Zanzibar has a population of one million persons with an estimated 1% HIV prevalence. Approximately 40,000 women deliver annually, 98% of whom register at ANC. To provide health services to its population, Zanzibar has a separate Ministry of Health from the mainland,. There are nine main hospitals and over 120 primary health care units in Zanzibar, which all offer reproductive child health service (RCHS). The Ministry of Health and Social Welfare's plan is to establish PMTCT services within all RCHS clinics by 2010 and provide HIV counseling and testing services to 80% of pregnant women attending ANC.

Through USG/PEPFAR support, the Zanzibar Aids Control Program (ZACP) has established a National Coordination Unit and appointed a National Coordinator and two Zonal Coordinators. The role of these coordinators is to ensure effective program implementation and monitoring. In addition, ZACP has developed national PMTCT guidelines and training manuals with an emphasis on PMTCT opt-out testing policy; it also developed and disseminated Information Education and Communication materials in order to standardize national PMTCT services provision and demand creation. Furthermore, ZACP has established seven PMTCT service sites and trained and deployed 120 PMTCT service providers; over 90% of new antenatal attendees in these sites accepted HIV testing and over 95% of the identified HIV positive pregnant women received Nevirapine (NVP) prophylaxis and were referred to Care and Treatment Clinics (CTC).

To reach over 80% of pregnant women within the ten districts of the Islands, ZACP's FY 2007 plan is to strengthen the quality of existing PMTCT services and increase service uptake particularly in labour and delivery wards. ZACP will train additional health workers within the RCHS to ensure service availability at ANC and labour and delivery. In order to identify and refer HIV exposed infants for appropriate services including care and treatment, ZACP will train health care workers at pediatric wards on diagnostic counseling and testing. Furthermore, to establish effective mechanisms for testing and care of HIV-exposed infants, ZACP in collaboration with the Expanded Program of Immunization (EPI), Integrated Management of Childhood Illnesses (IMCI) and Nutrition Program established Technical Work Group. The purpose of this work group is to institute an integrated infant follow-up mechanisms in order to ensure HIV exposed infants are identified and receive appropriate clinical services within RCHS. The Work Group, in collaboration with Health Management Information System team (HMIS), is currently also working on the development of an integrated PMTCT and RCHS monitoring system and supportive supervision mechanisms. To ensure quality service provision, ZACP will continue providing quarterly supportive site supervision and train the District Reproductive Child Health Coordinators to plan and conduct supportive supervision.

The National Health Sector HIV/AIDS strategic plan is to increase access and utilization of PMTCT and PMTCT-Plus services by 50% by 2009. Currently only 11.7 % of pregnant women in Zanzibar access PMTCT services through ANC and labour and delivery. To achieve the national goal, ZACP will develop a national three-year expansion plan. In addition, to increase PMTCT service availability and accessibility within the ten district in the island, ZACP will establish ten additional PMTCT sites in FY 2007.

The proposed activities in FY07 include site assessment visits to determine site readiness, renovation of counseling and testing rooms, training and deployment of service providers, procurement and distribution to all sites of supplies including test kits and delivery kits, sensitizion of health workers, community leaders and religious leaders by creating information, education and communication materials and radio spot activities to tackle stigma and discrimination associate with the disease. Traditional birth attendants within the ten districts will also be sensitized to refer pregnant women to deliver in health facilities and advocate for PMTCT services.

To ensure effective national program coordination, three PMTCT staff were recruited and deployed within the PMTCT unit in ZACP and FY 2007 funds will support these positions. The role of the coordination unit is to plan PMTCT national expansion activities and implementation, monitor and provide technical assistance for the zonal and districts service implementors. Furthermore, the staff will conduct quarterly meetings to ensure partner coordination at the national level and plan quarterly supportive supervision visits.

With FY 2007 funds the ZACP will reach 18,000 pregnant women which will account for

45% of new ANC attendees in the implementing sites and will provide a minimum package of PMTCT to these clients and 360 mother-child-pairs will receive nevirapine (NVP) prophylaxis and will be referred to care and treatment as approriate.

