However, the conversation often included what Namibia is already doing to achieve these future goals. I am proud to lead a team that is forward-looking and forward-planning, never resting, but already reaching for the next challenge, the next goal, the next success that saves more lives of people throughout the country.

While relationships and technical assistance are critical, this cooperative agreement is vital in that it provides the mechanism through which the U.S. Government channels financial support to the Ministry of Health and Social Services. On Thursday, we are scheduled to have a signing ceremony with the U.S. Office of the Global AIDS Coordinator, which heads up PEPFAR worldwide, to confirm the funding total for Namibia from October 1, 2019.

Financing is important, and the U.S. Government is pleased to be the largest single government supporter in the world in combatting the HIV epidemic. Ending AIDS costs money. The U.S. Government recognizes this and places funds where they can best be used to end the epidemic in individual countries, which has an impact of increasing the health and global security for the entire world.

I am extremely proud to have the opportunity to work with PEPFAR because it is a program driven by transparent, accountable, and efficient investments. PEPFAR is a smart investment and is widely viewed as one of the most effective and efficient foreign assistance programs in history. PEPFAR uses the latest data and science to direct resources where the HIV/AIDS epidemic is the largest, the need is highest, and the dollars are most proficiently used.

The U.S. CDC and the Ministry of Health and Social Services first signed a cooperative agreement in 2004. Over the next 15 years, CDC, alongside other U.S. agencies as such USAID and Peace Corps, as well as multilateral partners and other stakeholders, have helped Namibia come a long way in addressing the HIV epidemic.

Together we have more than halved the incidence of HIV infections and we have more than halved the number of people dying from HIV. These are incredible achievements and they have been reached because of the partnerships we have established. Together, we are more effective than we are alone. Let’s continue to go forward, together.

Thank you.

CDC Country Director, Dr. Eric Dziuban

Good morning. Last year I attended my first Ministry of Health and Social Services site meeting and it was an event that stuck in my mind. It was the first time I had the opportunity to address the broad MoHSS team working towards epidemic control. It was an opportunity to pause and reflect on where we had been, where we are going, and was invaluable in helping us to chart our course more precisely for the next 12 months. It was also memorable for me because I choked up quite a bit when I spoke about some of the HIV cases I have treated as a clinician during my time working in ART clinics in a nearby country. Namibia has many causes for celebration in how the country is addressing the HIV epidemic. But we never want to forget the pain and suffering that has been caused by this virus, and the lives that have been lost. Different cultures have their own ways and norms for showing emotions during public remarks. And none of us want to be crippled by emotions when we are trying to get our work done. But it is important that you remember the loved ones you lost to HIV while you continue this fight every day. It is important that I remember the people I cared about because of this virus that is treatable and preventable. We must always honor and remember those who have died. And we must work our hardest, every day, to keep any more of the people in our communities … in our lives … from joining them.

Indeed, a lot has happened in the last year. I have been part of just the final year of the concluded five-year cooperative agreement, but it was impressive. Many of you will have seen the whole agreement through – or better yet, seen all three CDC-Ministry agreements through, and I recognize the wealth of experience and knowledge that comes with that. I won’t go into the successes of the most recent agreement, I will leave that to the Executive Director, but I will congratulate you all on the achievements that you have made.

With the Executive Director looking at the highlights and achievements of the previous cooperative agreement, it falls to me to talk about where we are going next and how we are going to get there. Put simply, what does the next cooperative agreement look like, and how will it be different to the one that has just concluded?

First, let me set out our overall vision for the next five years. In three words, our vision is to achieve sustained epidemic control. We will be working closely with the Ministry of Health and Social Services to develop a strategy that is grounded in setting the stage for the long-term transition to full Namibian domestic leadership. In the short term, we will be optimizing locally led program implementation in order to reach the last and most challenging hot spots and unmet needs in the country. The result of this focusing of effort will be a stronger, data-driven response that will allow Namibia to reach epidemic control in a sustainable manner.

But please do not mistake my words to think that we will be pulling away. The U.S. Centers for Disease Control and Prevention has developed another five-year cooperative agreement because we remain committed to being firm partners with the Ministry of Health and Social Services. We do operate on a yearly funding mechanism that means that we don’t yet know what, if any, funding we will receive after September 2020. That’s how it has always been. But I can tell you this – as an office and as a Mission – we are committed to advocating for a continued relationship.

Because while Namibia is a leader on the continent in terms of showing how epidemic control can be reached, the successes are still fragile, and beneath an incredible national picture of epidemic control there are concerning differences in healthcare outcome by age, sex, and region. It is our vision with the Ministry to continue to work together to eliminate these differences, and to work together to achieve sustained epidemic control.

So what does the next cooperative agreement look like? This will be the fourth cooperative agreement between CDC and the Ministry, and in the next five years we anticipate that Namibia will have fully reached HIV epidemic control in the country and will be shifting focus towards providing stable long-term quality care and treatment of those living with HIV and the strengthening of the primary healthcare system.

It is important to remember that ending the HIV epidemic does not mean that HIV goes away; it means that we will be seeing fewer and fewer new cases, but we will still continue to have the patients who are already diagnosed with HIV, and these patients will still need to have quality services in the form that best meets their needs.

One of the highlights of my first year in Namibia was to see firsthand just how rural and remote some communities are. I knew this before I arrived, but it was not until I experienced it firsthand that I really understood what we mean when we say that people have to travel long distances to access healthcare and just how hard that is, especially in the blazing heat that touches every corner of the country. I visited all 14 Regions last year but I never saw one that I would describe as having a “mild” climate.

In October last year, I joined the U.S. Ambassador to hand over ten CBART sites in Omusati and Oshana to the Ministry. I remember the journey to the first site well – it took over 2 hours by car and was on a road, that as a tourist, I would have missed. I would certainly not have known it led to a vibrant and dynamic community who had worked with the Ministry to identify and allocate land for their own, now fully functioning CBART site.

The Akutsima CBART site is the perfect example of what it will take to continue to provide quality care and treatment services to long-term patients. This community will need to continue to receive quality HIV care and treatment services on a regular basis. We must remember that while U=U (undetectable = untransmissable), the opposite is also true: H=H … a high viral load means a high risk of transferring the virus to other people. While Namibia is already on the cusp of epidemic control, there is no a guarantee that it will remain that way. It will be all too easy to rapidly backslide if the pressure to maintain high quality prevention, care, and treatment efforts is not maintained.

On to my second question – how will the new cooperative agreement be different? One highlight is that we will be expanding our partnership to reach more areas of Namibia. In recent years, PEPFAR funding has focused strongly on the high-burden regions of Namibia. This was the right decision because it ensured the best use of resources to have the greatest impact on the disease, and it has allowed Namibia to sit on the cusp of epidemic control. But the NAMPHIA results have shown us very clearly that the lower burden regions also need more intensive support, because it is in these areas that people living with HIV are more likely not to be virally suppressed. This is something that will be addressed under the new cooperative agreement.

We will also be focusing on the age differences. Children and teenagers also have poor viral load suppression. To put it simply, this means that the next generation of Namibians is at risk. The Ministry recognizes this as a vital area to address, and through the cooperative agreement we will be working fast and effectively to ensure that a child living with HIV has the best possible care, and reaches and maintains viral load suppression as soon as possible. We cannot have children’s lives being cut short because of inadequate treatment, and we do not want to be introducing a new pool of young adults who could rapidly pass and spread the infection to others. If we look back to the very early days of HIV infection, the warning is clear. In 1986 there were four cases of HIV in Namibia. At Independence there were six. Twenty-nine years later we have 200,000 cases of HIV. Let us help the next generation of Namibians avoid the dangers of an uncontrolled epidemic that all of you have experienced.

The new cooperative agreement will also be expanding to new areas – we will be working more deeply along the border of Namibia to ensure that non-Namibians receive healthcare services as per Ministry policy. And we will be working closer with other Ministries, such as the Ministry of Safety and Security, to ensure that persons within Correctional Facilities receive the same care and treatment services as those living in communities throughout Namibia, protecting them and those around them.

Therefore, the new cooperative agreement between CDC and the Ministry of Health and Social Services will be continuing what is working well, upscaling promising programs, and introducing new methods and strategies to help us reach our goal. It is an exciting opportunity to bring the AIDS pandemic definitively from crisis toward control. On behalf of CDC, I thank the Ministry for being such a dynamic and inspirational partner. I stand here and recognize you all for continuing to honor those we lost, and for the hope you provide to the Namibia of today and the future. Let the work commence.

Thank you.