TITLE: PMTCT Activities, Management and Staffing

ACTIVITIES: During the next fiscal year, USAID will continue to collaborate closely with the Government of

Tanzania, Ministry of Health and Social Welfare (MOHSW)/National AIDS Control Program (NACP), and

other key partners to further strengthen technical and program capacity for implementing the Emergency

Plan. USAID provides direct technical support for all of its HIV/AIDS PMTCT programs, which are

implemented in collaboration with Tanzanian governmental and non-governmental organizations. The non-

governmental implementing partners have established offices in Tanzania to carry out PMTCT activities. In

FY 2008, this funding will support in-country PMTCT program staff. In-country program staff will work with

implementing partners to expand PMTCT services, strengthen supervision systems, and conduct routine

monitoring and evaluation. In-country staff will assist other non-governmental partners by ensuring

compliance with national policies and guidelines, harmonizing PMTCT training efforts, PMTCT drug and

commodity forecasting and procurement and facilitating the exchange of lessons learned among partners.

Finally, staff will conduct site visits throughout mainland Tanzania and in Zanzibar to observe service

provision, monitor cooperative agreements, and ensure appropriate program implementation.

This activity links to #9490 in OP and to all activity narratives in the AB section. FY 2008 funds will support

two half-time equivalent staff that will assist in coordinating activities within this program area as well as

serve as technical leads for aspects of the work. The specific composition of the staffing is one full-time AB

specialist hired as a USPSC and one direct hire. The two staff members work directly with implementing

partners, both governmental and non-governmental, to improve the quality and reach of AB activities.

Technical assistance is provided through site visits, capacity assessments, mentoring and skills building, as

well as monitoring of progress. The two work directly with several implementing partners to develop

effective interventions and to disseminate lessons-learned to others. They are active members of the

national prevention technical working group, assisting the Government of Tanzania (GoT) to define national

priorities and strategies to achieve long-lasting behavior change. The two focus on the work of ABY

partners, ensuring state-of-the-art programming, incorporation of national guidelines, and coordination with

other implementing partners. They will assist in the identification of portfolio-wide, as well as national

prevention needs. They will assist in the development of a USG strategy to address these needs, ensuring

that USAID prevention related activities complement those provided by other USG agencies and fill gaps as

needed. They will also work with all USAID portfolio managers to ensure integration of prevention

interventions across the continuum of care and treatment. They will be active members of the USG

prevention thematic group.

This activity is linked to all activity narratives in OP and to 9410 in AB. FY 2008 funds will support one full

time equivalent staff (50% of each of two people) who will assist in coordinating activities within this

program area as well as serve as a technical lead for aspects of the work. The specific composition of the

staffing is two half-time prevention specialists - a direct hire and a USPSC. The two work directly with

implementing partners, both governmental and non-governmental, to improve the quality and reach of OP

activities. Technical assistance is provided through site visits, capacity assessments, mentoring and skills-

building, as well as monitoring of progress. The two work directly with several implementing partners to

develop effective interventions and to disseminate lessons-learned to others. The two are active members

of the National Prevention Technical Working Group, assisting the Government of Tanzania (GoT) to define

national priorities and strategies to achieve long-lasting behavior change. The two will be active members of

the USG Prevention Thematic Group.

In FY 2008, the USG will continue to collaborate closely with the Government of Tanzania, Ministry of

Health (MOHSW), and other key partners to further strengthen technical and program capacity for

implementing the Presidents Emergency Plan for AIDS Relief This will include the establishment and

expansion of quality-assured national systems in the areas of surveillance, prevention of mother-to-child

transmission (PMTCT), laboratory services, blood safety and blood transfusion, antiretroviral treatment,

care, and TB/HIV programs. USG agencies provide direct technical support for all of its HIV/AIDS programs

through US and Tanzania-based organizations, which manage and implement in-country activities. These

activities are funded through cooperative agreements and contracts that are performed at the field level in

direct partnership and collaboration with Tanzanian governmental and non-governmental organizations. The

non-governmental implementing partners have considerable experience in the field of HIV/AIDS and have

established offices in Tanzania to carry out these activities. The technical assistance (TA) and support

provided by USG agencies through our cooperative agreements and contracts will ensure a long-term

sustainable system for providing HIV/AIDS services to Tanzanians. In FY 2008, this funding will support the

in-country Palliative Care: Basic Health Care/Support program staff. The staff will: 1) support the National

AIDS Control Programme (NACP) - Counseling and Social Services Unit coordination role; 2) assist with

the provision of integrated, high quality care and support for people living with HIV/AIDS; 3) provide

guidance for the strengthening of referrals between community and facility based care; 4) assist in the

implementation of the preventive care package; 5) assist in the implementation of a prevention with

positives program for the community setting; 6) provide guidance on developing a monitoring information

system for palliative care; and 7) conduct field visits and supportive supervision to USG sites that are

implementing home-based care (HBC). The staff included in this request would have fiduciary responsibility

for USAID mechanisms in the area of palliative care, and would serve as Cognizant Technical Officers. In

this role, they would approve work plans, review progress and monitor programs, and would review and

compile quarterly and annual reports and oversee the palliative/HBC program mid-term review.

