TITLE: System strengthening to accelerate HIV/IDS Service expansion

NEED and COMPARATIVE ADVANTAGE: In Tanzania, the health workforce, especially at district level, is

shrinking in both numbers and requisite skills. A major anxiety at this time is the relatively small number of

eligible patients on ART. The Ministry of Health and Social Welfare (MOHSW) is concerned that it cannot

meet the demands for ART with the current workforce and systems. It is clear that unless systems are

strengthened to address the acute shortfall, in human resources, it will be impossible to meet HIV/AIDS

care and treatment goals. The Capacity Project draws on the extensive experience and expertise of its

global partners and now helps over 25 countries to improve capacity for workforce policy and planning and

to strengthen systems to support workforce expansion and performance.

ACCOMPLISHMENTS: Mainland: Technical support to MOHSW to develop a HR strategic plan that offers

appropriate strategic options to respond to the HR crisis and manage scarce human resources more

effectively; creating new capacity for over 250 HR leaders so as to focus HR priorities. Zanzibar: human

resource management capacity strengthening to improve worker productivity, and to enhance HRH tracking

capacity

ACTIVITIES:

Continue funding support to the AIDS Business Coalition, Tanzania (ABCT) to further strengthen leadership

capacity for HIV/AIDS awareness raising and capacity building within the private sector and in more

regions. This activity will allow ABCT to develop workplace HIV/AIDS policies and to conduct peer

counselor training among its 60 member organizations.

LINKAGES:

The project works in close collaboration with NIMR. Findings from the NIMR-led HR studies inform

interventions designed and supported by the Capacity project. The Benjamin William Mkapa Foundation

and Capacity Project will maintain the partnership to ensure smooth integration of new EHP hires in the

work place. The Capacity Project will work with MSH to design and implement leadership development and

HRM strengthening programs for central and district levels. The existing partnership between ABCT and

the Capacity Project will continue to advance private sector engagement in HIV/AIDS. The project is a

member of the HCD and USAID implementing partner groups. These provide a platform for sharing plans

and achievements. All related work is implemented in close collaboration with the appropriate central,

regional, district and local government authorities. The Capacity Project will work with various partners and

stakeholders and will encourage and facilitate effective collaboration.

CHECK BOXES: Human Capacity Development: In service training, retention strategy, task shifting,

strategic information. Workplace programs. The activities seek primarily to strengthen leadership capacity,

at central and district levels, through training, to enable leaders to take appropriate and timely action to

recruit and keep valued workers. The enhanced human resource information system will be a key decision-

making tool to HR leaders. Support to ABCT will expand the reach of HIV prevention messages and

improve the uptake of HIV/AIDS treatment and care services among private sector workers and their

families.

M&E: The project will develop a comprehensive and integrated M&E plan linked to existing M&E plans for

partner institutions. A simple and practical mechanism will be established that will allow for the tracking and

reporting of progress and results from FY 2008 and FY 2009 technical assistance activities to support the

implementation of the MOHSW HR strategic plan and the Emergency Hire Program (EHP). Standardized

tools will be used to ensure data quality and data will be stored in paper and electronic format. The outputs

will provide a basis for decision making on amendments and improvements on recommendations to achieve

targets. As part of the M&E process, project results will be documented and disseminated, in addition to

lessons learned including case studies from the EHP experiences.

SUSTAINAIBLITY: The project relies on effective partnerships with the MOHSW, district authorities, local

training institution, and NGOs to implement the described activities. The proposed implementation model

will allow the project to tap on existing strengths, mobilize, and build on local talent to leave behind

sustainable systems. As an example, the Project will team up with Zonal Training Centers (ZTC) in FY

2008 to implement planned district HRM capacity building activities. ZTC will take up lead responsibility

from FY 2009 onward, and roll out the training to other districts, with minimal support from the Capacity

Project.

TITLE: System strengthening to accelerate HIV/AIDS Service Expansion.

