The USG supports the Ministry of Health and Social Welfare (MOHSW) in scaling up and increasing access to PMTCT services. Currently over 500 public and private including Faith Based Organizations sites are providing PMTCT service and over 200,000 pregnant women are receiving basic PMTCT services including counseling and testing. So far, over 6,000 HIV positive pregnant women have received ARV prophylaxis.

The USG has played an instrumental role in supporting the MOHSW to establish national systems, engaged partners and rolled-out these services to cover most regional and district level facilities. The challenge that the program is currently facing includes: Scaling up services to lower level facilities and improving the uptake of PMTCT services. Other challenges include ensuring that follow-up and linkages for infants takes place and that the quality of PMTCT services, is of desired standards.

With the adoption of the improved PMTCT guidelines that includes the introduction of a more efficacious PMTCT regimen, plans to scale downwards and strengthen the quality of PMTCT services, the Tanzania PMTCT thematic group sees the need for two technical assistant visits to support the MOHSW and USG partners to proceed with these new directions/challenges.

Targets

Target Target Value Not Applicable Number of service outlets providing the minimum package of
PMTCT services according to national and international standards Number of pregnant women who received HIV counseling and
testing for PMTCT and received their test results Number of HIV-infected pregnant women who received
antiretroviral prophylaxis for PMTCT in a PMTCT setting Number of health workers trained in the provision of PMTCT
services according to national and international standards

Table 3.3.01:

This activity links to #9490 in OP and to all activity narratives in the AB section.

FY07 funds will support two full time equivalent staff who will assist in coordinating activities within this program area as well as serve as technical leads for aspects of the work. The specific composition of the staffing is one full-time AB specialist hired as a fellow supported by .5 FTE of an FSN and .5 FTE of an USDH/L,

The full-time staff member works directly with implementing partners, both governmental and non-governmental, to improve the quality and reach of AB activities. Technical assistance is provided through site visits, capacity assessments, mentoring and skills building, as well as monitoring of progress. The fellow works directly with several implementing partners to develop effective interventions and to disseminate lessons-learned to others. She is an active member of the national prevention technical working group, assisting the Government of Tanzania (GoT) to define national priorities and strategies to achieve long-lasting behavior change. The FSN focuses on the work of ABY partners, ensuring state-of-the-art programming, incorporation of national guidelines, and coordination with other implementing partners.

The USDH (which is currently vacant) will assist in the identification of portfolio-wide, as well as national, prevention needs. S/he will assist in the development of a USG strategy to address these needs, ensuring that USAID prevention related activities complement those provided by other USG agencies and fill gaps as needed. The senior USDH will also work with all USAID portfolio managers to ensure integration of prevention interventions across the continuum of care and treatment.

All 3 members of staff will be active members of the USG Prevention Thematic Group.

Table 3.3.02:

This activity is linked to #9461 and #9411in AB.

The USG/Tanzania Prevention Working Group has identified its critical technical assistance needs for FY07 funding in AB. These specific requests will assure effective support of the USG Team and identified implementing partners in this section of the COP. This technical assistance is envisioned to provide up to date technical information and programming guidance for effective AB messaging which includes AB for Youth and B Messaging for adult males. The identified technical assistance needs for USAID includes:

Technical assistance is needed in order to assure effective support and implementation of a USAID TBD implementing partner for a male involvement activity. USAID is requesting O/GAC's Gender Theme Group to provide assistance to USAID in workplan and activity negotiation once the implementing partner is identified. Ms. Susan Settergren has been identified as the consultant of choice.

Table 3.3.02:

This activity is linked to narrative # 8724 in OP.

