TITLE: TUNAJALI PMTCT Services in Dodoma, Iringa, Morogoro and Singida

NEED AND COMPARATIVE ADVANTAGE: Women constitute a significant proportion, nearly 60%, of

patients treated for HIV/AIDS in Tanzania. Therefore, enrolling HIV positive pregnant women into programs

providing ART is essential, specifically because administering treatment to pregnant women also offers

critical opportunity to address pediatric HIV infection and to reduce the prevalence of perinatally acquired

HIV. Of the women tested and counseled at PMTCT facilities in 2005 in Tanzania, 6.7 % were HIV positive

and were offered nevirapine (NVP) and infant feeding (IF) counseling. Full adherence rates of completion

of the antiretroviral prophylaxis course by these women are not known. HIV prevalence in targeted regions

is: 4.9% in Dodoma; 13.4% in Iringa; 5.4% in Morogoro; and 3.2% in Singida. Without adequate

interventions, it is expected that one-third of children born to these women will become infected with HIV.

ACCOMPLISHMENTS: PMTCT is a new initiative for TUNAJALI, however, Family Health International (FHI)

(Deloitte's technical partner under TUNAJALI), has established more than 280 PMTCT sites globally, and is

providing PMTCT support to 6 districts in Dodoma with support from the Abbott Fund.

ACTIVITIES: In keeping with the PMTCT regionalization efforts, TUNAJALI will expand its services to

support PMTCT services in Dodoma, Iringa, Morogoro, and Singida regions by supporting current

operational sites and establishing services in 38 facilities to enable more pregnant women to have greater

access to services, thereby reducing the risk of transmission from infected mothers to newborns in

Tanzania.

The minimum package of PMTCT services provided at these sites will include ‘opt-out' HIV counseling and

testing, referrals of positive women to a care and treatment center (CTC) for assessment of antiretroviral

therapy (ART) eligibility and care, ARV prophylaxis for HIV positive mothers Zidovudine (AZT) and

Nevirapine (NVP) or Single dose (SD) NVP) based on facility capacity and according to national guidelines

and infant feeding counseling. In order to build capacity and infrastructure, TUNAJALI will: purchase

medical supplies and laboratory equipment; train health workers using the nationally approved PMTCT

curriculum, and provide supportive supervision; effectively supplement MSD, Abbott, and other donor

supplies by procuring and delivering NVP, reagents, and other supplies to prevent disruption of services.

Additionally, TUNAJALI will train midwives in handling and staging HIV positive mothers and exposed

infants to reduce stigmatizing behavior and improve perinatal care skills.

In order to successfully increase the number of women who receive counseling and testing, TUNAJALI is

committed to scaling-up provider-initiated counseling and testing at labor and delivery wards and

implementing a pilot program involving lay counselors in the provision of counseling services to alleviate the

burden of overworked staff. Furthermore, TUNAJALI will train community-based volunteers to sensitize

communities and promote PMTCT services.

Follow-up care and support for mother-infant pairs and their families is essential to ensure the continuum of

comprehensive care. TUNAJALI will facilitate implementation of referral systems at sites to link mother-

infant pairs with CTC sites providing facility-based care and treatment. To develop linkages, maternal and

child health (MCH), PMTCT and CTC sites will engage in joint planning and budgeting to ensure integration

of services. Furthermore, establishing provider-initiated counseling at Maternal Child Health clinics to

ensure infants with HIV positive mothers are tested according to national guidelines and, if HIV positive

themselves, referred to a CTC.

Fostering capacity building among regional and district health authorities to plan and monitor PMTCT

activities will ensure that PMTCT services are integrated with district and regional systems thereby

maximizing resources, creating ownership, and building sustainability. In order to accomplish this,

TUNAJALI will provide technical support to regional and district authorities to conduct supportive

supervision, data collection, and reporting of PMTCT activities. To maximize sustainability, health

authorities will include PMTCT activities in council health plans.

LINKAGES: To ensure comprehensive care for mothers and infants, the project will link with TUNAJALI

home-based care/OVC initiatives, TB/HIV projects, prevention for positives initiatives, reproductive health

(RH), and maternal and child health (MCH) programs, in addition to other partners, to provide additional

community-based support services including home-based palliative care, nutritional, psychosocial, and legal

support. TUNAJALI will link with partners who have more experience in PMTCT to ensure access to

optimal services and coordinated support. To this effect, the project will partner with ENGENDERHEALTH

in Iringa, AXIOS (TBD) in Morogoro and Singida, and Abbott/FHI's PMTCT and pediatric AIDS program in

Dodoma. TUNAJALI will also work closely with USG partners to ensure the promotion of PMTCT and will

continue to work toward sensitizing communities, while mobilizing to increase uptake of PMTCT services.

At the national level, TUNAJALI will work with the National AIDS Control Program (NACP) to inform national

PMTCT policies and contribute to the development/adoption of standard operating procedures (SOPs) and

national guidelines focused on testing and counseling approaches, and to deliver services to women who

choose to give birth outside of a health facility.

CHECK BOXES: The main goal is to increase women's access to counseling and testing, thereby

facilitating their entry into the HIV/AIDS continuum of care. The project will work with ANC and

labor/delivery wards to improve these services. Linkages to services such as RH, Family Planning (FP),

under-age-5 child services, and malaria programs will be emphasized and encouraged. Renovation of

sites, training health workers, utilizing lay counselors, and providing technical support to facilities will all

exist within TUNAJALI's mission. The main target populations are pregnant women and PLWHA, but

realistically, community mobilization activities will target the general population as a whole.

M&E :TUNAJALI will work with regional health and council health management teams (RHMT and CHMT)

in supportive supervision and quality assurance. TUNAJALI will support the National AIDS Control Program

(NACP) in developing an electronic data collection system by the end of FY 2008. Meanwhile, sites will

utilize national PMTCT paper-based tools to capture data. Data compiled at the facility level will be sent to

the district reproductive and child health coordinator (DRCHC) for aggregation, then forwarded to NACP

and TUNAJALI to provide feedback to the sites, implementing partners, and donors. TUNAJALI will also

build the capacity of facility based staff and DRCHC in data entry, management, reporting, and use of data

for decision-making. Additional tools, including the national logistic management information system

Activity Narrative: (LMIS), also referred to as the indent system, will be adapted to collect data tracking drugs and

commodities to ensure effective and efficient management of resources. Internal audits will be carried out

regularly to ensure quality. By establishing and strengthening facility-level supervision, improving quality

assurance, bolstering health information systems, and ensuring activities conducted are carried out

according to national guidelines, the project will maintain continuous improvement in the quality of care and

promote sustainability.

SUSTAINABILITY: The project will establish PMTCT services as an integral part of the existing health

system, executed in conjunction with sites offering testing, counseling, and clinical care. TUNAJALI will

work with the district councils to include PMTCT activities in their comprehensive council health plans and

increase funding from additional sources such as basket funding and Global Fund (GF). Sustainability will

be ensured by the complete integration of PMTCT in reproductive and child health (RCH) services, and by

providing the necessary health infrastructure and staffing to ensure success. The project will build local

ownership by working through local government, while building human capacity through training, mentoring,

and supportive supervision.

