TITLE: Rapid strengthening of the Blood Safety Program in Tanzania

NEED and COMPARATIVE ADVANTAGE: The funding for this activity supplements Track 1.0 funding.

In the past, blood transfusion services in Tanzania have been predominantly hospital-based and reliant on

replacement donations. This system was susceptible to higher prevalence of transfusion transmissible

infections. Tanzania has since established a centralized coordinated blood transfusion system that is

responsible for collection, processing, storage, and distribution of blood and blood products to health

facilities. This system relies on voluntary, non-remunerated repeat blood donors (VNRBD). The Ministry of

Health and Social Welfare (MOHSW) - National Blood Transfusion Service (NBTS) is responsible for

provision of safe and adequate blood to all Tanzanians.

ACCOMPLISHMENTS: Seven blood transfusion centers have been renovated, equipped, and staffed for

utilization. Of these, four centers have been operational since 2006 and the remaining three were

inaugurated in 2007.

Because of donation protocol, units of blood collected also represent the number of blood donors counseled

and tested for HIV and other TTIs. This component of blood donation significantly contributes toward

attaining the PEPFAR goal for people receiving counseling and testing for HIV/AIDS. Blood collection from

VNRBD has increased from 20% before 2005 to 80% in 2007. Large sensitization campaigns addressing

blood donation stigma are conducted through mass media including television, radio, and newspapers.

A quality systems manual and monitoring and evaluation (M&E) tools (both paper-based and electronic

forms) were developed and are currently being distributed to all implementers. In FY 2006, a computer

system was implemented for management of NBTS information and is operational in one out of the seven

zones in Tanzania. Currently, this system is undergoing implementation in the three additional zones and

plans are underway for provision of nationwide coverage. Utilizing FY 2008 funds, the new centers will be

technologically advanced. MOHSW management is presently in the process of establishing the NBTS as

an executive agency through an act of Parliament.

ACTIVITIES: These activities will be accomplished through bilateral funding to complement Track 1.0

funding.

The Abbott Foundation will renovate 13 regional hospital based blood bank facilities while USG funding will

support NBTS in procuring and installing equipment for storage and distribution in these facilities. This

includes blood testing equipment, refrigerators, and cool boxes.

Access to adequate and safe blood transfusions will be accomplished through increasing opportunities, and

a growing desire by the public, to participate in blood donation. Generating interest will result from a public

sensitization campaign distributing positive messages about donating blood. Mass media, through

information, education, and communication (IEC) material production and distribution, has potential for very

broad coverage of community sensitization messaging. Ten newly procured vehicles will improve logistics

for blood transportation from mobile teams to the zonal center, in addition to improving blood distribution,

mobilization campaigns, and supportive supervision. Phones for health and Personal Digital Assistant

(PDA) equipment will be used by the mobile teams to enter data while in the field, reach donors for recall,

and to send motivational messages to new and repeating donors. NBTS will also develop audio/visual

prevention messages to be used during donor recruitment and sensitization campaigns. This will

necessitate the procurement of audio/visual devices through which each team in the various zones can

relay educational, preventive, counseling, and recruitment messages. Goals are in place to increase the

blood donation rate in the population from 3.3 units per 1,000 to at least 20 units per 1000 people.

The NBTS will equip four of the seven zonal blood banks to perform automated screening for HIV, HBV,

HCV, and Syphilis. This will decrease turn around times for blood, reduce staffing needs for screening, and

reduce the margin of error for testing. Transfusing blood components significantly reduces the physical

need for blood collection. NBTS will also equip four zonal blood transfusion centers with modern

component separation equipment for the production of blood components.

The NBTS, in collaboration with the Tanzania Red Cross, will set up and maintain blood donor clubs in six

additional regions to make a grand 18 regions of Tanzania with donor clubs, paving the way for sustainable

blood stores for the people of Tanzania. With technical assistance from CDC and American Association of

Blood Banks (AABB), the National Blood Transfusion Service (NBTS) will promote rational use of blood in

hospitals by orientating and training physicians, members of the blood committees, and staff at the blood

banks. NBTS will encourage organizations to utilize Government of Tanzania (GoT) and USG procurement

systems (e.g., MSD and SCMS) to ensure a reliable and continuous supply of reagents, test kits, and

supplies for blood collection and processing at zonal centers and regional blood banks. Technical

assistance (TA) from AABB and NBTS will determine the cost of providing one unit of blood and establish

mechanisms for cost recovery.