The USG/Tanzania Prevention Working Group has identified its critical technical assistance needs for FY07 funding in OP. These specific requests will assure effective support of the USG Team and identified implementing partners in this section of the COP. This technical assistance is envisioned to provide up to date technical information and programming guidance for effective messaging to high risk groups which includes IDU, CSW and other MARP populations. The identified technical assistance needs for USAID includes:

Technical assistance to work with the in-country Prevention Working Group to review the USG Other Prevention portfolio. The consultant will take a critical eye at the activities to assist in determining which activities are successfully moving USG/T towards their prevention goals. This TA needs to take place well in advance of preparation for the FY08 COP. No consultant has been identified; it is anticipated that this visit will take place in coordination with the CDC technical assistance visit of Dr. Richard Needle.

Table 3.3.05:

This activity is linked to all activity narratives in OP and to 9410 in AB.

FY07 funds will support .5 full time equivalent staff who will assist in coordinating activities within this program area as well as serve as a technical lead for aspects of the work. The specific composition of the staffing is .5 FTE of a full-time prevention specialist hired as a Fellow.

The .5 FTE Fellow works directly with implementing partners, both governmental and non-governmental, to improve the quality and reach of OP activities. Technical assistance is provided through site visits, capacity assessments, mentoring and skills building, as well as monitoring of progress. The Fellow works directly with several implementing partners to develop effective interventions and to disseminate lessons-learned to others. The Fellow is an active member of the National Prevention Technical Working Group, assisting the Government of Tanzania (GoT) to define national priorities and strategies to achieve long-lasting behavior change.

The Fellow will be an active member of the USG Prevention Thematic Group.

Table 3.3.05:

This activity is linked with activity #7667 in Other Prevention and with #7668 and #9425 in AB.

The AED T-MARC Project was awarded by USAID in September 2004. With FY07 funds, USG will conduct a mid-point program evaluation of this project to determine progress achieved, and to identify potential improvements to be incorporated into program implementation.

A two person consultant team will be procured to conduct a three week external program evaluation of the AED Tanzania Marketing and Communications (T-MARC) project. This program evaluation will be used to determine the effectiveness of the implementing partner and to recommend improvements for program performance and effectiveness. .

USG agencies provide direct technical support for all of its HIV/AIDS programs through US and Tanzania-based organizations, which manage and implement in-country activities.

These activities are funded through cooperative agreements and contracts and are performed at the field level in direct partnership and collaboration with Tanzanian governmental and non-governmental organizations. The non-governmental implementing partners have considerable experience in the field of HIV/AIDS and have established offices in Tanzania to carry out these activities. The technical assistance (TA) and support provided by USG agencies to our cooperative agreements and contracts will ensure a shared vision for a long-term sustainable system for providing HIV/AIDS services to Tanzanians.

In FY07, this funding will support the in-country Palliative Care Basic Health Care program with TA from USG agencies Headquarters. The TA will work closely with the Minstry of Health and Social Welfare National AIDS Control Program Home-based Care Program and USG-funded partners who are charged with the implementation of the national guidelines for facility- and home-based palliative care. The TA will support the monitoring of various partners to achieve the goals of the national program and ensure the enhancement of existing services to include new components and stronger linkages with ART sites and the community.

Targets

Target Target Value Not Applicable Total number of service outlets providing HIV-related palliative care
(excluding TB/HIV) Total number of individuals provided with HIV-related palliative care
(excluding TB/HIV) Total number of individuals trained to provide HIV-related palliative
care (excluding TB/HIV)

Table 3.3.06:

FY07 funds will support one full time equivalent staff who will assist in coordinating activities within the USG portfolio, serve as a technical lead for aspects of the work, and facilitate programming collaboration across stakeholders. The staff member will work directly with implementing partners, both governmental and non-governmental, to improve the quality and expand the scope of services provided to orphans and vulnerable children. Activities will include site visits, capacity assessments, mentoring and skills building, as well as monitoring of progress. The staff member will continue to play an integral role in assisting government to operationalize the national plan of action, rationalizing resource utilization and expectations for reach. As the only OVC specialist on the USG team she will assist in the development of a USG strategy to address emerging issues, ensuring that USG OVC related activities complement those provided by other entities, incorporate best practices and lessons-learned, and fill gaps as needed. She continue to be an active participant in national technical working groups, providing direct technical support for the development of curriculums and materials, as well as serving on the USG/Tanzania's OVC thematic group.