NEED and COMPARATIVE ADVANTAGE: In Tanzania, the health workforce, especially at district level, is

shrinking in both numbers and requisite skills. A major anxiety at this time is the relatively small number of

eligible patients on ART. The Ministry of Health and Social Welfare (MOHSW) has expressed concerns

regarding increasing demands for ART with the current workforce and systems. It is clear that unless

systems are strengthened to address the acute shortfall in human resources, it will be impossible to meet

HIV/AIDS care and treatment goals. The Capacity Project (CP) draws on the extensive experience and

expertise of its global partners and now helps over 25 countries to improve capacity for workforce policy and

planning and to strengthen systems to support workforce expansion and performance.

ACCOMPLISHMENTS: On the mainland, CP provides technical support to the MOHSW to develop a

human resource (HR) strategic plan that offers appropriate strategic options to respond to the HR crisis. CP

manages scarce HRs more effectively, thereby creating new capacity for over 250 HR leaders to focus HR

priorities. In Zanzibar, CP conducts HR management capacity strengthening to improve worker productivity

and to enhance HRH tracking capacity

ACTIVITIES: Continue funding support to the AIDS Business Coalition of Tanzania (ABCT) to further

strengthen leadership capacity for HIV/AIDS awareness raising and capacity building within the private

sector and in more regions. This activity will allow ABCT to develop workplace HIV/AIDS policies and to

conduct peer counselor training among its 60 member organizations.

LINKAGES: The project works in close collaboration with National Institute of Medical Research (NIMR).

Findings from the NIMR-led HR studies informed interventions designed and supported by the CP. The

Benjamin William Mkapa Foundation and CP will maintain a partnership to ensure smooth integration of

new EHP hires in the work place. The CP will work with MSH to design and implement leadership

development, and HRM strengthening programs for central and district levels. The existing partnership

between ABCT and the CP will continue to advance private sector engagement with HIV/AIDS initiatives.

The project is a member of the HCD and USAID implementing partner groups. These provide a platform for

sharing plans and achievements. All related work is implemented in close collaboration with the appropriate

central, regional, district, and local government authorities.

CHECK BOXES: Human capacity development occurs in service training, retention strategy, task shifting,

and strategic information. Activities seek primarily to strengthen leadership capacity at central and district

levels through training to enable them take appropriate and timely action to recruit and keep valued

workers. The enhanced human resource information system will be a key decision making tool to HR

leaders. Support to ABCT will expand the reach of HIV prevention messages and improve the uptake of

HIV/AIDS treatment and care services among private sector workers and their families.

M&E: The project will develop a comprehensive and integrated M&E plan linked to existing M&E plans

implemented by partner institutions. A simple and practical mechanism will be established that will allow for

the tracking and reporting of progress and results from FY 2008 and FY 2009. Technical assistance

activities will support the implementation of a MOHSW HR strategic plan and the Emergency Hire Program

(EHP). Standardized tools will be used to ensure data quality and data will be stored in paper and

electronic format. The outputs will provide a basis for decision making on amendments and improvements

in order to achieve targets. As part of the M&E process, the project will document and disseminate results

and lessons learned including case studies from the EHP experiences.

SUSTAINAIBLITY: The project relies on effective partnerships with the MOHSW, district authorities, local

training institution, and NGOs, to implement activities described. The proposed implementation model will

allow the project to build on existing strengths, mobilize, and build on local talent to leave behind

sustainable systems. As an example, the project will team up with Zonal Training Centers (ZTC) in FY 2008

to implement planned district HRM capacity building activities. ZTC will take up lead responsibility from FY

2009 onward and roll out the training to other districts, with minimal support from the CP.

TITLE: Strengthening Human Capacity Response for Implementation of the National Plan of Action for OVC

NEED and COMPARATIVE ADVANTAGE: Tanzania faces a crisis in its ability to provide needed services

to orphans and vulnerable children (OVC). Presently, only one third of districts have trained social workers,

and even those social workers are not trained on child development or the particular needs of OVC.