The NBTS will ensure the quality of services offered at all blood service sites by implementing a quality

management plan, subject to continued review. Additionally, the NBTS will hold regular advocacy meetings

with decision makers from hospitals in order to disseminate updated NBTS policy and guidelines. NBTS

management will provide supportive supervision to monitor the quality of pre-and post-test counseling,

recruitment, testing, blood collection, transportation, storage, and distribution. A standardized tool will be

developed for this purpose and corrective training or advice will be solicited as needed.

In order to assess its quality, impact, efficiency, and effectiveness, the NBTS will implement a three-year

strategic plan and a comprehensive monitoring and evaluation (M&E) plan. Existing data collection and

reporting tools will be reviewed for accuracy and relevance. Feedback will be incorporated into the tools for

improvement of the M&E tools. The NBTS will also formulate a staff retention program to ensure skills-

based management training background for employees. The NBTS will work with the National Malaria

Control Program and President's Malaria Initiative to promote malaria prevention and the use of ITNs

among blood donors, general population, and pregnant women and children under five years of age. NBTS

will also collaborate with the NACP to promote HIV prevention through donor messages.

Activity Narrative: LINKAGES: The NBTS will link with the National Malaria Control Programme (MACP) and PMI to promote

Malaria prevention messages. The NBTS also intends to collaborate with NACP to promote VCT through

outreach activities. Linkages will also occur in collaboration with private business to devise blood donor

incentive and retention.

The NBTS intends to collaborate with Phones for Health and local mobile phone companies for tracking

data, donor notification, and incentives. The NBTS will also directly and indirectly link with the Ministry of

Education and Vocational Training, to ensure that blood safety is included in the training curricula and

advocate that culture and sports become part of blood safety activities, NACP to develop consistent

messages for donor VCT and HIV prevention; the Injection Safety Department, to ensure injection safety

and proper waste disposal; and Haukeland University Hospital, which also provides capacity building and

quality improvement for NBTS.

CHECK BOXES: The blood safety program aims at ensuring adequate numbers of voluntary, non-

remunerated repeating blood donors as a safe source of blood for transfusion. The program will target the

general population.

M&E: The NBTS will collaborate with the AABB to develop an M&E program that will encompass all the key

processes such as collection, processing, distribution, and utilization of blood. Gathering statistics on the

number of annual blood collections reflect the effectiveness of the NBTS to reach goals set by key

stakeholders. In addition, documentation of blood donor recruitment and retention reveals a percentage of

the population who received counseling. These process indicators ensure effectiveness of the quality

management system, the objective of which is to ensure that the NBTS supplies safe and adequate blood.

The required PEPFAR indicators will constitute part of the monitoring tools to ensure planning,

implementation, and effectiveness of project objectives. Qualified M&E personnel will be hired to achieve

the COP 2008 M&E implementation plan and its roll out to the zonal centers.

Gap analyses will be performed to identify potential opportunities for enhancement and improvement.

Subsequently, a model will be developed that incorporates existing NBTS procedures and desired industry

M&E best practices.

SUSTAINAIBLITY: Currently there are plans to institute cost recovery mechanisms for the blood transfusion

services offered by the NBTS. In addition, making the NBTS an executive agency will ensure Government

Fiscal allocations to NBTS for blood safety program activities.

TITLE: MOHSW - Infection Prevention and Control (IPC) - Injection Safety (IS) program

A situation analysis of IPC-IS was conducted in five referral/consultant hospitals. Data revealed that IPC

practices were poor due to: lack of guidelines and standards for certain procedures; inadequate knowledge

and skills among health workers; lack of equipment and supplies; inadequate supportive supervision; and

lack of renovation and maintenance of infrastructure.

MOHSW, with support from the CDC, JSI-MMIS, and other partners, initiated the implementation of the IPC

-IS to foster and encourage necessary improvement within health facilities. The objectives of the program

are to: strengthen the national capacity to establish policies and standards for IPC-IS; ensure industrial

standards of quality and safety of injection devices; ensure availability and affordability of injection devices;

ensure rational, and cost effective use of injections; ensure safe and appropriate health care waste and

sharps management in all health care facilities; develop post exposure prophylaxis for HIV exposure and

vaccination of health workers at risk of hepatitis B infection.