FY08 funds will support two full-time equivalent staff who will assist in coordinating activities within the USG

portfolio, serve as technical leads for aspects of the work, and facilitate programming collaboration across

stakeholders. The staff members will work directly with implementing partners, both governmental and non-

governmental, to improve the quality and expand the scope of services provided to orphans and vulnerable

children. Activities will include site visits, capacity assessments, mentoring and skills building, as well as

monitoring of progress. The staff members will continue to play an integral role in assisting government to

operationalize the National Plan of Action, rationalizing resource utilization and expectations for reach. As

the only OVC specialists on the USG team they will assist in the development of a USG strategy to address

emerging issues, ensuring that USG OVC related activities complement those provided by other entities,

incorporate best practices and lessons-learned, and fill gaps as needed. They will be active participants in

national technical working groups, providing direct technical support for the development of curriculums and

materials, as well as serving on the USG/Tanzania's OVC thematic group. Each will have fiduciary

responsibility for USAID activities as Cognizant Technical Officers.

During the next fiscal year, USAID will continue to collaborate closely with the Government of Tanzania,

Ministry of Health (MOH)/National AIDS Control Program (NACP), and other key partners to further

strengthen technical and program capacity for implementing the Emergency Plan. USAID provides direct

technical support for all of its HIV/AIDS counseling and testing (CT) programs, which are implemented in

collaboration with Tanzanian governmental and non-governmental organizations. The non-governmental

implementing partners have established offices in Tanzania to carry out CT activities. In FY 2008, this

funding will support in-country CT program staff. In-country program staff will work with implementing

partners to expand CT services, strengthen supervision systems, and conduct routine monitoring and

evaluation. In-country staff will assist other non-governmental partners by ensuring compliance with national

policies and guidelines, harmonizing CT training efforts, and facilitating the exchange of lessons learned

among partners. Finally, staff will conduct site visits throughout mainland Tanzania and in Zanzibar to

observe service provision, monitor cooperative agreements, and ensure appropriate program

implementation.

The FY 2008 funds will support one full time equivalent staff member who will coordinate this program area

as well as serve as technical lead. The position, although hired by USAID, has been designed by the USG

team to serve the needs of the entire portfolio, and will be accountable to meeting the needs of all agencies.

Their role is multifaceted and includes: coordination of drug, equipment, and commodity forecasting,

procurement, and distribution across and within USG agencies; technical assistance to the USG and

implementing partners regarding appropriate volume and types of procurements vis-à-vis Government of

Tanzania (GoT) and USG regulations, policies, and protocols; identification of drug and commodity related

barriers to implementation of the broader USG program; design and implementation of solutions to the

same; and oversight of Antiretroviral (ARV) drug partners. In FY 2008, the Tanzania team is working

towards a more consolidated procurement process to achieve efficiencies as well as to ensure compliance

with GoT and USG regulations. To that end, not only is one agent, John Snow International/Supply Chain

Management Systems (JSI/SCMS), procuring all of the USG ARVs, as JSI have done in all previous years,

but this same agent will also be procuring all test kits, a significant portion of treatment and care related

drugs and commodities, all biologic surveillance reagents, and laboratory reagents. In addition, s/he will

work directly with implementing partners to assist and facilitate their procurement needs. To fulfill this role,

the staff member will make frequent site visits, assessing pipelines and logistics systems. They will work

directly with SCMS to design interventions to remediate problems. They will also work with GoT, other

donors, the Global Fund for AIDS, TB, and Malaria and the Tanzania AIDS Coordinating Committee to

identify and solve systemic issues. The individual will play a leading role in the ARV drugs thematic group.

With the significantly increased complexity of USG procurement planning and implementation, it has been

determined that a senior USPSC is needed to guide and oversee the program.