TITLE: The Rapid Funding Envelope for HIV/AIDS (RFE) Public-Private Partnership Initiative in Tanzania

NEED AND COMPARATIVE ADVANTAGE: To increase participation of civil society, 10 donors and

TACAIDS co-operated in creating a "Rapid Funding Envelope for HIV/AIDS" on mainland Tanzania and in

Zanzibar. RFE is a competitive mechanism for projects on HIV/AIDS in Tanzania. RFE supports not-for-

profit civil society institutions, academic institutions in compliance with national policy and strategic

framework with the goal of contributing to longer-term objectives of the national response and encouraging

projects that promote institutional partnerships. To date, although the private sector is involved in the fight

against HIV/AIDS, services tend to be limited to their employees, and often lack the continuum of care and

sustainability due to lack of commitment at higher level. This program seeks to use the RFE mechanism to

inform the private sector of the need to expand workplace programs, and establish partnerships with private

organizations to strengthen these interventions, leveraging resources from existing medical structures within

these private institutions to make care and treatment available to employees and their communities who

would otherwise not have access to these services.

ACCOMPLISHMENTS: To date, RFE has conducted seven rounds of grant making and approved $11.2

million from pooled funds, for 78 projects. In FY 2007, RFE successfully held a 4th round, providing awards

worth $3.5 million to 23 CSOs (seven had OVC activities); monitored and managed existing sub grantees;

created a reliable base from which donors can utilize without duplicating efforts; continued to strengthen

CSOs, financially and technically, thus laying a solid foundation for further funding; and facilitated increased

resources for CSOs via disbursement of significant funding in a short timeframe.

ACTIVITIES: Ongoing activities will include management of the RFE-Public-Private Partnership initiatives to

be established with FY 2007 plus-up funds focusing on strengthening collaboration with private

organizations; selecting and providing grants for workplace organizations for treatment and care activities in

support of the continuum of care efforts in the workplace and neighboring communities. In particular this

will involve oversight of projects worth $800,000 in grants to approximately 20 organizations. The 20

companies will be awarded matching contribution grants for creating or extending their workplace programs.

The companies will be paired with our in-place partners to ensure that their programs adhere to best

practices and national standards. The focus of the activities will include: 1) Support the implementation of

workplace AIDS policies. 2) Support the development of peer counselors. 3) Provide materials, training, and

other components needed to support prevention-related personnel.

These funds will be used to expand prevention services in the companies while leveraging corporate

resources to expand HIV/AIDS treatment and care services beyond the workplace, and using the family

centered approach, include family and community members who may otherwise not have been able to

access services in these private facilities. Specific activities will include: 1) Grants and financial

management of sub grantees, including disbursements of grants, liquidation reviews of sub grantee

financial reports and monitoring & evaluation of projects; 2) Technical monitoring and management of sub

grantees, including review of project work plans and progress reports, review of project deliverables and

monitoring & evaluation of projects; 3) Financial administration of the RFE-PPP fund, including preparation

of financial reports and engaging project audits; 5) Grants/Project administration including external RFE-

PPP communications/correspondence, convening of meetings with the donor/partners and preparation of

(ad-hoc) reports.

The program will strengthen collaboration with private organizations to find unique alternatives to which

private-for-profit companies can contribute towards alleviating the burden caused by HIV/AIDS. a) RFE-PPP

program will solicit and review short-listed private-for-profit organizations, conducting pre-award

assessments to determine organizational, financial, technical management competency of the existing

medical programs and identify potential weakness that may be mitigated towards improving the continuum

of care. b) At least five successful organizations will be contracted and funded directly with USG funds. c)

Supportive supervision will be provided to the projects, including monitoring & evaluation, guidance &

oversight of the projects through regular site visits. 2) Capacity building towards graduation towards direct

funding from donors will be provided through training and coaching/mentoring. 3) Additional support will be

sought from multi-donors to fund similar workplace programs. If successful, non-pooled USAID funds will

support management of these grants.

LINKAGES: In keeping with previous arrangements, Deloitte Consulting Limited as the Prime, also the lead

for grants and finance management will link with a partner (TBD) as the lead technical partner for supporting

the RFE-PPP, and will work closely with donors, keeping within the mandates of the AIDS Business Council

of Tanzania (ABCT). RFE-PPP will also develop formal linkages with large funding mechanisms; including

regional facilitating agencies (TMAP) to feed into the development information networks system, a common

database of organizations funded to avoid duplication of efforts. In effort to encourage organizational

development, RFE-PPP will share funding experience with potential donors/organizations to create

awareness and encourage buy-in.

CHECK BOXES: RFE-PPP will seek to fund organizations with existing medical programs, building capacity

as needed to afford the continuum of care to their employees, as well families and surrounding

communities. The RFE will support capacity building through various steps including the pre-award

assessment that highlights key areas of weakness to be strengthened in the capacity building plan;

technical assistance/training on programmatic (HIV) issues and finances; and ongoing mentoring and

technical assistance.

M&E: Annual work plans will be developed and will include built-in M&E processes for which the relevant

staff member takes responsibility. Management of the RFE-PPP will include conducting the following

monitoring & evaluation activities: regular update of project through participation in activities; review

quarterly technical reports for performance against work plan; monitoring through field visits; collection of

data; and preparation of site visit reports and progress reports. These reports will be shared with private

organizations concerned, and donors, to enable improvement and development of the program. Best

practices and lessons learned will be captured and shared.

SUSTAINABILITY: The private organizations involved will be encouraged to foster local community

networks, and continue to leverage their own resources that will assist in continued operations of the project

once RFE-PPP funding has ended. RFE-PPP requires projects to consider sustainability during proposal

development, and ensures that a realistic plan has been developed to integrate the project into existing

programs. RFE-PPP supported organizations will also be provided with institutional capacity building

Activity Narrative: support enabling them to grow/graduate towards receiving accreditation as care and treatment centers, and

allow them to receive direct funding and/or increase the level of funding from other donors, post RFE-PPP

funding. The new management structure at Deloitte has been designed to better manage the function of the

RFE to include capacity for managing the RFE-PPP, since the original mandate of the RFE has changed

from its original form and size of projects funded.

TITLE: The Rapid Funding Envelope for HIV/AIDS (RFE) Public-Private Partnership Initiative in Tanzania.

NEED AND COMPARATIVE ADVANTAGE: To increase participation of civil society, ten donors and

TACAIDS co-operated in creating a "Rapid Funding Envelope (RFE) for HIV/AIDS" on mainland Tanzania

and Zanzibar. RFE is a competitive mechanism for projects addressing HIV/AIDS in Tanzania, and

supports not-for-profit civil society institutions, academic institutions in compliance with national policy, and

strategic framework. The goal is to contribute to longer-term objectives of the national HIV/AIDS response

and encourage projects that promote institutional partnerships. To date, although the private sector is

involved in the fight against HIV/AIDS, services tend to be limited to their employees, and often lack the

continuum of care and sustainability due to lack of commitment at higher level. This program seeks to use

the RFE mechanism to inform the private sector of the need to expand workplace programs and establish

partnerships with private organization to strengthen these interventions. By leveraging resources from

existing medical structures within these private institutions, it is possible to enable employees and their

communities to access care and treatment.

