The National TB and Leprosy Programme (NTLP) has requested I-TECH to assist with three activities which will improve the quality of TB/HIV co-management training for health workers. The first component of this activity involves development of improved TB/HIV training materials for health workers. The National TB/HIV training is a 6 day interdisciplinary course for health care workers. The course currently consists of slides with no accompanying training materials including facilitator guide, participant handbook, or job aids. I-TECH has been asked to enhance the curricula and make it more teachable and interactive. Some content review will be needed and there is also a need to incorporate the International Standards for TB Care. There is a draft facilitator guide that is currently being pilot tested. Using this pilot-tested draft, I-TECH will also enhance the facilitator guide to make it more usable and to better reflect the revised curriculum. I-TECH will develop a participant manual and job aids. This will be a collaborative process with NTLP, PATH, and the 4 Zonal Training Centres that are involved in the pilot. The UCSF Curry TB Center will provide technical assistance with content review. The second component of this activity involves review of the national draft TB/HIV policy for grammar, language and flow. A final content review will also be conducted, with technical assistance from the Curry TB Center at UCSF. The third component involves provision of technical assistance in development of a TB/HIV operations manual for use in health care facilities. I-TECH has also been asked to assist in the development of an Operations Manual in collaboration with NTLP and PATH, and with technical assistance from the Curry TB Center. Deliverables for this work will include: National TB/HIV Policy; National TB/HIV Operations Manual; Facilitator guide (x2 with revision); Participant handbook (x2 with revision); Finalized slide sets (x2 with revision); Job Aids (x2 with revision); and Designed CDROM.

Table 3.3.07:

Tanzania's zonal training centers (ZTCs) are well positioned to strengthen sub-national expertise and ensure that trainings in the HIV/AIDS sector are well-organized to support the National AIDS Control Programme (NACP), referral hospitals, National Institute for Medical Research (NIMR), and city, regional and district health management teams. ZTCs are a critical capacity-building partner and Tanzania's success in the fight against HIV/AIDS depends heavily on these institutions. I-TECH is funded to strengthen the capacity of ZTCs to mount the strongest possible response to the epidemic. The ZTC system is comprised of eight centers, which are decentralized to achieve maximum access to quality training for healthcare professionals. The Northern ZTC, situated at the Centre for Educational Development in Health (CEDHA) in Arusha, is the largest ZTC serving four regions. It offers a diploma program in health personnel education and many short courses for health professionals. Other ZTCs are smaller in size and scope, housed at Clinical Officer Training Centres (COTC) (e.g., Western ZTC, Kigoma) or with Assistant Medical Officer's Training Schools (e.g., Lake ZTC at Bugando Hospital, Mwanza). I-TECH will collaborate with IntraHealth and MOHSW/NACP to build the ZTCs' capacity to conduct PITC trainings to 200 in-service providers from 4 regions, using the training of trainers approach to create master trainers. This strategy complements the GOT's efforts in the workforce capacity development process in the short term and increases human capacity in the long term (skills-based mentoring). PITC trainings will be conducted using the five-day curriculum developed by NACP and in accordance with national guidelines. These initial trainings will be used to pilot test materials and I-TECH and the ZTCs will work with NACP and IntraHealth to revise the curriculum, as needed. The reprogrammed funds will also assist the ZTCs to establish relationships and distribute a basic package of HIV/AIDS support materials (i.e., plans, teaching aids, media materials, monitoring and evaluation instruments, management tools, etc.) as a baseline for capacity development.

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 200  national and international standards

Table 3.3.09:

ITECH Pre-Service Education This activity relates to OPSS (7678 and 8981), Lab (7676), and PMTCT (7825).

Full integration of HIV/AIDS into pre-service curricula is central to assuring sustainability of PEPFAR programs. Given the gaps in pre-service training for HIV, I-TECH will work to develop capacity of allied health institutions to integrate HIV modules into existing pre-service curricula for clinical officers (COs), assistant medical officers (AMOs), and pharmacists. This initiative will complement the existing pre-service programs for nursing and lab that are being implemented through Twinning partnerships.

The goal of all pre-service efforts is to assure that trainees enter clinical practice or social service with an acceptable level of knowledge about HIV disease and its management. A five-level training framework, based on a tested model developed by the US-based AIDS Education and Training Center (AETC) network, will be used to help provide in-country partners with an understanding of the importance of preceptorships, on-site clinical training, and technical assistance in human capacity development efforts.

