TITLE: ADDOs' Linkage to Community HIV/AIDS Palliative Care Services.

NEED and COMPARATIVE ADVANTAGE: The community-based palliative care services face several

bottlenecks in HBC kits distribution, lack of or poor dissemination of IEC for HIV/AIDS materials and

prevention products and ineffective referral system to other HIV/AIDS service for PLHAs.

The Accredited Drug Dispensing Outlets (ADDOs) and the larger systems in which they are embedded

provide a platform for direct delivery of health services that would improve quality of care to people living

with HIV/AIDS. Key advantages of the ADDOs include geographical accessibility, additional human

resources of trained dispensers, available proper storage for medicines and other products, developed

procurement mechanism within the private sector distribution, established record keeping system that

support data collection and reporting and legally allowed to dispense prescription only medicines including

those for treatment of opportunistic infections.

ACCOMPLISHMENTS: To date, RPM+ has provided technical assistance to the Ministry of Health and

Social Welfare (MOHSW) and the Tanzanian Food and Drug Administration (TFDA) to strengthen district's

capacity to address regulatory and inspection barriers in the private retail sector, incorporated HIV/AIDS

and communication skills training modules into the dispenser's core training, addressed human capacity

development needs through training of the ADDO dispensers, accredited 584 outlets in Morogoro region,

leveraged resources from other US Government investment (President's Malaria Initiative) to achieve policy

changes that support the delivery of subsidized goods in the private sector.

ACTIVITIES: Major activities for FY 2008 are to continue linking community-based home-based care (HBC)

kit distribution to ADDOs to improve efficiency of HBC kit distribution and increase coverage of community-

based HBC services to rural areas and contribute to comprehensive HIV/AIDS care for PLWHA. This

includes extending RPM+'s pilot work with the Tunajali Program in Morogoro for the use of ADDOs to

extend home-based care services. RPM+ will provide additional training (HIV/AIDS-HBC-services related)

to dispensers of participating ADDOs to strengthen their capacity to handle HIV/AIDS related services.

RPM+ will also orient Council Health Management Teams (CHMTs), community-based organizations

(CBOs) and HBC providers on the new roles of ADDOs in support of national HIV/AIDS prevention, care,

and treatment programs.

RPM+ will also strengthen the referrals from ADDOs, where people routinely come with signs and

symptoms suggesting they should be tested for HIV/AIDS, and services for PLWHA. The program will

provide support in tracking the functioning of developed referral system, and conduct feedback meetings

with ADDOs and local health authority to discus successes, challenges, and how to improve the developed

referral system. In addition ADDOs could serve as HIV testing spots piloting the use of lay testers.

An ongoing piece of RPM+'s work is to strengthen ADDOs commodities management and the ADDO HBC

distribution system through support supervision. In collaboration with other partners' support, RPM+ will

work with CHMTs to conduct ADDO-HIV/AIDS-focused quarterly supportive supervision in participating

ADDOs.

Lastly, RPM+ will work jointly with Family Health International and the Health Policy Initiative to advocate for

necessary policy change to support integration of HIV/AIDS activities into ADDOs. This would include

identifying the issues needing policy review/change, holding consultative meetings with MOHSW and the

National AIDS Control Program to discuss possible policy changes, and sharing current intervention results

in support of desires policy changes.

LINKAGES: RPM+ has been working with MOHSW/TFDA and other stakeholders at the national level

during the roll out of ADDOs. MSH has also closely worked with regional, district and local stakeholders to

mobilize them and seek their support for the ADDO roll out. MSH would engage all these stakeholders for

this proposed intervention. At district level, MSH will work with the Council Health Management Teams

(CHMTs) and the Council Multisectoral AIDS Committees Council Food and Drugs Committee.

In addition, RPM Plus would work with Tunajali program and its sub-grantees mandated to support

implementation of palliative care services to ensure coordination and technical guidance in the planned

activities. As well as leverage resources from other USG funding such as PMI to integrate the services.

CHECK BOXES: Linking ADDOs to community-based HIV/AIDS palliative care activities will involve building

capacity of private sector grass root health provider staff to provide basic HIV/AIDS services to underserved

community, with general population as a target. In addition, through this activity local authority capacity will

be strengthened to support implementation of ADDO/HIV AIDS activities. RPM+ has wraparounds in

malaria and child health portfolios.

M&E: A monitoring plan will be developed to document how ADDO-HBC linkage works; MSH will closely

work with FHI to develop a detailed monitoring and evaluation plan that document processes and other

relevant indicators. This will entail using tools already in place or developing new ones to capture data

based on NACP M&E framework and Emergency Plan Indicators.

SUSTAINAIBLITY: Initiative to link ADDO owners to micro financing institutions for loans is aimed at

improved financing business sustainability. Also, RPM+ has been working with TFDA and MOHSW to

institutionalize the dispensers training and guarantee availability of qualified dispensers. Furthermore, the

owner's contribution to both initial investment and maintenances costs of the ADDO enterprise has

gradually been increasing. Other ideas such as the community health fund have also been discussed.