The Prevention of Mother to Child Transmission of HIV (PMTCT) unit is under the National AIDS Control program (NACP) of the Ministry of Health and Social Welfare (MOHSW). The unit receives technical and financial support from the Government of Tanzania's development partners and multilateral organization to support PMTCT services in the country. CDC is one of the partners supporting expansion and strengthening the PMTCT services by providing technical and financial support. The support provided by CDC enables the unit to coordinate activities conducted by different partners in PMTCT by ensuring adherence to guidelines and standards.

Expansion of PMTCT services started in April 2003. The main objective then was to increase access of the services to cover all the regions and districts by June 2006. The PMTCT unit coordinated all implementing partners at the national level including German Development Cooperation (GTZ), MDM- Spain, Axios, EGPAF, and Refugees Camps to scale up services at the national level. Presently there are 544 sites providing PMTCT services countrywide (including 130 hospitals, 187 health centers and 227 dispensaries) in 20 out of 21 regions and 119 districts out of 124. This is only 10.1% of 5379 health facilities existing in the country. CDC directly supports the implementation of PMTCT services in 165 sites, covering 70 districts in 18 regions.

At the national level, an estimated 1,383,164 pregnant women attend ANC annually. with an HIV prevalence of 8.7%, approximately 120,335 of these are estimated to be HIV positive,. However, only 15,284 HIV positive pregnant mothers were reached through the existing PMTCT services in 2005. This is only 12.7% of the estimated HIV positive mothers who attend ANC. Therefore, in order to increase the number of pregnant women accessing PMTCT services, the MOHSW has set the priority to expand PMTCT services to more sites while strengthening the existing sites by training 358 Health Care Workers (HCWs) from the existing sites and 110 from 37 new sites. In addition, the MoHSW is in the process of developing a five-year Health Sector Strategy on HIV and AIDS and one of its priorities is to increase coverage of PMTCT services to 50% of health facilities by 2010.

At the 165 CDC supported sites, between June 2005 and May 2006, 98,977 pregnant women were received as new ANC clients out of that 90132 pregnant women were counseled and tested and 7497 were identified to be HIV positive, out of which 4760 women received Nevirapine (NVP).

In FY 2007, NACP will strengthen PMTCT services by operationalizing new guidelines, with an emphasis on opt-out approach and ensure that new ANC attendees and pregnant women delivering at health facilities receive this service. In addition, opt-out CT will be extended to postnatal clinics to provide NVP to HIV exposed infants within 72 hours of birth, infant-feeding counseling and provide care and supportive for the HIV positive mother including referral to ART clinics.

To ensure linkages to support care for HIV positive eligible women from antenatal and post delivery points, the HCWs will be trained on when and how to link these women to ART services for continuum of care. The PMTCT unit will work closely with the ART program to ensure proper coordination between the two at facility and central level. Furthermore, the revised PMTCT registers will accommodate the referral recordings and track follow up and reporting. The unit will work with the NACP logistics unit and Medical Store Department (MSD) by recruiting a logistician who will ensure that there is a constant supply of test kits, drugs and other supplies at site level. At facility level, the technician, in charge of the laboratory will handle quality assurance for tests performed atANC, labour and delivery wards as well as provide technical assistance in re-testing of discordant results.

PMTCT program monitoring activities are performed by the NACP; the PMTCT unit will work closely with Health Management Information Systems team (HMIS) and other technical assistance providers on the ground to ensure data accuracy, completeness and timely flow from the implementation sites to the central level. The program intends to decentralize supervision activities from the zonal level to the regional and district levels in order to increase efficiency and promote ownership of the program by the Council Health Management team (CHMT).

In order to increase male involvement in the program, innovative approaches shall be

tested including providing invitation letters to men to attend RCHS with their partners. This intervention has been effective in some PMTCT implementing areas. Another method is to give priority to couples who show up for the clinics. Involvement of influential people like community leaders, religious leaders, Members of Parliament in advocating for PMTCT service utilization and male participation is crucial. Therefore, the program will focus on community sensitization activities after finalizing the PMTCT communication strategy.