ACCOMPLISHMENTS: To date, RFE has conducted seven rounds of grant writing and has approved $11.2

million from pooled funds for 78 projects. In FY 2007, RFE successfully held a 4th round, providing awards

worth $3.5 million to 23 CSOs (seven of which had OVC activities); monitored and managed existing sub

grantees; created a reliable base from which donors can utilize without duplicating efforts; continued to

strengthen CSOs, financially and technically, thus laying a solid foundation for further funding; and

facilitated increased resources for CSOs via disbursement of significant funding in a short timeframe.

MAJOR ACTIVITIES: Ongoing activities will include management of the RFE-Public-Private Partnership

initiatives to be established with FY 2007 plus up funds, RFE funds will be focused on strengthening

collaboration with private organizations and selecting and providing grants to workplace organizations for

treatment and care activities in support of the continuum of care, These efforts will be focused in the

workplace and neighboring communities. In particular, this will involve oversight of projects worth $200,000

in grants to approximately 20 organizations. The 20 companies will be awarded matching contribution

grants for creating or extending their workplace programs. The companies will be paired with Deloitte's in-

place partners to ensure that their programs adhere to best practices and national standards. The focus of

the activities will include: to support the implementation of workplace AIDS policies; support the

development of peer counselors; and provide materials, training, and other components needed to support

prevention-related personnel.

Additionally, these funds will be used to expand prevention services while leveraging corporate resources to

expand HIV/AIDS treatment and care services beyond the workplace. This will include using the family

centered approach, which provides programs to family and community members who may otherwise not

have been able to access services in these private facilities. Specific activities will include; disbursements

of grants; liquidation reviews of sub grantee financial reports; and monitoring & evaluation of projects.

Additionally, RFE will provide technical monitoring and management of sub grantees including review of

project work plans and progress reports, review of project deliverables, and monitoring & evaluation of

projects.

Financial administration of the RFE-PPP fund will be supported including preparation of financial reports

and engaging project audits. RFE will develop grant/project administration including external RFE-PPP

communications/correspondence, convening of meetings with the donor/partner, and preparation of (ad-

hoc) reports.

The program will strengthen collaboration with private organizations to find unique ways in which private-for-

profit companies can contribute toward HIV/AIDS initiatives in order to alleviate the burden caused by

HIV/AIDS. A RFE-PPP program will solicit and review short-listed private-for-profit organizations, conduct

pre-award assessments to determine organizational, financial, and technical management competency of

the existing medical programs, and identify potential weakness that may be mitigated towards improving the

continuum of care.

At the very least, five successful organizations will be contracted and funded directly with USG funds.

Supportive supervision will be provided to the projects, including monitoring and evaluation, guidance, and

oversight of the projects through regular site visits. Additional support will be sought from multi-donors to

fund similar workplace programs. If successful, non-pooled USAID funds will support management of these

grants.

LINKAGES: Deloitte Consulting Limited will serve as the prime partner and will collaborate closely with

donors, such as a TBD partner as the lead technical partner. RFE-PPP will also develop formal linkages

with large funding mechanisms; including Regional Facilitating Agencies (TMAP) to feed into the

development information networks system, a common database of organizations funded to avoid

duplication of efforts. In effort to encourage organizational development, RFE-PPP will share funding

experiences with potential donors/organizations to create awareness and encourage buy-in.

AREAS OF EMPHASIS: RFE-PPP will seek to fund organizations with existing medical programs, building

capacity as needed to afford the continuum of care to their employees, as well families and surrounding

communities. The RFE will: support capacity building through various steps including the pre-award

assessment that highlights key areas of weakness to be strengthened in the capacity-building plan;

technical assistance/training on programmatic (HIV) issues; finances; and ongoing mentoring and technical

assistance.

M&E: Annual work plans will be developed and will include built-in M&E processes for which the relevant

staff member takes responsibility. Management of the RFE-PPP will include: conducting the following

monitoring & evaluation activities; regular update of project through participation in activities; review

quarterly technical reports for performance against work plan; monitor through field visits; Collect data;

prepare site visit and progress reports; these reports will be shared with private organizations concerned,

and donors, to enable improvement and development of the program, Best lessons learned will also be

captured and shared.

SUSTAINABILITY: The private organizations involved will be encouraged to foster local community

networks and continue leveraging their own resources in order to assist in continued operations of the

project once RFE-PPP funding has ended. RFE-PPP requires projects to consider sustainability during

Activity Narrative: proposal development; and ensure that a realistic plan has been developed to integrate the project into

existing programs. RFE-PPP supported organizations will also be provided with institutional capacity

building support enabling them to grow/ graduate towards receiving accreditation as care and treatment

centers (CTC), and allow them to receive direct funding and/or increase the level of funding from other

donors post RFE-PPP funding. The new management structure at Deloitte has been designed to better

manage the function of the RFE, to include capacity for managing the RFE-PPP, since the original mandate

of the RFE has changed from its original form and size of projects funded.

TITLE: The Rapid Funding Envelope for HIV/AIDS (RFE) in Tanzania

NEED AND COMPARATIVE ADVANTAGE: To increase participation of civil society, ten donors and the

Tanzanian Commission for AIDS (TACAIDS) cooperated in creating a "Rapid Funding Envelope (RFE) for

HIV/AIDS" to assist with the HIV/AIDS response in mainland Tanzania and Zanzibar. The RFE is a

competitive mechanism to support not-for-profit civil society institutions, academic institutions, and

partnerships on projects up to a maximum of 12 months. The RFE allows Civil Society Organizations

(CSOs) to implement projects, build capacity, and improve project coordination and management skills,

while gaining experience and lessons learned on HIV/AIDS interventions. Projects funded by the RFE are

required to comply with national policy and the strategic framework for HIV/AIDS as set by TACAIDS and

the Zanzibar AIDS Commission (ZAC), with goals of contributing to longer-term objectives of the national

response and encouraging projects that promote institutional partnerships and have potential for scale up.

ACCOMPLISHMENTS: To date, the RFE has conducted seven rounds of grant making and approved

$11.2 million for 78 projects. In FY 2007, the RFE successfully held a fourth round, providing awards worth

$3.5 million to 23 CSOs; monitored and managed existing sub-grantees; created a reliable base for donors

to reference without duplicating efforts; continued to strengthen CSOs, financially and technically, thus

laying a solid foundation for further funding; and facilitated increased resources for CSOs via disbursement

of significant funding in a short timeframe. Generally, funding leveraged from other donors cover the cost of

the grants, and the USG funds are used for management of the funds. Ongoing activities for FY 2008 will

include:

1. Grants and financial management of existing sub-grantees including disbursements of grants, liquidation

reviews of sub-grantee financial reports, and M&E of projects.

2. Technical monitoring and management of existing sub-grantees, including a review of project work plans

and progress reports, review of project deliverables, and M&E of projects.

3. Completion of the fifth open round of funding including conducting pre-award assessments and sub

contracting to about 40 CSOs,

4. Financial administration of the RFE fund (USG and multi-donor accounts) including management of

donor receipts, preparation of financial reports, and engaging project audits.

5. Grants and project administration including external RFE communications/correspondence, convening of

donor meetings, and preparation of (ad-hoc) reports.

This component of the funding for the RFE will support management of palliative care activities. The

management funds are maintained in a non-pooled account, which will leverage an approximately additional

$2 million of funding through multi-donor support of palliative care projects.