ACCOMPLISHMENTS: Key previous accomplishments by the MOHSW regarding injection safety include:

trained 2,700 healthcare providers on IPC - IS; coordinated three stakeholders coordinating forum

meetings; conducted supportive supervision to 56 health facilities; and developed national infection

prevention and control guidelines pocket guide in both English and Kiswahili in collaboration with JHPIEGO

- ACCESS.

ACTIVITIES: In FY 2008, the MOHSW/HSIU plans to:

1. Build capacity through zonal training centers and the regions to conduct comprehensive IPC-IS trainings

at all facility levels by: conducting trainings of trainers (TOT) to establish a pool of qualified multidisciplinary

facilitators in each zone and in all regions as requested by other partners in the regions; procuring and

distributing training materials for each zonal training center in collaboration with other USG partners.

2. Collaborate with JSI to conduct trainings of healthcare providers on recommended IPC-IS practices.

The MOHSW will: train 2,000 healthcare providers and conduct refresher training for IPC-IS core teams of

20 TOT on IPC-IS using the Kiswahili version of the guidelines and conduct an evaluation of the training

program on IPC-IS for health workers in the lower level facilities.

3. Strengthen capacity of MOHSW IPC-IS to coordinate activities to improve the quality of healthcare

services provided in the health facilities by: maintaining current staff and covering fixed costs; purchasing

facilities and supplies, including fuel and vehicle maintenance, telephone charges, and postage and courier

services; and conducting an annual audit of the program. In addition, representatives from the MOHSW

will: attend international conferences and workshops to share experiences and lessons learned; conduct

quarterly stakeholders coordination forum (SCF) meetings; convene quarterly technical meetings to share

lessons and findings from the field among partners; and disseminate meeting minutes among partners for

future improvements.

4. Conduct supportive supervision to health facilities that have already received health care training. This

will involve regional health management teams (RHMT), district health management teams (DHMT) and

HMT at regional, district, and national levels conducting follow-up visits to monitor the implementation of the

IPC-IS program. Reports will be written and feedback provided to the facilities post analysis.

4a. Conduct "on the job" mentoring and supportive supervision of districts and primary health facilities by:

familiarizing 1000 HCW with the new checklist; collaborating with RHMTs and DHMTs to integrate the

checklist into the comprehensive supervision checklist for the health management teams; utilizing the

checklist to collect feedback from the field, making sure to incorporate constructive criticism into the

curricula.

5. Collaborate with JSI, to develop and implement advocacy and behavior change strategies to improve IPC

-IS practices by: reviewing IEC/BCC strategies for sensitization/orientation and training of health workers;

working with partners to develop various training packages and IEC materials for health care settings;

conducting trainings for TOT for national, zonal and hospital based settings; conducting orientation

workshops at facility levels on the different IEC/BCC approaches.

6. Disseminate guidelines regarding integration of health services to members of the RHMT and officials

from various health programs.

LINKAGES: The MOHSW, through the Health Services Inspectorate Unit (HSIU) will continue to coordinate

IPC-IS activities implementation throughout the country. The MOHSW will continue to collaborate with the

CDC, the WHO, JSI- MMIS, JHPIEGO-ACCESS, Expanded Program for Immunization, MSD, RCH,

Environmental Health and Sanitation Section, Directorate of Human Resource Development, Muhimbili

University College of Health Sciences , University Research Company, GTZ-Tanzania German Program to

Support Health, and College of Engineering Technology -University of Dar es Salaam - Department of

Chemical Processing Engineering in order to improve the quality of health services throughout Tanzania.

The partners will support the MOHSW's promotion of public-private partnerships and implement a global

communication and advocacy strategy to leverage and coordinate support for IPC-IS by 2009.

CHECK BOXES: With regard to human capacity development, in-service training will be conducted for

healthcare workers. Tutors from health training institutions will be trained and will in turn train their students

as well as reviewing the curriculum. Medical schools within Muhimbili University College of Health Sciences

will be required to include IPC-IS and quality improvement subjects in their curriculum.