Approximately 40 pre-service schools will receive technical assistance through this activity. By the end of FY06, I-TECH will have established collaborative relationships with training institutions and obtained MOH support for involvement in pre-service training. With this input, and guidance from MOH and CDC, memorandums of understanding (MOUs) will be established with training institutions as necessary. I-TECH will also work with Zanzibar to determine to what extent materials created for the mainland pre-service programs can be adapted for pre-service training at Zanzibar College of Health Sciences.

By the end of FY06, I-TECH will have convened a working group to address the full integration of HIV/AIDS related content into the teaching programs. Routine and on-going meetings of the working group will be sponsored, and continual updates with stakeholders will be assured (i.e., training institutions, MOH).

After identifying and collecting existing resources and needs assessment data, I-TECH will analyze the discipline's current curriculum and school preparedness in offering HIV/AIDS pre-service training. By conducting a task analysis of CO, AMO, and pharmacist job descriptions and/or competencies, essential skills for pre-service curriculum development for FY 2007 will be defined. Key instructional institutions will be identified for initial participation with guidance from the MOHSW.

In FY07, the measurement of pre-service clinical training outcomes will be improved and learning objectives for the curriculum that are specific to learners' needs will be formulated. I-TECH will gather content from current curriculum, other preexisting curricula, and/or write original content, depending on the educational objectives. It is anticipated that HIV/AIDS training modules will be inserted into the existing pre-service training program in lieu of conducting curriculum revision. Participatory and interactive learning methods that fit within the existing programs of pre-service institutions will be incorporated to engage learners. As a first step, full time and part-time faculty at pre-service institutions will be trained to teach the new modules using supportive materials such as videos and/or other training aids. I-TECH will design and pilot faculty training, and observe faculty teaching the material. Key modules will be taught to faculty based on pre-test findings and a training session will be held to address any identified training deficiencies. At least one site visit to each training institution will be conducted to observe and mentor faculty as they teach from the HIV curriculum. Based on the pilot, revisions will be made and the materials finalized according to MOHSW protocol.

I-TECH will implement a clinical mentoring training series with appropriate faculty, facilitate planning sessions on how to integrate the revised materials into their current teaching schedules, and support the organization of clinical training experiences (i.e., mini-residencies, preceptorships, and rounding with trainer/mentor).

I-TECH will also provide TA to other pre-service partners on instructional design and supportive media production. All materials will be validated with national stakeholders. Work conducted on the mainland will be adapted for Zanzibar where appropriate.

I-TECH's evaluation efforts in support of the above activities will involve identifying key

benchmarks with in-country partners to monitor and facilitate. Effectiveness of this capacity building activity will include evaluation of curriculum implementation, measurement of knowledge, and capacity to apply skills in the practicum setting and workplace. I-TECH will collect appropriate SI information for this PEPFAR funded activity.

Since it already works in close collaboration with UCSF and the HIV/AIDS Twinning Center, two technical partners involved in pre-service work in Tanzania, I-TECH is uniquely positioned to serve as the coordinating mechanism for all activities related to pre-service training. I-TECH also plans to coordinate with the François-Xavier Bagnoud Center (FXBC) to help assure integration of Prevention of Mother-to-Child Transmission of HIV (PMTCT) content into the work of all pre-service training partners. I-TECH's framework for developing and/or revising pre-service training may be helpful in standardizing approaches.

This activity relates to OPSS activities #7778 and #7714 and ARV Services activity #8868.

The first, and most significant, component of this activity is provision of support to the NACP and Ministry of Health and Social Welfare (MOHSW) training department to assess and improve the current in-service care and treatment training package, and strengthen the Zonal Training Center (ZTC) network's capacity to plan, implement, and evaluate HIV/AIDS training strategies and activities. The assessment and strengthening of the current in-service materials will be conducted in collaboration with FHI.

The ZTC system, decentralized to achieve maximum access to quality training for healthcare professionals, is comprised of eight centers. The Northern ZTC, situated at the Centre for Educational Development in Health (CEDHA) in Arusha, is the largest ZTC serving four regions. It offers a diploma program in health personnel education and many short courses for health professionals. Other ZTCs are smaller in size and scope, housed at Clinical Officer Training Centres (COTC) (e.g. Western ZTC, Kigoma) or with Assistant Medical Officer's Training Schools (e.g. Lake ZTC at Bugando Hospital, Mwanza). These ZTCs are well positioned to ensure strengthen sub-national expertise and ensure trainings in the HIV/AIDS arena are well-organizaed. Since I-TECH has developed similar training systems in Namibia and the Carribean, experienced gleaned and lessons learned will benefit Tanzania.