Table 3.3.08:

This activity relates to the CT technical assistance that wil be provided by CDC and DOD. FY 2007 funds will support counseling and testing (CT) technical assistance (TA) visits by USG headquarters staff including Centers for Disease Control and Prevention (CDC), Department of Defense (DOD), and the United States Agency for International Development (USAID). This activity supports the travel, per diem and miscellaneous costs of USAID participation. The TA builds upon a March 2006 interagency technical assistance visit made by the CT technical working group (TWG). This TA team made a number of recommendations to strengthen national CT services including: increased CT promotion, introduction of an updated HIV test kit algorithm, use of lay counselors in CT settings, development of a provider-initiated counseling and testing (PICT) training curriculum, and stronger prevention counseling including increased condom education and distribution. In the coming year, USG staff will provide technical assistance in order to improve upon these issues, as well as to address the complexities of HIV counseling and testing for couples and children.

In FY 2006, USG/Tanzania made progress with CT issues. Following the March 2006 CT TWG visit, a supplemental TA visit was conducted in September/October 2006. During this visit, assistance was provided to the Ministry of Health (MOH) through the National AIDS Control Program (NACP) to finalize national PICT guidelines, and to adapt a draft CDC PICT training curriculum to the local context to be used in future PICT trainings.

Future TA visits will be supported in FY07 to enhance the capacity of a new CT partner, IntraHealth International, to assist NACP in the national roll-out of PICT in clinical settings. In the second quarter of FY 2007, TA assistance will focus on PICT training for health workers as well as training on couples counseling and testing for counselors already trained in VCT.

In the third quarter of FY 2007, members of the interagency CT TWG, including representatives from DOD and USAID, will return to observe settings where national PICT roll-out has occurred, as well as to monitor the progress made on their March 2006 recommendations, and make further recommendations as necessary. The CT TWG will pay particular attention to child counseling and testing issues.

A subsequent TA visit in the fourth quarter of FY 2007 will focus on the national progress of PICT, CT promotion, condom education and distribution, and other issues as requested by NACP and other partners. During this visit, assistance will also be given in the preparation of the FY 2008 COP.

During FY 2007, four interagency TA visits will be made to Tanzania to assist in national PICT roll-out as well as conduct site visits and assist in implementation of activities to address the CT TWG's March 2006 recommendations.

Targets

Target Target Value Not Applicable Number of service outlets providing counseling and testing
according to national and international standards Number of individuals who received counseling and testing for HIV
and received their test results (including TB) Number of individuals trained in counseling and testing according to
national and international standards

Table 3.3.09:

The FY 2007 funds will support one full time equivalent staff member who will coordinate this program area as well as serve as technical lead. The position, although hired by USAID, has been designed by the USG team to serve the needs of the entire portfolio and will be accountable to meeting the needs of all agencies. Their role is multifaceted and includes: coordination of drug, equipment, and commodity forecasting, procurement, and distribution across and within USG agencies; technical assistance to the USG and implementing partners regarding appropriate volume and types of procurements vis-à-vis Government of Tanzania (GoT) and USG regulations, policies and protocols; identification of drug and commodity related barriers to implementation of the broader USG program; design and implementation of solutions to the same; and oversight of Antiretroviral (ARV) drug partners.

In FY 2007 the Tanzania team is working towards a more consolidated procurement process to achieve efficiencies as well as to ensure compliance with GoT and USG regulations. To that end, not only is one agent, John Snow International/Supply Chain Management Systems (JSI/SCMS), procuring all of the USG ARVs, as JSI have done in all previous years, but this same agent will also be procuring all test kits, a significant portion of treatment and care related drugs and commodities, all biologic surveillance reagents, and laboratory reagents. In addition, s/he will work directly with implementing partners to assist and facilitate their procurement needs. To fulfill this role, the staff member will make frequent site visits, assessing pipelines and logistics systems. They will work directly with SCMS to design interventions to remediate problems. They will also work with GoT, other donors, the Global Fund for AIDS, TB, and Malaria, the Tanzania AIDS Coordinating Committee to identify and solve systemic issues. The individual will play a leading role in the ARV drugs thematic group.