M&E: The MOHSW, through HSIU, is in the final stages of reviewing and updating supportive supervision

guidelines. This will be utilized at all levels of health services provision during supervision. The guidelines

will cater to internal and external supportive supervision/inspection requirements. The MOHSW will also

strengthen capacity of RHMT in supervising CHMTs and individual facilities in their regions. Supervision

visits will be conducted quarterly to ensure compliance. The MOHSW will collaborate with partners to track

progress of the different activities through monthly work plan monitoring and reporting sessions.

SUSTAINABILITY: The MOHSW will advocate for inclusion of IPC-IS activities in Comprehensive Council

Health

Plans (CCHP) and Comprehensive Hospital Plan (CHP). Each program is advised to budget for health

care waste management in addition to integration of IPC-IS training in other programs, including routine

health care services. HMTs and CHMTs should plan for PPE, safety boxes, and other supplies and

injection devices in their CHPs and CCHPs to ensure sustainability. This will also be reiterated during

trainings of HCWs and sensitisation of HMTs that will ensure sustainability of the program activities. In

collaboration with key stakeholders, MOHSW will develop and implement advocacy and behavior change

strategies to improve IPC-IS practices.

TITLE: MOHSW Laboratory Infrastructure and Capacity Building

NEED and COMPARATIVE ADVANTAGE : Research conducted by NIMR in 1995 found laboratory

services in the country to be the weakest link to provision of quality HIV/AIDS Prevention, Care and

Treatment. Through PEPFAR funding, MOHSW has developed an operational plan to improve the quality of

laboratory services in collaboration with CDC and other Development Partners. With FY 2008 funds,

MOHSW will continue to implement the plan of strengthening Laboratory capacity for HIV diagnosis,

disease staging, treatment monitoring, and strategic information. It will also continue to coordinate the

planning and execution of laboratory infrastructure activities implemented by all partners.

ACHIEVEMENTS: Coordinated and collaborated in the training of 197 lab staff on CD4, Hematology,

Chemistry, and 200 lab staff on Rapid HIV testing, three Development Partners meetings, and two

meetings on the establishment of the Infant HIV Diagnosis Program which came up with infant diagnosis

capacity assessment report and an implementation plan.

Collaborated with USG lab partners to develop and implement the Standard Lab Investigation Form, 73 Lab

Standard Operating Procedures, Planned Preventive Maintenance Guidelines for lab equipment, the

National lab Quality Assurance Framework, and paper based lab information tools.

ACTIVITIES: The Ministry of Health and Social Welfare (MOHSW) will extend Early Infant HIV Diagnosis

using DBS samples to three Zonal Referral Hospitals to ensure that early infant HIV diagnostic services are

available in each zone through coordinating the establishment of an efficient DBS sample collection and

transportation system by treatment partners in all four zones on Tanzania mainland and coordinating the

training of healthcare workers on DBS sample collection and transportation. MOHSW will Conduct

supportive supervision to zonal labs to monitor and evaluate performance.

MOHSW will implement the Quality Assurance Program through the National HIV Quality Assurance

Laboratory and Training Center (NHQALTC). All four zonal and 23 regional hospital laboratories and

Zanzibar will participate on External Quality Assurance (EQA) Program for CD4 count, Rapid HIV Testing,

HIV Serology, Chemistry, Hematology, and DNA PCR. MOHSW will provide EQA panels to zonal and

regional hospital laboratories, refresher Training on laboratory quality systems to 69 laboratory staff in

Public and Private Health Laboratories. Through FY 2008, MOHSW will hire personnel to run the

NHQALTC and maintain running cost, including salaries and wages. MOHSW will start the process of

providing funding for the NHQATC through government mechanisms ideally as an executive agency of the

MOHSW. MOHSW will provide subsidy to the National and Zonal Advisory Committees on Diagnostic

Services and their Lab Quality System Subcommittees to enable them to implement, monitor and evaluate

QA activities in all labs in the country.

MOHSW will also coordinate strengthening of the paper-based and electronic laboratory information

systems in 20 regional hospital laboratories. Up-to-date daily, monthly, quarterly, and annual laboratory

statistics available in all targeted facilities and provide computer hardware and software to the 12 remaining

regional hospital laboratories. Training of 184 laboratory staff in regional laboratories in basic computer

skills and laboratory information system. will be undertaken as well as the development of and

implementation of relevant laboratory worksheets and other tools.