To strengthen HIV-exposed infant follow up, infant follow-up forms have been developed and will soon be introduced to facilities providing PMTCT services. These forms will be placed at ANC and the staff at ANC will be responsible for filling and submitting the forms through the PMTCT monthly reporting system. The forms address issues of cotrimoxazole prophylaxis, and timing of infant diagnostic tesing for the exposed child. In addition, the program will strengthen infant feeding counseling and support to HIV exposed children by building capacity of HCWs in this area. This will be done in collaboration with institutions that work on infant and young child Nutrition. Furthermore, the program, in collaboration with RCHS, has developed identification codes for mothers and infants on ANC and child cards, which are to be rolled out soon.

On addressing other special needs (psychosocial, legal, material support) for HIV positive women, the program will link with the respective NGOs, CBOs and FBOs in the community working in areas of HIV supportive care. Lastly, the program will maintain the PMTCT coordinating unit (equipment and staff), In addition, it will conduct needs assessment 37 new sites set for expansion in FY 2007.

The HIV/AIDS Faith Based Initiative and ZACP will establish an abstinence and faithfulness program for youths and the general population that will focus on teachings promoting the following; social, psychological, spiritual and health gains to be realized by abstaining from sexual activity; teaching abstinence and faithfulness basing on the Koran and the Bible to discourage sexual activity outside marriage; teachings that abstinence from sexual activity is the only certain way to avoid out of wed-lock pregnancies, sexually transmitted diseases, and HIV/AIDS, importance of AB in reducing and prevention of HIV transmission among unmarried individuals especially young people, information on decisions of unmarried individuals to delay sexual activity until marriage, adoption of social and community norms that support delaying sex until marriage, spiritual, marriage counseling for couples. The FBO AB program will adopt mass media communication strategies that will address promotion of AB activities for youths aged 10 -24 and adults. These communicating themes like "Yes, You can and Not, Me, Not now" will raise awareness, increase understanding of the negative aspects of early sex, develop resistance to peer pressure and promote parent and child communication. Use of television and radio spots to support a compassionate response from faith communities on AB messages will use quotes directly from the Bible and Koran and urge individuals not to practice stigma and discrimination.

This activity also relates to other activities in PMTCT (#7756), Care and Treatment (#7757), Counseling and Testing (#8690), and Strategic Information (#8224) and Laboratory Infrastructure (#7755).

Zanzibar is made up of the islands of Unguja and Pemba, with a population of approximately 1,078,964. Since 1988, home-based care (HBC) services have been established in 100 health facilities within eight districts. More than 154 health care workers and 30 community volunteers have been trained on HBC. Still, there are few trained counselors, and the quality of counseling is unsatisfactory due to poor infrastructure, as well as a lack of privacy and confidentiality.

One component of this activity is to continue support to HBC services in Zanzibar and coordinate all HBC services in the five regions of Zanzibar. With FY07 funds, activities will focus on linking facility-based and community home-based care interventions; expanding HBC services from 8 to 10 districts; establishing linkages with faith-based institutions, civil service organizations, and community-based organizations; building capacity, specifically training and retraining of 154 health care workers and community volunteers who will provide HIV - related palliative care to a total of 842 individuals; procuring and distributing HBC kits; reviewing and developing the HBC guidelines and training manuals; providing supportive supervision of HBC services; and developing a monitoring and evaluation component for HBC and integrating into the comprehensive Zanzibar system. Funding will also be used to provide technical support to assist ZACP to address gender issues as an integral part of training and guidelines. Finally, ZACP will be provided with the Stigma Took Kit, developed by PACT, for use by all USG partners.

The second component of this activity will expand and harmonize the overall HBC monitoring system. Funding will be used to introduce a paper-based HBC monitoring system. The system will enable providers to use collected information to improve services at service delivery points as well as contribute to the overall continuum of care. The monitoring system will be introduced in two new districts and eight existing sites where HBC services are currently provided. Funding will also be used to bring together stakeholders, including regional and district level personnel, selected HBC workers, all partners working in HBC and other stakeholders. The outcomes of the meeting will include the development of monitoring tools, a work plan with a timeline outlining development of the HBC monitoring system, and the development of data collection tools. Data collection tools will be pre-tested in three districts. The paper-based system will then be rolled out at a national level. Supportive supervision will be built into data collection training to ensure data quality and data use for program planning. Collected data will be incorporated into a national electronic database.