With the significantly increased complexity of USG procurement planning and implementation it has been determined that a senior USPSC is needed to guide and oversee the program. This position had previously been a FSN position at State but had never been filled.

USAID TA for ARV Services Each year, it is important to call together all of the treatment implementing partners, the government of Tanzania and key members of the PEPFAR Treatment Technical Working Group (TWG) to share perspectives on effective service delivery, discuss challenges and possible solutions, and to map out a way forward to scale up services strategically and cost effectively. The Treatment TWG brings a fresh eye to service delivery in this resource challenged environment, bringing experiences and lessons learned from other countries in the region.

In FY2007, given the anticipated scale-up of services under regionalization this annual meeting wll be a critical component of our planning.

These funds will support the Headquarters staff who will attend the meeting and provide the in-country team and our host country counterparts technical assistance during the week of the meeting.

Table 3.3.11:

USAID SI Management and Staffing

FY07 funds will support 1.5 full time equivalent staff that will assist in coordinating activities within SI as well as serve as technical leads for aspects of the work. The specific composition of the staffing is one full-time Monitoring and Evaluation (M&E) specialist supported by a second part-time equivalent senior advisor.

The full-time M&E specialist will work directly with implementing partners, both governmental and non-governmental, to improve the quality, timeliness and utilization of monitoring and evaluation data. Activities will include site visits, data quality assessments, capacity assessments, mentoring and skills-building, as well as monitoring of progress. The M&E specialist will work closely with MEASURE/Evaluation, leveraging their specific technical expertise to fill capacity gaps specifically identified for each partner through the implementation of a capacity building plan. The M&E specialist, who has a particular knowledge of the GoT's ART M&S system, will also participate in technical assistance activities to the GoT in this area.

The senior advisor will assist in the identification of portfolio-wide, as well as national M&E needs. S/he will assist in the development of a USG strategy to address these needs, ensuring that USAID SI related activities complement those provided by other USG agencies and fill gaps as needed. The senior advisor will also work with all USAID portfolio managers to ensure effective M&E support and provide direct, strategic, technical assistance as needed.

Both the program specialist and senior advisor will be active members of the USG Strategic Information Thematic Group.

FY 2007 funds will support .5 full time equivalent staff who assists in coordinating activities within this program area as well as serves as technical leads for aspects of the work. This is an FSN position that works directly with implementing partners, both governmental and non-governmental to achieve outcomes in policy development and implementation. Her primary implementing counterparts are the Health Policy Initiative, the State University of New York, and the Government of Tanzania (GoT). Activities include developing strategies to affect policy changes; identifying portfolio-wide, as well as national policy barriers to achieving PEPFAR as well as GoT care, treatment and prevention goals; and providing technical assistance to partners and stakeholders to address policy barriers. She will assist in the development of a USG strategies to address these needs, ensuring that USAID policy related activities complement those provided by other donors and fill gaps as needed. A major deliverable in this area is the passing and implementation of the national HIV/AIDS policy. Additional areas of engagement include stigma and discrimination, gender, and systems strengthening. The program specialist is an active member of the USG OPSS Thematic Group.

This activity relates to USAID #8921, #9490, #9410, #9573, #9177, #8685, and #8974.

USAID estimates that its costs to manage, support, and provide technical assistance to USG/Tanzania activities for which it is directly responsible total $2,826,099. Of this amount, $1,163,063 in staff charges have been allocated across relevant program areas; $120,000 is charged as an IRM tax; and $255,000 are ICASS charges. The USAID program supports the design, implementation, and monitoring of activities related to: orphans and vulnerable children; the provision of home-based care; voluntary counseling and testing; social marketing of HIV related products; treatment; monitoring and evaluation; non-clinical policy development; prevention for youth and high-risk populations; and TB/HIV. Its particular strength is in supporting the roll of the non-governmental sector to reach Tanzania's goals.