MOHSW will ensure the Incorporation of the HIV/AIDS in-service training modules in the pre-service

laboratory training curriculum. This will result in Pre-service graduates being equipped with laboratory skills

necessary to support HIV/AIDS care and treatment program. In order to accomplish this the pre-service

laboratory training modules will be reviewed in collaboration with the American Society for Clinical

Pathologists.

Equipment maintenance is a key element to success of laboratory programs. MOHSW will strengthen the

capacity of zonal workshops to provide first and second line maintenance of laboratory equipment. 75%

reduction in laboratory equipment downtime. MOHSW will train 15 Laboratory Equipment

Engineers/Technicians on the first line maintenance of laboratory equipment and provide essential

workshop tools to six zonal equipment workshops and subsidy to cover running cost of servicing equipment

within the zone.

MOHSW will strengthen the capacity of the Diagnostic Services Section of the MOHSW to coordinate the

implementation of Laboratory Operational Plan to support HIV/AIDS Prevention, Care and Treatment

Program by ensuring the availability of adequate staff and necessary tools. MOHSW will hire program

officers and project support staff. The activities of QA and administrative activities will necessitate MOHSW

to procure a vehicle and provide for communication, fuel and vehicle maintenance.

LINKAGES - Diagnostic Services Section of MOHSW coordinates improvement of all HIV testing sites to

support various national programs including NACP and PMTC, and work with CDC and various

implementing partners including U.S. Department of Defense (DOD), National Institute For Medical

Research (NIMR), African Medical Research Foundation (AMREF), Association of Public Health

Laboratories (APHL), Clinical and Laboratory Standards Institute (CLSI), American Society for Clinical

Pathologists (ASCP), Japanese International Cooperation Agency (JICA), AXIOS, Abbot Fund, Clinton

foundation, Track 1 ART Partners in improving laboratory infrastructure and capacity building to support

HIV/AIDS Prevention, Care and Treatment Program.

CHECK BOXES: - On Human Capacity Development, in-service training will be conducted in all testing

facility to fill the gap of the current pre-service laboratory training curriculum. At the same time, MOHSW will

work with laboratory training schools to review the current pre-service modules so as to incorporate the in-

service training modules to support HIV/AIDS care and treatment program.

M&E: MOHSW has developed tools to be used to evaluate laboratory performance and they will be used

during supportive supervision. Laboratory performance will also be evaluated by sending out Proficiency

Testing panels and evaluating the results centrally. All training modules include pre- and post test

evaluation to measure the knowledge gain of participants. A random of HIV test samples from a testing site

will be sent to a higher level laboratory for retesting on regular basis. Approximately 10% of the budget will

be used for M&E.

SUSTAINABILITY: MOHSW will train Trainer-of-Trainees (TOT) from various programs including PMTCT,

VCT, NACP, etc. who will be tasked with rolling out trainings in their program areas. Zonal TOT will also be

trained to roll out HIV disease monitoring trainings in their respective zones. The TOT approach is designed

to provide sustainability of training activities by empowering the programs/zones with capacity to conduct

frequent trainings and hence, increasing the number of trainees.

Activity Narrative: TITLE: MOHSW Laboratory Infrastructure and Capacity Building

TITLE: Strengthening HIV Reporting within Routine Health Systems

NEED and COMPARATIVE ADVANTAGE: The Health Information and Research Section (HIR), Health

Management Information Systems (HMIS) Unit of the Ministry of Health of Health and Social Welfare

(MOHSW) is the overall coordinator of routine health data system in the country, the custodians of routine

heath data system from government, parastatals, non-governmental organizations (NGOs) and private

heath facilities, and is responsible for generating indicators that track Millennium Development Goals (MDG)

and the national strategy for poverty reduction, MKUKUTA in Kiswahili. The need for quality monitoring of

the health data collected and reported at health facilities is important in ensuring that policy makers and

stakeholders can effectively monitor and evaluate health activities.

HIR is responsible for ensuring the reporting of accurate data. With the integration of HIV/AIDS into routine

health care, data quality becomes increasingly critical. There is a need for accurate dissemination of health

systems from facilities as programs including Prevention of Mother-to-Child Transmission (PMTCT) and

Care and Treatment (C&T) are scaled up to meet the expanding needs of the country.