TITLE: USAID Management & Staffing for ARV services

These funds will support one new half-time position for a staff member who will assist in coordinating

activities and providing technical direction within the treatment program area. The role is needed based

upon the scope and magnitude of the treatment roll-out in Tanzania, and the evolving responsibility of the

USG in the scale-up of these services given "regionalization." In FY 2007, USG/Tanzania ART

implementing partners will fully transition to the newly adopted regionalization plan designed by the

Government of Tanzania (GOT). Under this regionalized plan, each USG partner supports the scale-up of

ART services at all levels of treatment facilities within assigned geographic regions. In all designated

treatment sites in each region, USG partners will provide some level of support, and will be integrated within

the regional and district annual health budget and plans. In support of this, the new staff member will work

directly with implementing partners, both governmental and non-governmental, providing technical

assistance to the National AIDS Control Program (NACP) and USG ART partners, and having fiduciary

responsibility at USAID as Cognizant Technical Officer. Field visits and attendance at regional authority

meetings will be necessary.

TITLE: Management & Staffing - SI USAID

USAID SI Management and Staffing FY 2007 funds will support 1.5 full time equivalent staff that will assist

in coordinating activities within SI as well as serve as technical leads for aspects of the work. The specific

composition of the staffing is one full-time Monitoring and Evaluation (M&E) specialist supported by a

second part-time equivalent senior advisor. The full-time M&E specialist will work directly with implementing

partners, both governmental and non-governmental, to improve the quality, timeliness, and utilization of

monitoring and evaluation data. Activities will include site visits, data quality assessments, capacity

assessments, mentoring and skills-building, as well as monitoring of progress. The M&E specialist will work

closely with MEASURE/Evaluation, leveraging their specific technical expertise to fill capacity gaps

specifically identified for each partner through the implementation of a capacity building plan. The M&E

specialist, who has a particular knowledge of the GoT's ART M&S system, will also participate in technical

assistance activities to the GoT in this area. The senior advisor will assist in the identification of portfolio-

wide, as well as national M&E needs. She will assist in the development of a USG strategy to address these

needs, ensuring that USAID SI related activities complement those provided by other USG agencies and fill

gaps as needed. The senior advisor will also work with all USAID portfolio managers to ensure effective

M&E support and provide direct, strategic, technical assistance as needed. Both the program specialist and

senior advisor will be active members of the USG Strategic Information Thematic Group.

ACTIVITIES

FY 2008 funds will support one full time equivalent, locally employed staff (LES) who will assist in

coordinating activities for the OPSS program area at USAIDTanzania. The employee will also serve as the

technical lead for aspects of the work, including assistance with partner oversight. The LES will assist with

activities

across program areas, as well as manage other human capacity development activities within USAID

across

program areas. She/he will also serve as the Inter-Agency Technical Team Lead for OPSS.

USAID estimates that its costs a total of $4,600,000 to manage, support, and provide technical assistance

to USG/Tanzania activities for which it is directly responsible. Of this amount, $1,300,000 in staff charges

has been allocated across relevant program areas and $443,000 is assigned under ‘cost of doing business'.

The USAID program supports the design, implementation, and monitoring of activities related to: orphans

and vulnerable children (OVC); the provision of palliative care; voluntary counseling and testing; social

marketing of HIV-related products; treatment; prevention of mother-to-child transmission (PMTCT);

prevention for youth and high-risk populations; behavior change communications; monitoring and evaluation

(M&E); policy development; and human capacity development. Its particular strength is in supporting the

role of the non-governmental sector to reach Tanzania's goals.

At an operational level, USAID's Emergency Plan program benefits from significant in-kind support from the

larger Mission. Through cost sharing of financial, maintenance, human resource, and other administrative

services, significant cost efficiencies are created, allowing for a relatively small team to manage and support

a portfolio of significant size. This narrative describes the support provided by 21 current staff positions, as

well as a request for four additional staff planned with FY 2008 funding. The costs associated with this

narrative include salary and benefits for management and key administrative support staff, as well as the

costs for travel, professional development, communication, and relevant equipment and office supplies for

these staff to perform their functions. ICAS and IRM costs are provided in a separate narrative (see 8921).

Six of the 21 current positions are critical program support staff, including a senior US Personal Services

Contract (PSC) contracting officer and 5 Foreign Service Nationals (FSNs), all of whom provide direct

contracting, financial, or administrative support. The 14 programmatic staff positions, including five

vacancies, are led by the USAID HIV/AIDS team leader and the deputy team leader, both of whom are

Foreign Service Limited (FSL) staff. The remaining US Direct Hire (USDH), FSL, or US PSC positions are

filled with a HIV/AIDS Prevention Program Officer, and a Public-Private Partnership US PSC Advisor. A US

PSC Supply Chain specialist is presently being hired. One additional US PSC staff position in prevention

and counseling and testing is currently vacant, but is expected to be advertised soon.