LINKAGES: In keeping with previous arrangements, Deloitte Consulting Limited is the prime partner and

the lead for grants and finance management. They will link with Management Sciences for Health (MSH) as

the lead technical partner for supporting the RFE, and Emerging Markets Group (EMG) for initiating

capacity-building initiatives to CSOs. The RFE will work closely with the TACAIDS and ZAC in all aspects

of work; ensuring that they champion decisions made, including the path that each RFE round makes. RFE

will also develop formal linkages with large funding mechanisms including Foundation for Civil Society and

Regional Facilitating Agencies (World Bank T-MAP funding agents) to develop information networks and a

common database of funded CSOs to avoid duplication of efforts. In efforts to encourage organizational

development, RFE will share funding experiences with each donor to ensure that the right level of funding

and capacity support is provided to the CSO. With a special round under the proposed PPP initiative,

linkages will be formed with private organizations and workplaces to create partnerships in support of

workplace facilities providing HIV-related services to local communities.

CHECK BOXES: The RFE will fund organizations that support OVC within the national guidelines,

specifically targeting young girls, to provide them access to income-generating opportunities. The RFE will

support capacity building through various steps including the pre-award assessment that highlights key

areas of weakness to be strengthened in the capacity plan, technical assistance/training on programmatic

(HIV) issues and finances, and ongoing coaching from the grant manager and technical advisor.

M&E: The RFE will develop annual work plans, which will include built-in M&E for which the relevant RFE

staff member takes responsibility. RFE management will continue to conduct the following M&E activities:

regular update of project through participation in activities; quarterly reviews of technical reports for

performance against work plan; monitoring through field visits; collection of data; preparation of site visit

reports; and progress reports. The progress reports will be shared with concerned CSOs and donors, to

enable improvement and development of these organizations. Best lessons learned will be captured and

shared, publicized on the RFE website, and processed in a database according to the plans of TACAIDS

and ZAC. They will also be shared through the OVC Implementing Partners Group.

SUSTAINABILITY: RFE will encourage CSOs to foster local community networks that will assist in

continued operations of the project once RFE funding has ended. RFE requires projects to consider the

issues of sustainability during the proposal development and ensures that a realistic plan has been

developed to integrate the project into existing programs. RFE supported CSOs will also be provided

institutional capacity-building support enabling them to graduate to direct funding and/or increase the level

of funding from other donors post RFE funding. A new management structure will be proposed to the

donors to better manage the function of the RFE, whose mandate has changed from its original form due to

the number and size of projects funded.

TITLE: Deloitte Facility-based Palliative Care

Deloitte Consulting Limited is the primary treatment partner in Dodoma, Iringa, and Morogoro. It provides

palliative care to most of those registered in their Care and Treatment Clinics (CTCs). This includes both

patients on Anti-Retroviral Therapy (ARTs) and not yet eligible on ARTs. Patients receive WHO staging,

provision of cotrimoxazole in accordance with national guidelines, diagnosis and management of

opportunistic infections, including tuberculosis screening and referral and cryptococcal infection, nutritional

assessments/counseling (and referrals), symptom and pain management (for outpatients, pain

management is currently restricted to non-opioid medicines such as ibuprophen and paracetamol), and

psychosocial support. General counseling addresses disclosure of HIV status, adherence to care and

treatment, behavior change counseling for prevention of HIV transmission, and other individual specific

issues, as appropriate. Pediatric formulations of cotrimoxazole are available for children.

In FY 2008, after an assessment of nutritional supplement options are evaluated, an expanding number

may receive nutritional support. A growing number of people living with HIV/AIDS are involved as peer

counselors and in assisting with linkages to local organizations that can help to promote adherence, provide

psychosocial support, and to handle referrals for community services (e.g. income generating activities and

legal service).

An important linkage is between facility-based palliative care and community home-based care (HBC). This

link is critical as all palliative care cannot be done at the facility. There are two-way referrals from the CTC

to the community HBC program and from the community HBC program to the CTC. The program strives to

have 100% of patients registered in Care and Treatment be referred to a community home-based care

program.

Total palliative care targets are de-duplicated at the national program level for patients who receive facility-

based services from this partner and home-based services from either this or other USG-supported

partners.

TITLE: TUNAJALI ( We care) Integrating ART and TB Services in 4 Regions of Tanzania

NEED AND COMPARATIVE ADVANTAGE: The goal of TUNAJALI in FY 2008 is to strengthen the

continuum of quality HIV care and treatment. However, co-infection with TB presents unique challenges

whether a patient presents with active symptoms or with Immune Reconstitution Syndrome (IRS) weeks

later. Timely identification and treatment of each disease mutually improves the outcome of the other, hence

need for close collaboration and coordination between the programs. Experience gained by Deloitte and

Touche (D&T) and Family Health International (FHI) in involving TB staff, with USG partners, provides an

advantage to scaling-up and integrating services. With training, mutual referral, supportive supervision and

mentoring, TUNAJALI's strategy aims to capture patients suspected of TB-HIV co-infection, ensuring

prompt diagnosis and supervised treatment.

ACCOMPLISHMENTS: As of March 31, 2007, with QuickStart and Plus-up funds, D&T/ FHI expanded the

comprehensive care approach to 33 sites in Dodoma, Morogoro, and Iringa. D&T/FHI has made significant

progress, establishing a foundation that will enable the program to increasingly expand quality care and

treatment over the coming years The program established referral services between all the CTCs and 35

TB programs in 35 district hospitals; strengthened referral procedures, including follow-up care through

HBC; providing 20,324 patients with comprehensive care, including 9,294 on ART and 3, 597 receiving

treatment for TB disease.

ACTIVITIES: In FY 2008, Tunajali plans to strengthen the TUNAJALI care and treatment program in 38

sites in 4 regions: Dodoma, Morogoro, Iringa and Singida, to ensure that all patients have access to the

comprehensive continuum of care, including timely and appropriate management of TB-HIV co-infection.

1) Tunajali will strengthen the capacity at CTCs to address co-infection, and screening HIV patients for TB

through: a) Training CTC staff in new and established sites on integrated management of TB-HIV co-

infection, using Ministry of Health and Social Welfare (MoHSW) guidelines. b) Providing ongoing technical

assistance (TA) on managing co-infected patients, paying attention to the management of opportunistic

infection. c) Referring patients suspected of TB for sputum smears and x-ray before being placed on

supervised TB treatment. Special emphasis will be placed for the correct diagnosis and treatment of

pediatric patients. e) Providing HIV test kits to TB clinics. e) Providing co-trimoxazole to TB clinics for

prophylaxis.

2) Assessing and improving TB infection control at care and treatment clinics, inpatient and transient waiting

wards. a) Performing minor renovations to improve ventilation and ensuring other infection control

measures are in place.

3) Strengthening referral and collaboration between care and treatment and TB clinics. a) Orienting all

Regional Health Management Teams (RHMT) on the new integrated approach in the management of

combined TB-HIV patients. b) Collaborating with RHMT and Council Health Management Teams (CHMT),

in the provision of supportive supervision and mentorship to CTC teams, to ensure quality service. c)

Monitoring service provision, data keeping, analysis, utilization, reporting back to the sites and report

writing. d) Ensuring data collection tools are continuously available. e) Recording best practices, lessons

learnt and disseminating them.