Adequate and qualified human resources, along with short- and long-term emergency measures to

supplement the available work force, are required to respond to the needs of OVC, and to support the

effective rollout of the National Plan of Action (NPA). A Human Capacity Assessment (HCA) has been

completed, and there are creative programs that have been initiated to address the challenges. This activity

will build on the HCA report recommendations and support scale up of ongoing initiatives, such as training

of para-professional social workers, enhancing OVC program management and supportive supervision, and

generally strengthening local government authorities (e.g., social welfare officers and community

development officers).

ACCOMPLISHMENTS: This would be a new endeavor for the Capacity Project, but it would build on the

previous HCA undertaken by the Capacity Project. The training curriculum and trainers prepared through

the twinning program between the Jane Addams School of Social Work and the Tanzanian Institute of

Social Work would roll out services on a broad scale.

ACTIVITIES: The Capacity Project would use the existing HCA report to develop an action agenda that

would plot and prioritize the required labor to implement the NPA. This would include a short-term and a

long-term national Human Resource Plan to respond to the OVC crisis and accelerate the rollout of the

NPA. The short-term plan would integrate the plan to use para-professional social workers that will be

trained in a short period, as a "just-in-time" measure to address immediate needs in the community. The

longer-term plan would take into consideration the enhanced social worker curriculum, and focus on

increasing the quality of social work training institutions in Tanzania, as well as strengthening recruitment

and retention in field positions. The Capacity Project will work with the Department of Human Resources

(DHR) and the Department of Social Welfare (DSW) at the Ministry of Health and Social Welfare (MOHSW)

on an HR performance-based evaluation and appraisal system, and help to develop standards for social

worker's interaction with OVC. A key component of this activity will be the broad-scale rollout of the para-

professional social worker training to 50 districts (ten regions), and subsequently to monitor the intervention.

In addition, in collaboration with the Prime Minister's Office for Regional and Local Government

(PMORALG), develop and implement a capacity-building strategy of mainstream social welfare officers in

the local government and emergency hiring plan. The scale up of the work force for OVC services will

occur hand in hand with enhancements to local OVC program management and supportive supervision that

the Capacity Project will develop, as well as strengthening key local government authority's involvement in

the oversight of OVC programs.

LINKAGES: This activity will link to the Tanzanian NPA for OVC and with all the USG-funded OVC

Implementing Partner Group (IPG) network. The Capacity Project collaborates with the MOHSW,

PMORALG, and the Ministry of Higher Education, and will increase their focus on the DSW and the

MOHSW, as well as with TACAIDS and UNICEF. Most importantly, the activity will be linked to the work of

the Most Vulnerable Children's Committees (MVCCs) at the local level.

CHECK BOXES: The main thrust of this project is to increase the human resource capacity to care for OVC

and to ensure that their services can be managed and monitored.

M&E: This activity will support the implementation of the NPA to care for OVC through the trained para-

social workers. All OVC needs and services will be monitored with the national DMS. This system is being

maintained at the local level through the MVCCs, ensuring that information about caregivers trained and

available for supporting OVC needs at the local level feeds not only into the national system, but is also

available to MVCCs at the local level for planning, decision making, and monitoring.

SUSTAINABLITY: All activities and strategies are designed to build the capacity of available human

resources at DSW and local GOT structures, as well as MVCCs. Both short- and long-term hiring and

recruitment plans will reinforce the ongoing national strategies and initiatives for sustainability. The

PMORALG will be involved in the entire process to catalyze the absorption of the new cadre of para-social

workers to the local government workforce as well as integration of social work training in the orientation.