At an operational level USAID's PEPFAR program benefits significantly from in-kind support from the larger Mission. Through cost sharing of financial, maintenance, personnel, and other administrative services, significant cost efficiencies are created, allowing for a smaller team to manage and support a portfolio of significant size. This narrative describes the support provided by 10 staff and includes, in addition to salary and benefits, the costs for travel, professional development, communication, and relevant equipment and office supplies to perform their functions.

The team is currently comprised of 13 staff and one vacant position. Four are United States Direct Hire (USDH), 8 Foreign Service Nationals (FSNs), and 2 are on contract. The USDHs provide senior level management and oversight and contracting support and are included in the costs of this narrative. They serve as the USAID HIV/AIDS team leader, deputy team leader, and a senior contracting officer. The 4th position is vacant as a result of the departure of FSL Berger. This position is being included in the USAID bid list for 2007 and should be filled by June. The USG will seek candidates with particular experience in prevention as well as counseling and testing.

Five FSNs provide technical and managerial support across the portfolio. One is a generalist manager for care, treatment, TB and PMTCT. The four others provide contacting, financial, administrative and secretarial support. An additional 3 FSNs provide primarily technical assistance and are included in program areas within the COP.

An additional 2 staff are contracted to support PEPFAR activities. One is a technical specialist and is described in the prevention areas, while the other provides communication support. All technical staff are members of relevant thematic groups.

In 2007 USAID is requesting three new positions, two of which will be hired as U.S. Personal Services Contractors while the third would be an mid-range FSN position. The first contracted position would provide specialist support for the creation and effective implementation of public private partnerships and marketing. The individual would bring new skills to the USG team (e.g. direct experience in the private sector), enabling the creation of local partnerships, leveraging private sector financing, and bringing to fruition the many opportunities being identified by O/GAC's private sector advisor. Several of these new activities are described in the COP and would be supported by this position.

The second contract position, although hired by USAID, will be specifically designed to support cross-agencies efforts, coordinating and implementing drug and commodity procurement and logistics for the USG and its partners as well as providing senior leadership to USG engagement with the GoT. As part of the USG's efforts to create efficiencies and reduce vulnerabilities to drug and commodity stock outs, it wishes to more directly engage with government, stakeholders, and partners to identify and address what have been intractable, and sometimes political, barriers to effective drug and commodity logistics. In addition, the USG is asking SCMS to play a larger role than JSI/DELIVER did in terms of tracking a range of drug and commodity inputs (e.g. GFATM) and serving as an early warning system to avoid stock-outs. To achieve these goals, the USG has determined it needs a senior level procurement and logistics specialist. This position will replace the procurement position requested by the State Department in 2006 that was never filled. Finally, USAID is requesting an additional secretary as the office currently has only one secretary for 12 professional staff.

Relevant ICASS charges are described in narrative # 8921.

In fiscal year 2008, USAID is considering requesting one additional FSN position to support the graduation of local organizations from sub-grantee status in the program areas of care and treatment.

This activity relates to USAID #7829, #9490, #9410, #9573, #9177, #8685, and #8974.

USAID estimates that its costs to manage, support, and provide technical assitance to USG/Tanzania activities for which it is directly reponsible total $2,826,099. Of this amount $120,000 is charged as an IRM tax and $255,000 are ICASS charges. As USAID is co-located with the Embassy, there are no Capital Security Cost Sharing charges.

At an operational level USAID's PEPFAR program benefits significantly from in-kind support from the larger Mission. Through cost sharing of financial, maintenance, personnel, and other administrative services, significant cost effeciencies are created, allowing for a smaller team to manage and support a portfolio of significant size. The team is currently comprised of 13 staff and one vacant position. Four are United States Direct Hire (USDH), 8 Foreign Service Nationals (FSNs), and 2 are on contract.