LINKAGES:TUNAJALI is committed to working in close collaboration with NTLP and USG, especially to

increase staff, training, and in planning, monitoring and supervision of activities. Involving the District

Medical Office should improve service and quality, and help ensure sustainability. TUNAJALI will ensure

collaboration with the NTLP and create linkages to and from local TB clinics to VCT, PMTCT service, HBC

and OVC programs to facilitate prompt and appropriate referrals to CTCs. Sub-grantees from TUNAJALI

will link with partners working in the region, including the sister TUNAJALI HBC program, to help strengthen

provision of comprehensive care in urban and rural settings. The program also will support linkage to

national and community-based programs, involving PLHA and volunteers to reduce stigma, promote

provider initiated testing and counseling (PITC) and improve patient adherence. Partners will be

encouraged to leverage lab, test-kits, reagents and x-ray diagnostic resources and drugs, referring patients

to access services, where available through support from the NTLP or other sources, such as the NACP,

MOHSW and Global Fund.

CHECK BOXES: Activities include training of health workers, renovation of infrastructure, supply of

commodities, strengthening district and regional health systems, strengthening linkages and referral to other

programs in and around the region. Efforts to increase the number of women and children enrolled, by

linking with PMTCT and Mother/Child Health (MCH) activities, and to increase male enrollment by using a

family centered approach to care that will justify gender-related activities. Our treatment and care activities

will focus on PLHA identified through VCT and PICT initiatives from out and in-patient wards, as well as

pediatric and TB departments.

M&E: Establishing records has been a challenge as sites had only kept log books or patient registers. By

supporting a qualified data clerk at each site, TUNAJALI will ensure consistent use of tools (paper-based or

electronic) to capture longitudinal data and provide evidence of improved patient management. Data

analysis will show trends and highlight programmatic strengths and weaknesses allowing for feedback to

the site for improvement on patient management, and factors that effect outcomes. Quality Assurance

protocols will be used to ensure accuracy. Supportive supervision by a regional data manager in the RHMT

office, in collaboration with local TB programs and the NLTP, will ensure quality data collection. Regular

meetings with CHMTs and RHMTs will help local health authorities monitor progress. The program will use

the TB/HIV monitoring and evaluation system and will contribute towards its improvement.

SUSTAINABILITY: TUNAJALI plans to focus on strengthening the technical and management capacity of

local staff involved in the care and treatment of HIV and TB, by training, mentoring and providing supportive

supervision to ensure quality of care believed to be the cornerstone for sustainability. These efforts will be

complemented by other sustainable efforts, including educating patients and communities, and linking them

to support programs within their own communities, including the TUNAJALI HBC program to provide

support needed for reassurance. In addition, TUNAJALI will work within the existing health network,

collaborating with NLTP and local authorities to create a sense of ownership.

TITLE: The Rapid Funding Envelope for HIV/AIDS (RFE) in Tanzania

NEED AND COMPARATIVE ADVANTAGE: To increase participation of civil society, ten donors and the

Tanzanian Commission for AIDS (TACAIDS) cooperated in creating a "Rapid Funding Envelope (RFE) for

HIV/AIDS" to assist with the HIV/AIDS response in mainland Tanzania and Zanzibar. The RFE is a

competitive mechanism to support not-for-profit civil society institutions, academic institutions, and

partnerships on projects up to a maximum of 12 months. The RFE allows Civil Society Organizations

(CSOs) to implement projects, build capacity, and improve project coordination and management skills,

while gaining experience and lessons learned on HIV/AIDS interventions. Projects funded by the RFE are

required to comply with national policy and the strategic framework for HIV/AIDS as set by TACAIDS and

the Zanzibar AIDS Commission (ZAC), with goals of contributing to longer-term objectives of the national

response and encouraging projects that promote institutional partnerships and have potential for scale up.

ACCOMPLISHMENTS: To date, the RFE has conducted seven rounds of grant making and approved

$11.2 million for 78 projects. In FY 2007, the RFE successfully held a 4th round, providing awards worth

$3.5 million to 23 CSOs (seven of which were activities addressing the needs of OVC); monitored and

managed existing sub-grantees; created a reliable base for donors to reference without duplicating efforts;

continued to strengthen CSOs, financially and technically, thus laying a solid foundation for further funding;

and facilitated increased resources for CSOs via disbursement of significant funding in a short timeframe.

Generally, funding leveraged from other donors cover the cost of the grants, and the USG funds are used

for management of the funds. The amount of funding requested for FY 2008 includes an amount for the

USG to fund at least one specific OVC activity, in addition to approximately $250,000 in funding for the

management costs for the entire RFE.

ACTIVITIES: Ongoing activities for FY 2008 will include:

1. Grants and financial management of existing sub-grantees including disbursements of grants, liquidation

reviews of sub-grantee financial reports, and M&E of projects.

2. Technical monitoring and management of existing sub-grantees, including a review of project work plans

and progress reports, review of project deliverables, and M&E of projects.

3. Completion of the fifth open round of funding including conducting pre-award assessments and sub

contracting to about 40 CSOs,

4. Financial administration of the RFE fund (USG and multi-donor accounts) including management of

donor receipts, preparation of financial reports, and engaging project audits.

5. Grants and project administration including external RFE communications/correspondence, convening of

donor meetings, and preparation of (ad-hoc) reports.

This component of the funding for the RFE will support OVC activities. The RFE will coordinate a special

OVC round that will involve solicitation and reviewing of short-listed proposals, conducting pre-award

assessments to determine organizational, financial, and technical capacity of CSOs to identify and mitigate

weaknesses. One to two successful CSOs will be contracted. The balance of OVC funds will support

management costs paid by the USG, maintained in a non-pooled account, which will leverage an

approximately additional $2 million of funding through multi-donor support of similar OVC projects.

LINKAGES: In keeping with previous arrangements, Deloitte Consulting Limited is the prime partner and

the lead for grants and finance management. They will link with Management Sciences for Health (MSH) as

the lead technical partner for supporting the RFE, and Emerging Markets Group (EMG) for initiating

capacity-building initiatives to CSOs. The RFE will work closely with the TACAIDS and ZAC in all aspects

of work; ensuring that they champion decisions made, including the path that each RFE round makes. RFE

will also develop formal linkages with large funding mechanisms including Foundation for Civil Society and

Regional Facilitating Agencies (World Bank T-MAP funding agents) to develop information networks and a

common database of funded CSOs to avoid duplication of efforts. In efforts to encourage organizational

development, RFE will share funding experiences with each donor to ensure that the right level of funding

and capacity support is provided to the CSO. With a special round under the proposed PPP initiative,

linkages will be formed with private organizations and workplaces to create partnerships in support of

workplace facilities providing HIV-related services to local communities.

CHECK BOXES: The RFE will fund organizations that support OVC within the national guidelines,

specifically targeting young girls, to provide them access to income-generating opportunities. The RFE will

support capacity building through various steps including the pre-award assessment that highlights key

areas of weakness to be strengthened in the capacity plan, technical assistance/training on programmatic

(HIV) issues and finances, and ongoing coaching from the grant manager and technical advisor.