TITLE: Strengthening ART Commodities Management at Facility Level

NEED and COMPARATIVE ADVANTAGE: Although ART sites received technical assistance (TA) to

support comprehensive HIV/AIDS care and treatment, assessments done in various facilities reveals gaps

in HIV/AIDS commodities and pharmaceutical management including management information systems.

The planned expansion of HIV/AIDS treatment care services to lower facilities will require expanding human

resource training to accommodate new staff, whose basic training, skills and knowledge is limited. Follow up

on-the-job support to improve their skills and performance is needed. RPM Plus proposes to jointly address

these gaps in collaboration with the National AIDS Control Programme (NACP) and other USG partners to

provide the training, mentoring and on-the-job training materials needed at facility level.

ACCOMPLISHMENTS: In FY 2006 a rapid assessment of ART pharmaceutical management systems was

done in six faith-based hospitals followed by a dissemination and planning workshop. RPM Plus trained 31

staff from 23 ART sites on HIV/AIDS pharmaceutical management using NACP curriculum, provided TA to

the NACP in development of standard operating procedures (SOPs) for ARV pharmaceutical management

at facility level, and trained staff from 11 ART sites on the ART dispensing tool. RPM Plus also participated

in the ART logistic system training materials review organized by NACP and the SCMS project.

ACTIVITIES:

1. Conduct refresher trainings to pharmaceutical staff working in ART sites to reinforce skills and knowledge

on pharmaceutical management at facility level and provide back up teams to handle the increasing

number of patients enrolling in ART.1a) In collaboration with NACP and SCMS develop a training plan. 1b)

Adapt NACP curriculum to prepare training materials. Hold joint meetings with NACP and SCMS to plan

and harmonize training activities. 1c) Provide TA to Schools of Pharmacy to strengthen their capacity to

support NACP in implementation of HIV/AIDS related trainings.

2. Provide on going mentoring to trained staff in ART sites. This will ensure effective management of ARVs

and other HIV/AIDS related commodities and will increase quality of services. 2a) Adapt NACP supervision

check list. 2b) In collaboration with NACP and other partners under regionalization develop joint supervision

plan for management of ARVs and other HIV related commodities. 2c) Conduct quarterly supportive

supervisory visits.

3. Develop job aids for pharmaceutical management in collaboration with NACP, SCMS which focus

particularly on dispensing practice and inventory management (i.e. receiving, issuing). This will ensure

consistency and high quality in pharmaceutical services provided in ART pharmacies 3a) Design posters on

various aspects of Pharmaceutical Management 3b) Print and distribute posters/job aids to ART sites 3c)

provide on-site training regarding the benefits of and how to use the job aids.

4. Work in collaboration with TFDA/NACP to strengthen Adverse drug reaction (ADR) system for

Antiretroviral to ensure safety of ARVs drug supplied to PLWHA 4a) Conduct orientation of Pharmaceutical

staff on ADR monitoring for ARV 4b) Leveraging resources from PMI, RPM Plus will continue to participate

in ADR working group to address issues related to ADR monitoring and replicate best practice in ART

program c) Provide support to TFDA/NACP in raising public awareness in relation to ADR monitoring for

ARVs.

LINKAGAGE: IN FY 2006 RPM Plus worked in close collaboration with NACP, other partners involved in

regionalization such as Family Health International, and the Elizabeth Glaser Pediatric AIDS Foundation to

strengthen pharmaceutical management systems in selected hospitals. In FY 2008 RPM Plus will work

closely with SCMS, NACP and I-Tech to: identify areas of collaboration regarding common concerns;

harmonize TA; bring in expertise from similar programs in other countries. RPM Plus will also continue the

linkage with partners begun under COP06. RPM Plus will continue to work with TFDA and address issues

related to medicines quality and safety of ARVs.

CHECK BOXES: RPM Plus will continue to support NACP's and other PEPFAR partners initiative to build

capacity of pharmaceutical staff at ART sites through providing in-service, on job mentoring and job aids on

pharmaceutical management. Improved quality of ART services provided by these personnel will benefit the

population of all ages.

M&E: A monitoring plan will be developed to document achievement on TA provided to the site. The data

collection tools would be based National M&E Framework for ART program. RPM Plus will develop

additional indicators to monitor grogram progress. Data quality assurance protocol will be developed and

used to ensure accuracy. Periodical feedback meetings will be held with NACP, SCMS and other partners

and feed the information into national database.

SUSTAINAIBLITY: RPM Plus will use a monitoring, training and planning approach with the aim of

developing local staff capacity to identify problems existing in their facilities, provide skills in developing

interventions to address the identified gaps and on going self performance monitoring. Provision of TA to

the School of Pharmacy and Muhimbili University will build local capacity to support NACP in

implementation of training programs hence ensuring sustainability.