This activity relates to activity numbers AMREF follow on (CT), 7781(TB/HIV), 7756 (PMTCT), 7757 (Care and Treatment), and 8695 (Care).

The Ministry of Health and Social Welfare/Zanzibar AIDS Control Program (ZACP) has the responsibility of coordinating the Zanzibar health sector response to HIV/AIDS. An important aspect of this response is the Zanzibar client-initiated voluntary counseling and testing (VCT) program, which was initiated in 1988. To date, there are over 26 VCT sites in the Zanzibar, three of which operate with direct support from USG. During 2005 approximately 113,000 clients were reported by ZACP to have accessed VCT services in the existing USG and non-USG supported sites in Zanzibar. The ZACP Counseling Unit (CU) coordinates the Zanzibar counseling and testing (CT) program through the development of policies and guidelines, training protocols and manuals, standard operating procedures, and job aides. ZACP also provides supervision and technical guidance to the implementing partners, strengthens the training of counselors to secure the required quantity and quality of services, and monitors the progress of implementation of CT activities through reports from district councils, NGOs, and other stakeholders.

Currently, ZACP is reviewing the counseling and testing guidelines to put greater emphasis on provider initiated testing and counseling (PITC) including diagnostic counseling and testing (DCT). The development and finalization of the CT policies, technical guidelines, protocol and manuals will enable health care workers, and counselors to enhance their ability to provide quality CT services. These new proposed approaches to CT would provide support to enhance disclosure of HIV status and promote other preventive interventions. The USG is supporting the Zanzibar MOHSW process to rapidly roll out CT in public health facilities in Zanzibar and introduce PITC starting with DCT in in-patient departments (IPD), out-patient departments (OPD), TB and STI clinics. This will be coupled with the training programs for health care workers and counselors. In an effort to operationalize PITC, 2 pilot sites will be selected to assist the ZACP CU review its structure and functions in order to provide adequate capacity for managing and coordination of CT activities in Zanzibar.

Plans for FY 2007 include continuing to support the coordination function and expansion plan to increase access to quality CT services in public health facilities. The funds will strengthen the Counseling Unit at ZACP to carry out their coordinating roles and support the training of 136 health care workers and counselors to ensure a minimum quality standard for the services. Funds will also be used to promote the availability of CT services, print and disseminate revised CT guidelines and information, education and communication (IEC) materials, and monitor and evaluate of CT services.

The activities for FY 2007 will focus on following areas:

Activity 1. Establish VCT services at 8 new sites within 5 districts and maintain the existing activities at 3 sites. Renovations will be conducted at the new sites to ensure that clients have a private, comfortable space in which to receive CT services.

Activity 2. Establish PITC services at 2 new sites (Mnazi Mmoja Referral Hospital and Chake Chake Hospital). The introduction of PITC will respond to the increase access to Zanzibar Care and Treatment program. It is envisaged that by increasing the coverage of CT services in clinics providing TB and STI services, people living with HIV/AIDS will be identified and be referred to ART services.

Activity 3. Train 32 new counselors from 10 new sites (8 VCT and 2 PITC) and retrain 104 counselors from 26 existing health facilities. This activity will also strengthen the District Health Management Teams to manage and supervise the implementation of quality CT services at the council level through quarterly coordinating meetings. It will also strengthen the referrals and linkages to care, treatment and prevention activities in all sites, and the integration of CT services into other services

Activity 4. Work in collaboration with the IEC unit at ZACP to design, develop and pretest IEC messages for the public health facilities. IEC messages will address uptake of counseling and testing services at selected districts. Materials from the mainland National AIDS Control Program will be used or adapted whenever feasible, and production will be provided by the USG/USAID TBD partner in CT.