M&E: The RFE will develop annual work plans, which will include built-in M&E for which the relevant RFE

staff member takes responsibility. RFE management will continue to conduct the following M&E activities:

regular update of project through participation in activities; quarterly reviews of technical reports for

performance against work plan; monitoring through field visits; collection of data; preparation of site visit

reports; and progress reports. The progress reports will be shared with concerned CSOs and donors, to

enable improvement and development of these organizations. Best lessons learned will be captured and

shared, publicized on the RFE website, and processed in a database according to the plans of TACAIDS

and ZAC. They will also be shared through the OVC Implementing Partners Group.

SUSTAINABILITY: RFE will encourage CSOs to foster local community networks that will assist in

continued operations of the project once RFE funding has ended. RFE requires projects to consider the

issues of sustainability during the proposal development and ensures that a realistic plan has been

developed to integrate the project into existing programs. RFE supported CSOs will also be provided

institutional capacity-building support enabling them to graduate to direct funding and/or increase the level

of funding from other donors post RFE funding. A new management structure will be proposed to the

donors to better manage the function of the RFE, whose mandate has changed from its original form due to

the number and size of projects funded.

Activity Narrative: TITLE: The Rapid Funding Envelope for HIV/AIDS (RFE) in Tanzania

TITLE: The Rapid Funding Envelope for HIV/AIDS (RFE) Public-Private Partnership Initiative in Tanzania

NEED and COMPARATIVE ADVANTAGE: To increase participation of civil society, 10 donors and

TACAIDS co-operated in creating a "Rapid Funding Envelope for HIV/AIDS" on Mainland Tanzania and

Zanzibar. RFE is a competitive mechanism for projects on HIV/AIDS in Tanzania. RFE supports not-for-

profit civil society institutions, academic institutions in compliance with national policy and strategic

framework with the goal of contributing to longer-term objectives of the national response and encouraging

projects that promote institutional partnerships. To date, although the private sector is involved in the fight

against HIV/AIDS, services tend to be limited to their employees, and often lack the continuum of care and

sustainability due to lack of commitment at higher level. This program seeks to use the RFE mechanism to

inform the private sector of the need to expand workplace programs, and establish partnerships with private

organization to strengthen these interventions, leveraging resources from existing medical structures within

these private institutions to make care and treatment available to employees and their communities who

would otherwise not have access to these services.

ACCOMPLISHMENTS: To date, RFE has conducted seven rounds of grant making and approved $11.2

million from pooled funds, for 78 projects. In FY 2007, RFE successfully held a 4th round, providing awards

worth $3.5 million to 23 Civil Society Organizations (CSOs) (seven had OVC activities); monitored and

managed existing sub grantees; created a reliable base from which donors can utilize without duplicating

efforts; continued to strengthen CSOs, financially and technically, thus laying a solid foundation for further

funding; and facilitated increased resources for CSOs via disbursement of significant funding in a short

timeframe.

ACTIVITIES: Ongoing activities will include management of the RFE Public Private Partnership (PPP)

initiatives to be established with FY 2007 Plus-Up funds focusing on strengthening collaboration with private

organizations; selecting and providing grants to workplace organizations for treatment and care activities in

support of the continuum of care efforts in the workplace and neighboring communities. In particular this

will involve oversight of projects worth $200,000 in grants to approximately 20 organizations. The 20

companies will be awarded matching contribution grants for creating or extending their workplace programs.

The companies will be paired with our in-place partners to ensure that their programs adhere to best

practices and national standards. The focus of the activities will support companies in Tanzania in

arranging for local, on-site VCT ‘worker and community' test days, and to ensure that all workers are aware

of - and take advantage of - HIV counseling and testing in the workplace.

These funds will be used to expand prevention services in the companies while leveraging corporate

resources to expand HIV/AIDS treatment and care services beyond the workplace, and using the family

centered approach, include family and community members who may otherwise not have been able to

access services in these private facilities. Specific activities will include; 1) Grants and financial

management of sub grantees; including disbursements of grants; liquidation reviews of sub grantee

financial reports and monitoring & evaluation of projects; 2) Technical monitoring and management of sub

grantees; including review of project work plans and progress reports; review of project deliverables and

monitoring & evaluation of projects; 3) Financial administration of the RFE-PPP fund; including preparation

of financial reports and engaging project audits; 5) Grants/Project administration including external RFE-

PPP communications/correspondence; convening of meetings with the donor/partner; preparation of (ad-

hoc) reports.

The program will strengthen collaboration with private organizations to find unique alternatives to which

private-for-profit companies can contribute towards alleviating the burden caused by HIV/AIDS. a) RFE-PPP

program will solicit and review short-listed private-for-profit organizations, conducting pre-award

assessments to determine organizational, financial & technical management competency of the existing

medical programs and identify potential weakness that may be mitigated towards improving the continuum

of care. b) At least five successful organizations will be contracted and funded directly with USG funds. c)

Supportive supervision will be provided to the projects, including monitoring & evaluation, guidance &

oversight of the projects through regular site visits. 2) Capacity building towards graduation towards direct

funding from donors will be provided through training and coaching/mentoring. 3) Additional support will be

sought from multi-donors to fund similar workplace programs. If successful, non pooled USAID funds will

support management of these grants.

LINKAGES: In keeping with previous arrangements, Deloitte Consulting Limited as the Prime, also the lead

for grants and finance management will link with a partner (TBD) as the lead technical partner for supporting

the RFE-PPP, and will work closely with donor, keeping within the mandates of the AIDS Business Council

of Tanzania (ABCT). RFE-PPP will also develop formal linkages with large funding mechanisms; including

Regional Facilitating Agencies (TMAP) to feed into the development information networks system, a

common database of organizations funded to avoid duplication of efforts. In effort to encourage

organizational development, RFE-PPP will share funding experience with potential donors/organizations to

create awareness and encourage buy-in.

CHECK BOXES: RFE-PPP will seek to fund organizations with existing medical programs, building capacity

as needed to afford the continuum of care to their employees, as well families and surrounding

communities. The RFE will support capacity building through various steps including the pre-award

assessment that highlights key areas of weakness to be strengthened in the capacity building plan;

technical assistance/training on programmatic (HIV) issues and finances; and ongoing mentoring and

technical assistance.

M&E: Annual work plans will be developed and will include built-in M&E processes for which the relevant

staff member takes responsibility. Management of the RFE-PPP will include conducting the following

monitoring & evaluation activities; Regular update of project through participation in activities; Review

quarterly technical reports for performance against work plan; Monitoring through field visits; Collection of

data; Preparation of site visit reports and progress reports; these reports will be shared with private

organizations concerned, and donors, to enable improvement and development of the program, Best

lessons learned will be captured and shared.

SUSTAINAIBLITY: The private organizations involved will be encouraged to foster local community

networks, and continue leveraging own resources that will assist in continued operations of the project once

Activity Narrative: RFE-PPP funding has ended. RFE-PPP requires projects to consider sustainability during proposal

development; and ensure that a realistic plan has been developed to integrate the project into existing

programs. RFE-PPP supported organizations will also be provided with institutional capacity building

support enabling them to grow/ graduate towards receiving accreditation as Care and Treatment Centers,

and allow them to receive direct funding and/or increase the level of funding from other donors, post RFE-

PPP funding. The new management structure at Deloitte has been designed to better manage the function

of the RFE, to include capacity for managing the RFE-PPP, since the original mandate of the RFE has

changed from its original form and size of projects funded.