TITLE: System Strengthening to Accelerate HIV/IDS Service Expansion

NEED and COMPARATIVE ADVANTAGE: Tanzania suffers from a dramatic shortfall of skilled health

workers, with nearly 60% of positions vacant. The situation is particularly serious in rural districts, where a

combination of factors leaves huge gaps in staffing. The Ministry of Health and Social Welfare (MOHSW) is

concerned that it cannot meet the demands for ART, with the current workforce and weak recruitment and

retention, as well as management and information systems. Unless systems are strengthened to address

the acute shortfall in human resources, it will be impossible to meet Government of Tanzania and

Emergency Plan HIV/AIDS care and treatment goals. The Capacity Project draws on the extensive

experience and expertise of its global partners and now helps over 25 countries to improve capacity for

workforce policy and planning and to strengthen systems to support workforce expansion and performance.

ACCOMPLISHMENTS: Mainland: The Capacity Project provided technical support to the MOHSW to

develop a Human Resource (HR) strategic plan that offers an array of critical strategic interventions to

respond to the HR crisis and manage scarce human resources more effectively. In addition, Capacity

trained over 250 national and district HR leaders in management and leadership so that they are prepared

to meet the challenges posed by a decentralized HR system, as part of their support to the recently initiated

Tanzanian Emergency Hiring Plan (EHP). Capacity developed key assessments to set the stage for

essential remedies in the recruitment system that have been intractable for years. In Zanzibar, Capacity

has supported the MOHSW to strengthen the HR Management Information Systems (HRMIS) and assess

worker productivity, followed by specific interventions to improve worker productivity, and to enhance HR

tracking capacity. Also, Capacity developed a strategic plan for the autonomy of the only tertiary care

hospital in Zanzibar.

ACTIVITIES: 1. Ensure that systems are in place to manage and use Human Resources for Health

information effectively for decision making. This will involve the completion of a functional data system for

mainland Tanzania, linked at central, regional, and district levels. 1a) Play a leadership role to coordinate

HRMIS partners' efforts to ensure integration of component systems and plan for phase piloting and

implementation down to the district level; 1b) expand infrastructure through hardware procurement; 1c) train

at least 150 managers in the use of the system and the information generated from the system for data

driven decision making.

2. Strengthen the ability of the Department of HR at the MOHSW to lead the implementation of the full HR

strategy, which crosses many departments, and, indeed, several Ministries (Prime Minister's Office for

Regional and Local Government, Ministry of Finance, Ministry of Higher Education, Civil Service

Commission, etc.). This requires the development of strong leadership skills and ability to orchestrate the

myriad of interventions to streamline the recruitment, hiring and deployment process and contribute to

retaining skilled health workers. It also requires overhauled policies and practices to support improvements

to the system. 2a) Over the course of the year, Capacity will work with the relevant parts of the Ministry to

address the particular bottlenecks that presently preclude a streamlined system. 2b) Assist in developing

practical recruitment and retention strategies to attract and keep qualified candidates, more so to improve

the shortage situation and worker imbalance in disadvantaged areas. 2c) assist MOHSW to strengthen the

ability of the key department (Department of HR, Department of Administration and Personnel) to work

effectively together to achieve the goals of the HR strategy. This includes additional teambuilding,

secondment of staff, and other interventions to improve morale and performance, 2d) scale up the use of

Open Performance Review and Appraisal System (OPRAS) at all levels, potentially linking performance to

incentives; 2e) work with National Institute of Medical Research (NIMR) to identify and test practical

retention interventions.

3. Work with NIMR to identify and test innovative productive improvement interventions, also incorporating

lessons learned in the experience in Zanzibar. Recent findings by NIMR show a loss of 40% in productivity

in mainland. Productivity improvement strategies are necessary to at least capitalize on the staff that is

available, and this intervention will contribute to step up HIV/AIDS service outputs. 3a) pilot task shifting to

demonstrate the potential of an expanded workforce, and pursue policy change that will permit task shifting

on a broad scale, adding appropriate cadres of support health workers to extend highly skilled health worker

efforts (e.g., use competencies as the basis to re-define the cadre specific job descriptions, and shift tasks

from higher to lower cadres); 3b) Complete ongoing productivity interventions for Zanzibar, evaluate and

disseminate the findings and work with MOHSW to develop scale up plans and accelerate productivity

improvement work on the mainland.