Of the nine FSNs, five provide technical and program management across the portfolio. Two are medical

doctors (one managing care and the other managing PMTCT). The remaining three FSN program

management specialists cover M&E, OVCs, and wraparound programs.

In 2009, USAID is requesting four new positions, one of which will be hired as US Direct Hire, while three

others will be mid-to-senior FSNs. The three will provide much needed additional bench strength across all

program components resulting from expansion in the USAID portfolio of more than 75% per year during

each of the past two years. A key priority for FY 2008 is to strengthen FSN staff capacity and build

leadership skills among them for strengthened program sustainability.

This activity is an Indefinite Quantity Contract (IQC) managed by USAID but designed to support all

PEPFAR agencies by providing a means to procure specialized services needed on a recurring but less

than continuous basis. It will also assist the PEPFAR program to effectively and efficiently operate in an

environment of Mission-wide right-sizing in which a freeze has been placed on the hiring of permanent staff,

particularly in support and administrative positions. Needs that have been experienced in previous years for

which such a mechanism would been extremely useful include: staff support for high-level delegation visits;

drafting of technical portions of HIV/AIDS procurements; facilitating Government of Tanzania staff travel to

the PEPFAR Implementers Conference; chartering flights to remote areas of the mainland for technical and

oversight visits; and partners meetings. In addition, it has been a challenge to equitably allocate cross-

agency costs, such as those associated with supporting delegations, given procurement constraints within

each agency.

An IQC is a particularly flexible mechanism that caters to unexpected needs; facilitates staff extension for

specific tasks; and supports cross-agency needs. It has been jointly defined by the PEPFAR agencies and

will be administered by the USAID in-country contracts officer. The officer will assist agencies to issue

specific task orders against the contract for identified short- and long-term needs of the USG HIV/AIDS

program. Funds requested for this activity are based on previous years' experiences and expected, specific

needs in FY 2008. Anticipated services to be procured under this mechanism include: staff support through

the creation of a short-term secretary, administration, and financial services hiring pool; travel services to

manage and oversee USG supported GoT travel as well as chartering services to support visiting

delegations and supervision visits to remote locations; delegation and meeting planning and facilitation; and

personal services contracts for special projects such as COP data entry, copy editors, document

preparation (e.g. briefing papers), and HIV/AIDS procurement development. All of these services will be

provided under the direct supervision of the in-country contracts officer and the technical direction of USG

staff. It is anticipated that, through this procurement, the USG will enjoy significant cost savings and greater

efficiencies in the use of its full-time administrative and technical staff.

The USG has also completed an extensive review of staffing structures and levels in the context of Staffing

for Results. The outcome is a unified structure and "footprint" based on current and projected funding levels.

In light of the complex and lengthy staffing processes of all agencies, it is know that there will be a

significant time lag between position approval and individuals recruited and hired. Therefore, funding is

needed to provide short-term task-based support to operationalize the new PEPFAR/Tanzania structure

while long-term placements are made. Skill sets needed may include writers, administrative support,

program development support, analysts, and short-term technical advisors.

The IQC, described in the Management & Staffing section of the FY'2007 COP, is expected to result in

program improvements by providing core USG staff additional time to focus on inherently governmental

work. Specific expectations for improvements include: greater time allocated to field visits, resulting in better

partner performance monitoring and review; greater time for donor coordination, resulting in reductions of

donor-program overlap; greater time for grants management and oversight, resulting in data quality

improvements in ‘results' reporting; and greater time spent in strategic planning, resulting in better overall

program design and more targeted allocation of funds.

TITLE: USAID Cost of Doing Business

This activity relates to USAID #7829, #9490, #9410, #9573, #9177, #8685, and #8974. USAID estimates

that its costs to manage, support, and provide technical assistance to USG/Tanzania activities for which it is

directly responsible total $4,300,000. Of this amount $82,000 is charged as an IRM tax and $361,000 are

ICASS charges. As USAID is co-located with the Embassy, there are no Capital Security Cost Sharing

charges. At an operational level USAID's PEPFAR program benefits significantly from in-kind support from

the larger Mission. Through cost sharing of financial, maintenance, personnel, and other administrative

services, significant cost efficiencies are created, allowing for a smaller team to manage and support a

portfolio of significant size.