TITLE: Tunajali HIV/AIDS Care and Treatment Project

NEED AND COMPARATIVE ADVANTAGE: The HIV epidemic has reached critical levels in regions where

Deloitte Consulting/Family Health International (FHI) work, with prevalence rates of 13.4% in Iringa, 5.4% in

Morogoro, and 4.9% in Dodoma. Singida's 3.2% prevalence is considered low compared to a 50% in-

patient rate. Deloitte and FHI have been treatment partners under a previous mechanism and a newly

awarded contract. The program successfully teams Deloitte's expert financial and programmatic

management with FHI's technical expertise in order to scale up access to the continuum of care and

treatment toward meeting the Government of Tanzania's five-year goal of enrolling about 400,000 people

living with HIV/AIDS (PLWHA) on Antiretroviral Therapy (ART) by the end of 2007. Deloitte/FHI is a well-

respected partnership, with established strong working relationships with the Government of Tanzania

(GoT).

ACCOMPLISHMENTS:

By March, 2007, Deloitte/FHI supported 33 sites in Dodoma, Morogoro, and Iringa; with 9,294 on ART (790

children), and 20,324 PLWHA on care, already exceeding FY 2007 targets of 9,000 and 20,000

respectively. In addition, the program trained 132 staff in ART management, 33 in monitoring and evaluation

(M&E), and eight in supervision. Unique to the program, Deloitte/FHI hired 24 "retired, but not tired" staff for

three regional hospitals, and linked with the Tunajali Home-based Care (HBC) program, supporting HBC

coordinators for effective referrals to/from HBC services, and strengthening adherence and prevention.

MAJOR ACTIVITIES:

The program, called Tunajali, will focus on scale up of services, ensuring care and treatment is integrated in

local systems, maximizing resources, and creating ownership towards sustainability. The scale up will

occur by providing grants to health facilities for ongoing activities in 38 Care and Treatment Clinics (CTCs),

and expand outward to 60 Health Centres, which will especially increase access to treatment for rural

patients. Tunajali will work closely with the Regional Health Management Team (RHMT) and District Health

Management Team (DHMT), the GoT entities charged with managing health services at the local level.

This includes building capacity of the RHMT/DHMT in planning, coordination, and monitoring. In Dodoma,

Morogoro, and Iringa, this is ongoing. With FY 2007 plus up funding, expansion was initiated to Singida.

Activities will be prioritized by planning and coordinating with local authorities, leveraging support from other

donors, including basket funds. Deloitte/FHI will work with the RHMT/DHMT to strengthen supportive

supervision and with facilities to development internal quality improvement measures.

The funding requested for FY 2008 includes support to renovate and equip 60 Health Centres with furniture

and equipment; purchase buffer stocks of lab reagents/supplies, and opportunistic infection (OI) drugs to

complement MSD supplies; procure vehicles for supportive supervision and transporting samples; and train

staff in ART, Provider-initiated Testing and Counseling (PITC), adherence counseling, pediatric HIV/AIDS,

and M&E, using national guidelines and curriculum. To increase case-finding, PITC will be initiated at

in/outpatient, pediatric and TB wards, and interventions will be strengthened to support Early Infant

Diagnosis (collecting filter paper samples and transferring to closest zonal testing center) and increase

pediatric treatment numbers. Emphasis will be on ensuring that providers are equipped to deal with

pediatric services at the lowest service level possible to ensure access. Vulnerable children from homes of

PLWHA who have been exposed but not tested will be identified. Referral networks and linkages to support

the continuum of care will also be strengthened to ensure two-way referrals between Care and Treatment

Clinics and other services, such as TB, HBC, hospital outpatient services, Prevention of Mother-to-Child

Transmission (PMTCT), family planning, and counseling/testing services. Referrals systems will be

monitored through simple referral and feedback mechanisms within facility and HBC programs, and

feedback sessions will be organized. Deloitte/FHI will link with IntraHealth to strengthen PICT, and with

Columbia for lessons learned in their prevention for positives study. Other preventive measures, including

access to safe water, Insecticide Treated Nets (ITNs), and nutritional assessment and education will be

provided. Family planning options will be offered. The program will work with PLWHA groups and

communities to promote ART literacy and treatment preparedness, and will involve PLWHA in supportive

roles to enhance adherence, awareness, and reduce stigma. PLWHA will be involved as counselors and

role models to provide communities with accurate messages, encouraging HIV+ health worker involvement.

Tunajali will attempt to equalize the gender imbalance through increased focus on male participation, family-

centered approaches to antenatal care, and stronger promotion of testing services with males. To reduce

stigma, the video recently developed by I-TECH will be used to sensitize providers to reduce the negative

impact on PLWHA. Tunajali will also focus on improving both the quality of services and the quality of the

workplace. To improve quality of ART services, the program will establish quality improvements (QI)

measures (using established processes) to monitor key facility-based indicators, ensuring adherence to

national tools/guidelines and Standard Operating Procedures. A participatory approach to QI will contribute,

along with other facility improvements and retention interventions, to improved morale among health

workers. To foster quality services, Tunajali will provide mentoring, training, and technical assistance; and

support M&E, including supportive supervision, data collection, and reporting.

Particular focus will be placed on ensuring adequate manpower at facilities. Tunajali will expand a

successful pilot of using retired officers to alleviate the human resource crisis, and will proceed with task

shifting: nurses to triage patients, lay counselors and HBC coordinators to assist in referral to/from HBC and

tracing defaulters, and final year Clinical Officer/Assistant Medical Officer/nursing students caring for

patients.

An important feature of the Deloitte/FHI partnership in Tunajali is the financial management technical

assistance. This is very critical as grant-making is extended to district health authorities and district

hospitals. Deloitte will ensure close financial management of sub grantees; including establishing financial

control systems to minimize opportunity for fraud, abuse, and mismanagement; monitoring disbursements

of grants; conducting financial assessments and periodic reviews of reports; and providing capacity building

to ensure fiscal accountability. These measures will also help to build transparency and sustainability.

They will also accelerate the possibilities for graduation toward direct funding in appropriate cases.

LINKAGES:

The Tunajali treatment program is integrated with Tunajali HBC and orphan programming. A quality

continuum of care is assured by strengthening linkages between entry points to care and treatment: TB,

MTCT, VCT services funded through the USG. Deloitte will also work with EngenderHealth to establish

Activity Narrative: PMTCT services based on EngenderHealth's previous experience. The program is also closely linked with

the National AIDS Control Programme (NACP) and the FHI technical assistance provided to NACP. In

addition, it works closely with all other treatment partners. Tunajali works through RHMT and CHMT in the

regions and the Ministry of Health and Social Welfare (MOHSW) at national level.

AREAS OF EMPHASIS:

Significant human capacity development will be undertaken at the facility level to improve morale and

maximize the staffing capacity; and with regional/local government to strengthen their response and

management of programs, and improve infrastructure. Gender will be emphasized to bring greater numbers

of HIV+ men for treatment. Focus will be placed on increasing pediatric patients by integrating more closely

with maternal child health services and strengthening linkages to PMTCT and immunization services.