ACCOMPLISHMENTS: 1.) To manage the data collected from health facilities, HIR/HMIS has regional and

district Health Management Information System (HMIS) focal persons at each district. This person is

already a member of the Regional or District Health Management Team, and is now tasked with reviewing

data collected from routine health activities. 2.) The current Health Statistics Abstract Report (HSAR),

produced in April 2006, provides a comprehensive health statistics summary for the health sector. It

includes health facility and resource information, morbidity and mortality statistics, disease reporting for

malaria, tuberculosis and leprosy, HIV/AIDS and Sexually Transmitted Infections (STIs), blood safety, EPI

and reproductive and health services, which includes vaccinations, antenatal care, deliveries and family

planning.

ACTIVITIES: 1.) Supportive supervision: HIR/HMIS will continue to build capacity of regional and district

HMIS focal persons on health data collection, analysis, dissemination, feedback, and use. 1a.) Conduct

orientation and retraining for regional and district Health Management Teams on new/updated data

collection tools 1b.) Conduct routine supportive supervision to regions and districts to address issues found

through visits, and to affect policy change to effectively strengthen the overall implementation and

continuation of health activities. 1c.) Conduct HMIS annual monitoring and evaluation meeting to discuss

strengths, constraints, and gaps and to build consensus on actions for policy and programmatic changes.

2.) Strengthening data quality and dissemination: HIR/HMIS will continue to strengthen its essential

responsibilities for providing key data and support for MOHSW activities to policy makers, donors and other

stakeholders, health workers, NGOs and the general population. 2a.) To process and produce an annual

Health Statistics Abstract Report 2b.) To conduct data communication and dissemination workshop for the

HSAR. 2c.) To attend short courses on monitoring and evaluation to continue to build the national capacity

to provide technical assistance for health information. 2d.) To provide technical assistance in the creation

and modification of data collection tools for routine health and to improve the comprehensiveness of

collection and reporting.

3.) Data quality assessment: In addition to routine supportive supervision, we propose as part of program

monitoring and evaluation, an annual data quality assessment and review. With the government

components with which we work - the National TB and Leprosy Program (NTLP), the National AIDS Control

Program (NACP), the National Malaria Control Program (NMCP), Reproductive Child Health Services,

Expanded Program for Immunizations (EPI), Integrated Diseases Surveillance and Response (IDSR), EHS

Unit, Vital Registration, it becomes imperative to review how data from each system have impacted the

overall health of Tanzanians. The outcomes of such an activity will be to better identify, analyze, use and

disseminate data for decision-making. 3a.) Hold a stakeholder workshop to outline the data collection and

reporting efforts of each of the units, and coordinate the activities that we expect to review and address as

part of this activity. 3b.) Conduct facility data capacity assessments, with a focus on quality of data

collection and reporting, gaps and challenges to collection and reporting, current practice of use and

dissemination, and the effects of supportive supervision activities, all to determine profound factors for

quality data.

LINKAGES: The key HMIS linkages include: the Prime Ministers Office - Regional Authority and Local

Government (PMO-RALG) as the primary owners of health facilities and governance of employed staff.

Other linkages include: IDSR, which tracks disease outbreaks in the country; Vital Registration provides

data on birth and death and migration; RCHS and EPI, provides data on mother and child services; NMCP

provides data on malaria efforts; NTLP provides data on tuberculosis and leprosy; NACP programs focus on

HIV/AIDS programs; the National Bureau of Statistics produces data on health denominators; and TACAIDS

governs Tanzania's multisectoral response for health. HMIS also links to national and referral hospitals; and

unilateral and multilateral partners.

CHECK BOXES: HIR/HMIS activities build the capacity of local health facilities to collect, report, and use

health data collected within the routine system of health. HMIS works with government entities on data

collection, tool creation and modification, and assists with the dissemination of health statistics for the

country.

M&E: HIR/HMIS works closely with other ministry counterparts, donors and stakeholders on the collection

and reporting of accurate data. MHIS will continue to promote the synthesis and use of data by district and

regional staff, which, in turn, strengthens the facilities with the skills to validate and use their data. To

strengthen the districts and regions, HIR/HMIS closely monitors the data collection at districts and regional

levels with supportive supervision visits to assess quality reports, and to be the changers of effective policy

to improve data efforts. The support reaches all 133 districts and 21 regions in mainland Tanzania, the

HMIS focal persons, and the district and regional health management teams. To that end, we see the need

for annual data quality assessments to again drive policy and infrastructure changes with, and for the

collective government of Tanzania and Tanzanians.