Table 3.3.15:

This activity is an Indefinite Quantity Contract (IQC) managed by USAID but designed to support all PEPFAR agencies by providing a means to procure specialized services needed on a recurring but less than continuous basis. It will also assist the PEPFAR program to effectively and efficiently operate in an environment of Mission-wide right-sizing in which a freeze has been placed on the hiring of permanent staff, particularly in support and administrative positions. Needs that have been experienced in previous years for which such a mechanism would been extremely useful include: staff support for a FLOTUS visit; drafting of technical portions of HIV/AIDS procurements; facilitating Government of Tanzania staff travel to the PEPFAR conference in Durban; chartering flights to Mbeya so that visiting delegations can see DOD activities within a limited timeframe; and partners meetings. Most of these needs were "one-off", but time consuming, and not an efficient use of permanent staff resources. In addition, it has been a challenge to equitably allocate cross-agency costs, such as those associated with supporting delegations, to the various agencies given procurement constraints within each agency.

An IQC is a particularly flexible mechanism that caters to unexpected needs; facilitates staff extension for specific tasks; and supports cross-agency needs. It has been jointly defined by the PEPFAR agencies and will be administered by the USAID in-country contracts officer. The officer will assist agencies to issue specific task orders against the contract for identified short and long term needs of the USG HIV/AIDS program. Funds requested for this activity is based on previous years' experiences and expected, specific needs in FY 2007.

Anticipated services to be procured under this mechanism include: staff support through the creation of a short-term secretary, administration, and financial services hiring pool; travel services to manage and oversee USG supported GoT travel as well as chartering services to support visiting delegations and supervision visits to remote locations; delegation and meeting planning and facilitation; and personal services contracts for special projects such as COP data entry, copy editors, document preparation (e.g. briefing papers), and HIV/AIDS procurement development. A particular need will arise if the recently announced POTUS visit materializes. All of these services will be provided under the direct supervision of the in-country contracts officer and the technical direction of USG staff. It is anticipated that, through this procurement, the USG will enjoy significant cost savings and greater efficiencies in the use of its full-time administrative and technical staff.

The USG has been undertaking an extensive review of staffing structures and levels in the context of staffing for results. The outcome is a unified structure and "footprint" based on current and protected funding levels. Following approval of the footprint by the Ambassador, the USG will then undertake a long-term hiring process. In light of the complex and lengthy staffing processes of all agencies it is know that there will be a significant time lag between approval and filling positions needed to implement the new configuration and work arrangements. Therefore, funding is needed to provide short-term task-based support to operationalize the structure while long-term placements are made. Skill sets that may include writers, administrative support, program development support, analysts, and short-term technical advisors. The USG agencies supporting PEPFAR have also identified a number of non-inherently governmental functions which - due to their volume and frequency - are limiting the time the USG team has to focus on mission-critical tasks. The agencies have collaborated to define a core group of professional service activities which could be out-sourced to qualified local candidates, saving the program financial resources and allowing agency staff to concentrate their efforts on inherently governmental tasks. The proposed activity focuses on providing short-term task orders geared to provide the following primary types of services: Support for document development (like the COP and ARP) including spreadsheets, project schedules. Conference management support, including event coordination, facility selection and rental, provision of audio-visual devices, note taking, and event summarization and documentation. Visitor support, including planning, organizing, and accompanying visitors and dignitaries, both domestic and international. Support for meetings, briefings, and presentations, including minutes, action tracking, presentation support, and facilities arrangement. Additional services could include, etc. and support for records management, document compliance reviews, and financial analysis. This activity, described in the Management & Staffing section of the FY'2007 COP, is expected to result in program improvements by providing core USG staff additional time to focus on inherently governmental work. Specific expectations for

improvements include: greater time allocated to field visits, resulting in better partner performance monitoring and review; greater time for donor coordination, resulting in reductions of donor-program overlap; greater time for grants management and oversight, resulting in data quality improvements in ‘results' reporting; and greater time spent in strategic planning, resulting in better overall program design and more targeted allocation of funds.

Table 3.3.15: