François-Xavier Bagnoud (FXB) Center's proposed workplan for FY 2007 builds on accomplishments and multiphase work started in FY 2005 and FY 2006, in support of the scale-up, standardization, and facilitation of an effective and sustainable national prevention of mother-to-child transmission of HIV (PMTCT) program for multidisciplinary teams of healthcare workers (HCWs).

In FY 2005, the USG invited FXB Center to provide technical assistance (TA) for the Tanzanian government's efforts to expand delivery of PMTCT services nationwide. Among the FXB Center's first activities was to work with the PMTCT Zanzibar Technical Working Group (TWG) to develop its PMTCT curriculum, which is based on the generic training package (GTP) created by the World Health Organization and Health and Human Services- CDC (WHO/HHS-CDC). The FXB Center also conducted an in-depth analysis of the national PMTCT guidelines and provided extensive recommendations for critical additions and updates. The FXB Center will finalize these guidelines in September 2006.

In FY 2006, FXB's goal is to collaborate with USG and MOHSW-mainland Tanzania to provide TA and continued support to develop national systems and standardization of PMTCT services that will promote long-term sustainability. FY 2006 funding supports development of the national PMTCT curriculum, which will be pilot-tested in October 2006. That funding also supports a midterm PMTCT program review of USG PMTCT sites to assess coverage, identify strengths and challenges, and develop systems for monitoring PMTCT training.

In FY 2006, FXB designed a preceptorship program for HCWs in Zanzibar based on needs, experiences, and outcomes of the PMTCT training. The preceptorship program is a vital follow-up component of PMTCT training, and is designed to provide onsite, supervised practical training to HCWs who have participated in the PMTCT training.

A key objective is to integrate PMTCT training into the pre-service curriculum, which will achieve and ensure sustainability of the efforts of the nascent PMTCT program. FXB Center is facilitating this process by assessing existing curricula. FXB will follow up by developing a plan to integrate PMTCT content into the curricula, and will complete the preceptorship and pre-service curriculum activities in October 2006 and March 2007 respectively.

For FY 2007, FXB proposes to build on these accomplishments to support the priorities of the national multisectoral strategic framework on HIV/AIDS. The goal of the FY 2007 workplan is to collaborate closely with MOHSW and USG to provide TA to facilitate program sustainability, enhance uniformity and standardization of PMTCT service delivery, and ensure continued monitoring of PMTCT training efforts and initiatives.

FXB proposes the following activities:

Facilitate linkage of PMTCT training efforts and capacity building for supervisors: The MOHSW has requested TA to support PMTCT supervisors at the regional, district, and facility levels to mentor and monitor HCWs following PMTCT training. FXB Center will develop a supervisor's guide to enhance the performance of HCWs, so that PMTCT service delivery reflects the standards communicated in the PMTCT training. This guide will provide mechanisms for: easy documentation of the skills and competencies expected from HCWs to have after training; identification of barriers to quality service delivery; and problem-solving strategies. The guide will be disseminated to the approximately 544 government-supported PMTCT sites.

Enhance uniformity and comprehensiveness of current site supervision: To help standardize the services provided at PMTCT sites, the FXB Center will develop and help to implement quarterly supportive supervision tools for supervisors at the 123 district offices. The tools will be based on national PMTCT indicators, will be designed for use at the facility level, and will include checklists and process improvement plans that will facilitate follow-up on unmet needs at facilities (e.g., supplies, human resource shortages, and service incapacities).

Support implementation of core elements of the PMTCT program and guidelines: Based on assessments and indicated needs by MOHSW, FXB Center will develop HCW support

tools including algorithms, wall charts, and other job aids related to district needs. According to the Health Sector HIV/AIDS Strategy paper, key intervention areas under training include the development of simple, easy-to-understand graphics for health professionals, as well as sensitizing HCWs to national guidelines and treatment algorithms. These tools will provide accessible reinforcement of the "take-away" messages from the national PMTCT guidelines and training curriculum, developed and implemented in FY 2005/2006. The staff at the 544 government-supported PMTCT sites is the initial target audience for these job aids.

Support the implementation and systematic, periodic revision of Tanzania's PMTCT guidelines and training materials, and facilitate refresher training for service providers: With the PMTCT TWG, the FXB Center will establish a system to periodically revise the national PMTCT guidelines and training materials. FXB will also design a comprehensive PMTCT national training plan and a system for the MOHSW to implement the plan at PMTCT sites nationwide.

Develop and support human capacity development for PMTCT: FXB Center will develop materials and conduct training for PMTCT managerial staff on the following topics: planning and project management; staff management, development and team-building. This is in harmony with the national strategy to introduce comprehensive management skills and empower HCWs to plan and implement HIV/AIDS programs in a continuum. This activity targets managers at the national and regional offices and will include facilitation of a twinning relationship between MOHSW counterparts in Tanzania and Botswana, which will enable them to share experiences and support development of management skills.

Address service provider resource issues: HCW retention has been identified as a priority by the MOHSW. With the support of the FXB Center in-country staff person, FXB will develop a comprehensive multisystem, multiphase, retention plan for HCWs, in collaboration with the MOHSW and the PMTCT TWG, both of which will determine coverage and target personnel. This builds on the work started by FXB to monitor PMTCT training. This activity will draw from a comprehensive HCW retention strategy developed by the FXB Center for the Botswana MOH. The strategy includes detailed guidance and supportive tools for MOH staff to facilitate implementation of each phase.