M&E:

Tunajali will collaborate with the NACP/MOHSW to implement the national M&E system for Care and

Treatment in Dodoma, Iringa, Morogoro, and Singida. At each site, data will be collected by an trained data

clerk using the national paper-based tools. Quality of data will be assured through supportive supervision by

Tunajali regional M&E officer working in collaboration with trained CHMT/RHMT staff. Data will be sent to

national units and Tunajali to be analyzed and used in reports for feedback to sites for future planning and

quality improvement as well as reporting to NACP and USG. Currently, all 33 CTCs are using the national

MS Access-based CTC2 database. This number is set to increase to 98 by Sept 2008. In FY 2008, Tunajali

will support training of 129 HCWs on M&E and provide technical assistance to 98 CTCs, four regional

offices, and 27 DHMT/CHMT.

SUSTAINABILITY:

Tunajali is committed to sustainability and plans to work through local authorities. Empowering local

authorities creates ownership, putting the responsibility of sustainability into their hands. Training/mentoring

of CTC staff, RHMTs and CHMTs to build technical and management capacity, and to continue using

national standards and guidelines also ensures sustainability. Authorities will be informed of lessons learned

and innovative approaches, facilitating the adoption and updating of national norms, standards and

guidelines. Tunajali will participate in the 2008/9 budgeting and planning cycles at district and regional

levels to ensure integration of our programs.

TITLE: The Rapid Funding Envelope for HIV/AIDS (RFE) Public-Private Partnership Initiative in Tanzania

NEED and COMPARATIVE ADVANTAGE:

To increase participation of civil society, 10 donors and the Tanzanian Commission for AIDS (TACAIDS)

cooperated in creating a "Rapid Funding Envelope (RFE) for HIV/AIDS" on Mainland Tanzania and

Zanzibar. RFE is a competitive mechanism for projects on HIV/AIDS in Tanzania. RFE supports not-for-

profit civil society institutions, academic institutions in compliance with national policy and strategic

framework with the goal of contributing to longer-term objectives of the national response and encouraging

projects that promote institutional partnerships. To date, although the private sector is involved in the fight

against HIV/AIDS, services tend to be limited to their employees, and often lack the continuum of care and

sustainability due to lack of commitment at higher level. This program seeks to use the RFE mechanism to

inform the private sector of the need to expand workplace programs, and establish partnerships with private

organization to strengthen these interventions, leveraging resources from existing medical structures within

these private institutions to make care and treatment available to employees and their communities who

would otherwise not have access to these services. This will be accomplished through public-private

partnerships (PPP).

ACCOMPLISHMENTS:

To date, RFE has conducted seven rounds of grantmaking, and approved $11.2 million from pooled funds,

for 78 projects. In FY 2007, the RFE successfully held a fourth round, providing awards worth $3.5 million

to 23 Civil Society Organizations (CSOs); monitored and managed existing sub grantees; created a reliable

base from which donors can utilize without duplicating efforts; continued to strengthen CSOs, financially and

technically, thus laying a solid foundation for further funding; and facilitated increased resources for CSOs

via disbursement of significant funding in a short timeframe.

ACTIVITIES:

Ongoing activities will include management of the RFE-PPP initiatives to be established with FY 2007 Plus-

Up funds focusing on strengthening collaboration with private organizations; selecting and providing grants

to workplace organizations for treatment and care activities in support of the continuum of care efforts in

the workplace and neighboring communities. In particular this will involve oversight of projects worth

$500,000 in grants to approximately 10 organizations. These funds will be used to expand services in the

existing medical structure in these private institutions, while leveraging corporate resources to expand

HIV/AIDS treatment and care services beyond the workplace, and using the family centered approach,

include family and community members who may otherwise not have been able to access services in these

private facilities. Specific activities will include:

1) Grants and financial management of sub grantees; including disbursements of grants; liquidation reviews

of sub-grantee financial reports and monitoring/evaluation of projects

2) Technical monitoring and management of sub grantees; including review of project work plans and

progress reports; review of project deliverables and monitoring & evaluation of projects

3) Financial administration of the RFE-PPP fund; including preparation of financial reports and engaging

project audits

4) Grants/Project administration including external RFE-PPP communications/correspondence; convening

of meetings with the donor/partner; preparation of (ad-hoc) reports.

FY 2008 funds will be used to expand on the FY 2007 initiatives, providing grants to additional workplace

programs. In particular, this project plans to: 1) identify another six - ten workplace programs to be awarded

grants through a special RFE-PPP round to be specifically funded by USG funds. The projects will focus on

care and treatment activities in the workplace and aim at leveraging corporate funds to extend the support

to family and community members. The program will strengthen collaboration with private organizations to

find unique alternatives to which private-for-profit companies can contribute towards alleviating the burden

caused by HIV/AIDS

a) RFE-PPP program will solicit and review short-listed private-for-profit organizations, conducting pre-

award assessments to determine organizational, financial & technical management competency of the

existing medical programs and identify potential weakness that may be mitigated towards improving the

continuum of care

b) At least five successful organizations will be contracted and funded directly with USG funds, targeting at

least 3,000 PLHA

c) Supportive supervision will be provided to the projects, including monitoring & evaluation, guidance &

oversight of the projects through regular site visits.

2) Capacity building towards graduation towards direct funding from donors will be provided through training

and coaching/mentoring. 3) Additional support will be sought from multi-donors to fund similar workplace

programs. If successful, non-pooled USAID funds will support management of these grants.

LINKAGES:

Deloitte Consulting Limited, also the lead for grants and finance management will link with a partner (TBD)

as the lead technical partner for supporting the RFE-PPP, and will work closely with donor, keeping within

the mandates of the AIDS Business Council of Tanzania (ABCT). RFE-PPP will also develop formal

linkages with large funding mechanisms; including Regional Facilitating Agencies (TMAP) to feed into the

development information networks system, a common database of organizations funded to avoid

duplication of efforts. In effort to encourage organizational development, RFE-PPP will share funding

experience with potential donors/organizations to create awareness and encourage buy-in.

CHECK BOXES:

RFE-PPP will seek to fund organizations with existing medical programs, building capacity as needed to

afford the continuum of care to their employees, as well families and surrounding communities. The RFE

will support capacity building through various steps including the pre-award assessment that highlights key

areas of weakness to be strengthened in the capacity building plan; technical assistance/training on

programmatic (HIV) issues and finances; and ongoing mentoring and technical assistance.

M&E:

Annual work plans will be developed and will include built-in M&E processes for which the relevant staff

member takes responsibility. Management of the RFE-PPP will include conducting the following monitoring

& evaluation activities; Regular update of project through participation in activities; Review quarterly

Activity Narrative: technical reports for performance against work plan; Monitoring through field visits; Collection of data;

Preparation of site visit reports and progress reports; these reports will be shared with private organizations

concerned, and donors, to enable improvement and development of the program, Best lessons learned will

be captured and shared.

SUSTAINABILITY:

The private organizations involved will be encouraged to foster local community networks, and continue

leveraging own resources that will assist in continued operations of the project once RFE-PPP funding has

ended. RFE-PPP requires projects to consider sustainability during proposal development; and ensure that

a realistic plan has been developed to integrate the project into existing programs. RFE-PPP supported

organizations will also be provided with institutional capacity building support enabling them to grow/

graduate towards receiving accreditation as Care and Treatment Centers, and allow them to receive direct

funding and/or increase the level of funding from other donors, post RFE-PPP funding. The new

management structure at Deloitte has been designed to better manage the function of the RFE, to include

capacity for managing the RFE-PPP, since the original mandate of the RFE has changed from its original

form and size of projects funded.