Activity 5: Monitor the progress of CT activities with the technical assistance from the USG. The tasks will include conducting supportive supervision and strengthening of monitoring and reporting

Activity 6: Adopt the monitoring system for CT used in mainland Tanzania. FY 2006 funding was used to support the SI Unit within the CT program, to revise the paper-based monitoring system and guidelines, to develop training materials and to train staff. In FY 2007, CT services will be introduced in 8 health facilities and PITC in 2 sites, increasing the total number to 36 sites. Therefore the monitoring system will be expanded to include these 10 new sites, which will be provided with data collection tools for the CT monitoring system. Staff from the existing 26 sites (3 USG- directly supported and 23 indirectly-supported) will be re-trained on the new CT guidelines and revised monitoring system. The SI unit will assist the CT program staff to train and re-train staff. The data will be collected at the facility-level and sent to the national-level, where data will be stored in a central, electronic database (ZACP). Supportive supervision for the monitoring system will be carried out periodically at all 36 sites to ensure data quality.

Through these efforts it is expected that approximately 20,000 individuals at these Emergency Plan (EP) supported sites will be counseled and tested in 2007.

Care and Treatment services Zanzibar has a population of 1 million with an estimated 0.6 % HIV prevalence in the general population. With this prevalence, it is estimated that there are approximately 6000 Zanzibaris needing care for HIV. The Ministry of Health and Social Welfare's plan is to establish Care and Treatment services within 12 health facilities, both public and private by the year 2011 so as to ensure all Zanzibaris who need services can access them. The Zanzibar AIDS Control Programme(ZACP) was launched in April 1987. Within the organization, the manager is assisted by an administrator cum financial officer. Unit heads, which include care & treatment, strategic information, PMTCT, IEC, counselling, testing & home based care, laboratory and STI control, are responsible for coordinating the implementation of the planned HIV activities.

Through the USG support, ZACP has established a National Coordination Unit and appointed a National Coordinator for Care and Treatment. The role of the coordinator is to ensure effective program implementation and monitoring. In addition, ZACP, through USG support and in collaboration with other partners, coordinated the establishment of care and treatment services at 2 sites in the year 2005 and is in the process of establishing services at 2 new sites by the end of the year 2006. From the time care and treatment services were initiated in Zanzibar in March 2005 until end of June 2006, 318 clients have been initiated on ARVs in the 2 existing sites. In order to ensure quality services are provided, to date 95 health care workers have been trained on HIV/AIDS care and treatment, 25 have been trained on adherence counseling and 26 have been trained on Paediatric HIV/AIDS management based on national guidelines. ZACP has also developed and disseminated IEC materials in order to increase demand for the services on the Islands.

The proposed activities in FY 2007 include strengthening and scaling up existing services. To scale up access to services to more Zanzibaris who need them, ZACP plans to coordinate expansion of HIV/AIDS services to two district and cottage hospitals. In doing this, ZACP will work with partners to conduct site assessments, build staff capacity and strengthen the infrastructure of the above sites. It will also coordinate health care workers and organize community sensitization activities. It will help strengthen care and treatment services in existing sites by strengthening the care and treatment management information system, referral systems. ZACP will also design demand creation activities. It will also continue to procure and distribute all necessary supplies in order to ensure smooth running of treatment services.

To ensure effective national program coordination, FY07 funds will continue to support the positions of the national care and treatment coordinator and other staff working in care and treatment services.

This activity links to activities HLAB MOHSW 7758, 7779 NIMR, CDCBase 7834, CLSI 7696, APHL7682, AIHA7676, ASCP 7681, AMREF 7672, RPSO 7792, BMC 7685, DoD 7746; Track 1 ART CU 7697/7698, EGPAF 7705/7706, HARVARD7719/7722, AIDSRelief 7692/7694, DoD7747, Blood Safety; CT NACP 7776, TB/HIV 7781, PMI, SCMS 8233, FHI 7712; SI NACP 7773, MOHSW 7761

In Zanzibar, the Ministry of Health and Social Welfare (MOHSW) has decentralized laboratory infrastructure and capacity building activities to ZACP. ZACP will apply the quality systems approach to support a network of regional, district, faith-based and private laboratories supporting HIV/AIDS prevention, care and treatment in their catchments areas. In order to perform this task, ZACP will equip staff in laboratories with skills and knowledge in Zanzibar to perform laboratory testing for HIV diagnosis, disease staging and treatment monitoring in order to optimize HIV/AIDS prevention, care and treatment services. ZACP will also coordinate the training of laboratory and non-laboratory staff in health facilities to support and help monitor performance of HIV/AIDS related laboratory testing services through supportive supervision. The inadequate capacity of laboratories in Mnazi Mmoja and Pemba island has been identified as a major obstacle in achieving the Emergency Plan's care and treatment goals for Zanzibar.