The ZTC assessment/inventory conducted by IntraHealth in FY06 will greatly inform the development of proposed activities. By the end of FY 2006, I-TECH will have established collaborative relationships, clarified roles and scopes of work with IntraHealth and other partners, obtained MOHSW support for ZTC involvement, and increased I-TECH visibility in Tanzania. I-TECH will also have conducted site visits to each of the ZTCs to establish relationships and distribute a basic package of HIV/AIDS support materials (plans, curricula, teaching aids, media materials, monitoring and evaluation instruments, management tools, etc.) as a baseline for capacity development.

At the launch of FY 2007 activity, I-TECH and its partners will have assessed ZTC capacity to coordinate standardized HIV/AIDS training and defined the ideal roles of referral hospitals and other local stakeholders with regard to HIV/AIDS training. Referral hospitals and additional stakeholders will be invited to join an ongoing strategic planning process to build a highly functional HIV/AIDS training network. With this input and guidance from MOHSW and CDC, memorandums of understanding (MOUs) will be established with training institutions as necessary.

I-TECH will work with each ZTC to create their own performance management plans which will include process indicators (e.g., monitoring types of trainings, numbers of participants, etc.) in addition to outcome indicators such as the percentage of people who are using training/knowledge in their work. For ZTCs with pre-existing strategic and management plans, I-TECH will review them and provide recommendations, especially in the area of HIV/AIDS. This process may be carried out individually or collectively, with support from the MOH to reach agreement on basic goals and methods of capacity development. Ongoing support of the ZTC M&E efforts will emphasize the use of data for program improvement. I-TECH will provide continual mentoring and seminars/workshops on relevant evaluation topics as appropriate.

New training methods, tools, and materials will be developed with NACP and infused in ZTCs through in-service training and TA on training program management, needs assessment, training methods, teaching skills, instructional design, and/or M&E. I-TECH will implement a training of trainer (TOT) series with appropriate ZTC staff and health professionals to establish a cadre of skilled HIV/AIDS faculty. I-TECH will foster a supportive culture among the geographically dispersed ZTCs by improving communication and convening them for periodic meetings to share experiences and lessons learned.

Program exchange visits between key ZTC staff and US-based AIDS Education and Training Center (AETC) sites, or with the Caribbean HIV/AIDS Regional Training (CHART) Network and/or Namibian National Health Training Center (NHTC) will be sponsored, and information gleaned from visiting other training networks will be applied to the ZTC planning process. A representative from Zanzibar will be engaged in the visit(s), as the MOHSW on Zanzibar has also expressed an interest in developing a zonal-based in-service

training system.

By the end of FY 2006, pre-production planning for stand-alone media to meet identified program needs (e.g., story/documentary of health care worker support group/profile on HIV+ health care worker) will be completed and supporting curriculum and training materials developed (trigger tapes, demonstration tapes, and videotaped case studies). Production and dissemination of this media for training and communication purposes will occur in FY 2007. Additional media will be developed based on ZTC training needs assessment, strategic planning and input from partners.

The ZTCs will be linked to the pre-service training activities under I-TECH and AIHA, and will explore the feasibility of establishing a national calendar to track training opportunities from multiple training organizations. The resulting effort will be coordinated with other deliverables. I-TECH will also assess the feasibility of establishing a mentoring plan with IntraHealth, MOHSW, and partners that enhances workforce capacity in the short term (matching existing positions or filling empty positions with temporary staff) and increases human capacity in the long term (skills-based mentoring). I-TECH will also collaborate with the National Institute for Medical Research (NIMR) to build the ZTCs' capacity to design and implement operational research related to HRH, thus encouraging evidence-based planning and decision-making.

The second component of this activity is the development and implementation of knowledge dissemination and management strategies. I-TECH will work with the NACP and ZACP to enhance and raise awareness of the existing NACP website, and will assess e-mail, internet, phone, and radio capacity of training institutions and organizations providing care and treatment services. This assessment will be a first step in ensuring access to current HIV/AIDS information for all training and service providers.

I-TECH will assure M&E integration in all areas of technical assistance, offer strong leadership to further develop M&E systems for training across all activity areas and collect appropriate information on PEPFAR funded activities. Deliverables include 1) Stakeholder strategic planning meeting held to vet assessment findings and proposed strategies, 2) MOUs established with training centers, 3) ZTC performance management plans reviewed and completed, 4) ZTC network meetings/workshops focusing on M&E, program management, needs assessment conducted, 5) Quarterly TOT held with ZTCs, 6) Media materials produced (type and amount to be determined through strategic planning process), 7) Report of recommendations on mentoring plan to enhance workforce skills completed, 8) Report on ZTC actual performance as matched against their program management plan produced and shared with stakeholders; 9) Summary report of knowledge management system implementation and recommendations for next steps.