SUSTAINAIBLITY: HIR/HMIS is the source for health data, and has the mandate for reporting quality data

that affects how policy makers implement and coordinate program activities and make decisions. The focus

on accurate reporting impacts those who report program data, and gives the ownership of accurate data

back to the programs that report. HIR/HMIS empower the districts and regions with the ability to conduct

Activity Narrative: quality data visits to facilities, as well as empowering the districts and regions with the responsibility to

report to the national level. The reciprocal reinforcing of data quality makes for stronger programs within the

routine health system.

This activty is additional funding in order to support activity number 16365.08. In particular, the focus of this

funding is to conduct three short training courses (approximately two weeks in length) in epidemiology and

lab training. Below is the narrative for activity number 16365.08 that this new funding will support.

NARRATIVE FOR ACTIVITY #16365.08

ACTIVITIES: FELTP is a two year, full-time training and service program, which involves classroom

instruction and field assignments. During the first year of the program short courses will be offered and a

cadre of ten students will be admitted. The first short course will be on routine program monitoring,

surveillance and outbreak investigation, laboratory quality assurance, as well as management. Participants

will include field epidemiologists, public health laboratory managers, and veterinary workers from various

regions working in HIV/AIDS and malaria.

Course participants will be required to conduct an applied learning project in Tanzania after which they will

present their work and receive degrees. The initial cohort of students will take classes in epidemiology,

communications, economics, management and will learn about quantitative and behavior-based strategies.

Field work will include: epidemiologic investigations and field surveys; evaluating surveillance systems; and

performing disease control and prevention measures.

FY 2008 funds will be use to support: a) ten students; b) provision of short courses; c) initial steering

committee and stakeholder meetings; d) travel cost related to FELTP seminars, outbreak, research and

surveillance evaluations, select conferences; and e) operations costs including stipends for fellows,

development and maintenance of field sites, accommodations for residents, tuition and honoraria.

An in country resident advisor for a number of years will be provided and funded through AFENET (African

Field Epidemiology Network) to help guide training and technical assistance. AFENET is a non-profit

network of organizations that share resources and best practices among FELTPs in Africa.

CDC Atlanta will provide technical assistance in the first year of the program in the form of physicians,

epidemiologists, public health advisors, instructional designers, and health communications specialists to

provide additional training and technical assistance.

LINKAGES: Developing partnerships is an important element of establishing, supporting, and sustaining the

program. Costs for establishing the Tanzanian FELTP program will be shared by African Field Epidemiology

Network (AFENET), the President's Malaria Initiative, MUHAS, NIMR, CDC Atlanta, and USAID

Washington.

SUSTAINAIBLITY: FELTP Tanzania will allow for key public health specialists to undertake training in-

country rather than traveling abroad. FELTP graduates will be field trained epidemiologists and laboratory

managers who will be competent in practical applications of epidemiologic methods. This will lead to

sustainable improvements interventions, implementation, surveillance and epidemic investigation and

response and overall supervision of the HIV/AID epidemic.

M&E: In order to ensure that FELTP is effective in developing personal to meet the human resource

shortage in Tanzania and is a sustainable program, a system for periodic monitoring and evaluation of

outputs and outcomes is critical. The an evaluation workgroup, with input from Atlanta and field-based staff,

has developed programmatic indicators for this activity. This M&E plan will allow the MOHSW to document

program activities, monitor and evaluate the program, implement program improvements, adjust the

program to changing priorities, and ensure the program is meeting the long-term priorities. In addition, a

database has been developed to support program management and the tracking of programmatic

indicators. All PEPFAR indicators necessary will be also incorporated into the monitoring system.

MAJOR ACTIVITIES:

1. Support establishment of the Tanzania Field Epidemiology and Laboratory Training Program to build

capacity to address the current human resource shortages.

2. Provide graduate training collaboratively with MUCHS, MOHSW, PMI, NIMR, USAID Washington,

AFENET, and CDC Atlanta.

3. Initiate short course trainings.