Since ZACP has limited capacity to perform all the roles effectively, it will constitute a national HIV/AIDS laboratory subcommittee that will be responsible for providing leadership and oversight in developing plans and reviewing progress in implementing laboratory infrastructure and capacity development strategies and advising the MOHSW on HIV/AIDS laboratory issues. The laboratory HIV/AIDS subcommittee will coordinate the planning and execution of laboratory infrastructure activities implemented by all partners and will oversee specific program activities and report quarterly to ZACP. It's task will also include coordination of laboratory data management, strengthening the national external quality assurance scheme (NEQAS), establishing planned preventive maintenance for laboratory equipment, development of standard operating procedures, and manuals as may be needed and oversee the renovation of Mnazi Mmoja and Chake Chake hospital laboratories in Unguja and Pemba islands respectively.

ZACP had started to implement activities to strengthen laboratory capacity for HIV diagnosis, disease staging, treatment monitoring. and strategic information. Within these activities, the ZACP collaborates with various implementing partners including MOHSW mainland, HHS/CDC Tanzania, National institute for medical research (NIMR) African Medical Research foundation (AMREF), the Association of Public Health Laboratories (APHL), the Clinical and Laboratory Standards Institute (CLSI), the American Association for Clinical Pathology (ASCP), JICA, GTZ, JICA, Clinton HIV/AIDS Initiative (CHAI) World Health Organization (WHO) and Track 1 Partners

In FY 2007, ZACP will implement Quality system at Mnazi Mmoja hospital by performing active gap analysis; renovation of the laboratories in Mnazi Mmoja and Pemba; Procure required equipment for the two laboratories and build Mnazi Mmoja laboratory as center of excellence for Zanzibar laboratories.

Finally, in order to assure program coordination and for sharing lessons and best practices, the laboratory subcommittee will convene a meeting of laboratory collaborating partners and stakeholders biannually. ZACP will also support study visits and participation in national and international meetings and training for six members of staff from ZACP, MOHSW, NBTC, and the laboratory facilities. Travel will be planned carefully to ensure that staff are not kept away from work places longer than necessary in order not to affect laboratory work at sites. Priority will be given to programs geared towards developing human resources and capacity to manage the laboratories. ZACP will organize a laboratory management training for laboratory technologists, lab managers and directors of laboratories.

Strengthening ZACP Strategic Information Capacity, Surveillance, HMIS, and M&E Activities

This activity relates to activity ID #7814 - World Health Organization (WHO) support to Strategic Information (SI); activity # 7809 - Behavioral Sentinel Surveillance (BSS)+ among most at-risk populations (MARPs) in Zanzibar; # 7756 - PMTCT, # 8690 - counseling & testing, # 8695 - Home-based Care HBC activities in Zanzibar.

This activity has four main components; surveillance including at antenatal clinics (ANC) and of MARPs, biological and behavioral surveillance, strengthening strategic information (SI) capacity at Zanzibar AIDS Control Program (ZACP), and monitoring and evaluation.

Surveillance Surveillance activities will be carried out using FY 2006 funds. ANC-based HIV surveillance will be conducted in early 2007 with the eight sites in the 2005 round participating. The current protocol will be modified prior to implementation and will include consent for anonymous linked HIV testing, storage of specimens with possible future additional testing, and collection of additional demographic and behavioral data that are not routinely collected at the clinic. To minimize errors in the field and the ANC laboratory, procedures for dried blood spots (DBS) for HIV testing will be implemented. Prior to implementation, the modified protocol will be submitted for local institutional review board (IRB) approval at the Zanzibar Health Research Council of the Ministry of Health and Social Welfare. The protocol will be submitted for scientific review by the Associate Director of Science of the Global AIDS Program in Atlanta. In the likely event that HIV prevalence continues to be below 1% after the next ANC round, with no indication of a significant increase, biennial ANC surveillance will be adopted. Therefore, no additional FY 2007 funds will be required for ANC surveillance. Data analyses will be performed on the 2007 round. Additionally, trend analyses will be performed on three data points (2002, 2005 & 2007) specifically on the sites that participated in all 3 rounds. ANC surveillance data will be compared to PMTCT counseling & testing data in order to assess the feasibility of replacing ANC surveillance with PMTCT as the main method of tracking the epidemic in the general population in Zanzibar.