4. A critical part of the EHP is the repair and clarification of the many steps in recruitment and retention,

including at the district level. To support the EHP, which will be working in about 40 districts by the end of

FY 2008, Capacity will work with district health management teams to strengthen capacity in HR

management, and provide grants to develop innovative recruitment and retention interventions. Many of

these interventions will improve the workplace climate, worker morale (such as clear expectations and job

descriptions, effective supervision, and participatory and feedback approaches). In addition, interventions

can include things such as internet access for distance-based learning or other improved communications,

opportunities for continuing education or upward mobility. A toolkit will used to allow districts to select

interventions that are appropriate for their needs. The program should reach 40 EHP districts and 200 HR

leaders by 2009 This is to ensure that districts take appropriate and timely steps to fill vacant positions and

retain valued staff. In partnership with MSH, Capacity will 4a) Establish and support HR working groups at

district level; 4b) Apply and improve the HR Management toolkit, build capacity for district HR leaders in

HRM and support action plans. 4c) Support HRH action forums at district level for cross sharing of

experiences and to further improve HRH practices. The Project will coordinate with Pharm Access which is

developing service level agreements with DHMT for more coordinated support to districts. 4d) To ensure

fiscal accountability, Capacity will help the districts set up financial controls and reporting systems, and

Capacity will undertake on-the-ground assessments to ensure fiscal accountability.

5. Approximately 40% of health services are provided through the private sector (both for profit and not-for-

profit). Capacity will work with both these sectors to ensure they have strong systems in place for HR

management and have interventions that also address recruitment and retention. This will ensure that the

work in the public sector will not distort the worker environment in both components of the private sector.

5a) Team up with Aga Khan Foundation to expand access to their creative distance-based learning Diploma

in Nursing programme, which gives enrolled nurses a unique opportunity to upgrade their knowledge and

skills and become Registered Nurses, without leaving the workplace for extended periods; 5b) Work with

NIMR to assess productivity and retention gaps in the "not for profit" sector and give focused attention for

productivity and retention improvement in the sector.

6. Provide funding support to the AIDS Business Coalition of Tanzania (ABCT) and the newly formed AIDS

Activity Narrative: Business Coalition of Zanzibar (ABCZ) to catalyze their leadership in the response to HIV/AIDS, for

example, promote corporate social responsibility for funding HIV/AIDS activities, workplace awareness

raising, and to cascade their approach to reach more private sector entities in more regions.

LINKAGES: The project works in close collaboration with NIMR, Management Sciences for Health, I-Tech,

PharmAccess, the Touch Foundation, the Aga Khan Foundation, the MOHSW, and other policy and

systems strengthening partners. These provide a platform for sharing plans and achievements. All related

work is implemented in close collaboration with the appropriate central, regional, district and local

government authorities.

CHECK BOXES: Human Capacity Development inherently includes in-service training, retention strategies,

workplace programs task shifting, and strategic information. The enhanced human resource information

system will be a key decision making tool to HR leaders. Support to ABCT will expand the reach of HIV

prevention messages and improve the uptake of HIV/AIDS treatment and care services among private

sector workers and their families.

M&E: The project will develop a robust M and E plan so that the HR MIS, component system, and all

interventions can be closely monitored and adapted during pilot phases. Standardized tools will be

developed by NIMR to monitor and evaluate the specific interventions for the EHP so that effective

interventions are identified for national scale up.

SUSTAINAIBLITY: The project relies on effective partnerships with the MOHSW, district authorities, local

training institution and NGOs, to implement activities described. The proposed implementation model will

allow the project to tap on existing strengths, mobilize and build on local talent so as to leave behind

sustainable systems.