The ZACP staff will also participate in the USG-funded behavioral surveillance survey with biological markers (BSS+) on commercial sex works (CSW) and men who have sex with men (MSM). This will include being trainers (ToTs); laboratory support, as well as protocol design, data management and analyses, report preparation, and dissemination. With FY 2007 funds, the staff will also participate in the repeat of the BSS+ among IDUs.

The ZACP SI section is in charge of HIV and STI surveillance, monitoring and evaluation of programs, and information systems activities. In its current capacity, this team consists of one surveillance coordinator and three data entry clerks. To adequately address all strategic information needs, the team should be expanded to include a Strategic Information Coordinator (Epidemiologist), a Surveillance Coordinator, a Monitoring and Evaluation (M&E) Officer, a Data Manager and 4 Data Entry Clerks. The SI Coordinator (Epidemiologist) will be the overall in charge of SI section; Duties will include; - 1) assisting the ZACP Program Manager in donor coordination, communication and submission of proposals/applications for funding, 2) design of surveys/targeted evaluations including submission for IRB approval, 3) oversight in the design of monitoring systems, reports & evaluations 4) oversight in data management, analyses, report writing and dissemination, 5)facilitating/promoting human capacity development for ZACP SI staff and other program areas, and 6) integration of HIV/AIDS intervention data with other program data e.g. EPI, OCGS, HMIS etc. The Surveillance Officer will coordinate all surveillance activities including implementation of survey protocols, provision of supportive supervision during data collection, and guiding data management, analyses & report preparation & dissemination. The M&E officer will provide leadership in the development/definition of indicators. They will also provide the M&E framework for the health sector, tracking progress against set goals/targets, reporting of indicators to ZAC and other National & International partners, in the development & implementation of program evaluations. The M&E officer will also provide oversight in SI capacity building efforts for all ZACP staff and other MoHSW staff involved in HIV/AIDS programs. The Data Manager will provide oversight in database development and will be the custodian of all SI data. They will also supervise data entry and provide leadership in data management, analyses and report

generation from program-specific monitoring systems. They will also provide leadership in the development of data quality assurance protocols including development of data cleaning protocols and supportive supervision schedules & protocols. Data Entry Clerks will enter all data for surveillance & program monitoring data. Additionally, the ZACP will train and maintain 1 district-level HMIS data entry staff at all 10 districts of Zanzibar.

To improve technical capacity of the SI team, on-site training will be provided by external consultants and USG Tanzania and Atlanta staff on a regular and ad-hoc basis. Training will include: basic epidemiology, basic computer skills, database management using Epi Info for Windows, data entry, analysis using improved statistical methodologies, data presentation, and report writing. Resources needed for the SI team include expansion of space, travel and transport budgets, and equipment (including computers, phones, office supplies, etc.).

M&E framework The FY 2006 funds that were allocated to ZAC will be rolled over to ZACP in FY 2007 to support the Zanzibar's AIDS Commission's (ZAC's) work in developing the health sector M&E framework. Initially, the ZAC was responsible for developing the framework and package, however, since the ZACP has the mandate for the health sector, it would be better suited to develop this M&E framework and tools/package.

In FY 2007, the USG will provide technical support to ZACP in the development of a health sector M&E framework which will include a comprehensive set of national and international indicators to track progress against set targets. It will also include guidelines for activity planning, monitoring and reporting; capacity building for data use; a more standardized/formalized way of reporting health information up to ZAC; and development/strengthening of existing linkages between the different program activities. The M&E Officer, identified above as part of ZACP SI capacity, will provide oversight for the development of the M&E framework including developing Terms of Reference (TOR) for the consultant. The M&E officer will then work with the consultant to collect relevant data and information for the framework; develop the framework with stakeholder input; as well as finalize and disseminate the framework. The two will also develop tools/packages and training materials for the M&E framework.