TITLE: Mildmay Maisha Kikamilifu Palliative Care Program in Kilimanjaro and Tabora Regions

NEED and COMPARATIVE ADVANTAGE: In the Tabora Region, there is no recognizable community-

based palliative care or an assigned implementing partner. Implementation of care guidelines has been

sporadic due to a lack of training and support of health workers at all levels. Mildmay has a model home-

based palliative care program comprising a cadre of trained health professional in Kilimanjaro, and

established patient support centers that act as referral hub for home-based care (HBC) services, especially

linking Care and Treatment Clinics (CTCs) and the community. To sustain the scale up of services and

quality, it is necessary to continue support for health workers, patient support centers. It is also essential to

consolidate linkages established with government structures, PLWHAs, community based trainers, carers

and treatment sites in Kilimanjaro and initiate new activities in the Tabora Region. Mildmay is well

positioned to address these needs based on their successful experience in Kilimanjaro to date.

ACCOMPLISHMENTS: Mildmay accomplishments in Kilimanjaro in the existing Maisha Kaikamililfu

(Kiswahili for "Life in its Fullness") include creating a pool of health workers well trained in the care and

management of people living with HIV/AIDS (PLWHA). Mildmay has provided 48 sub grants for HBC

activities, trained eight senior health workers at Diploma level, and forged sustainability linkages with

government and community-based/faith-based organizations (CBOs/FBOs). To date, over 2,500 clients

have received services through three patient support centers each month, 1,200 PLWHA have received

HBC, and 25 community support groups for PLWHA have been organized, and 16 income generating

activities (IGAs) have been organized for groups of PLWHA.

ACTIVITIES: With FY 2008 funding, Mildmay will:

1) Train health workers from Tabora Region in the care and management of people living with HIV/AIDS:

1a) train 15 health workers on design, set up and management of home based palliative care programs

using NACP curriculum; 1b) train 12 (eight new and four continuing senior health workers on the 18-month

Mildmay Diploma to provide the much needed management and leadership of HBC services at the district

level.

2) Initiate HBC in Tabora Region with a model developed by Mildmay in Kilimanjaro to support the national

program, using the basic service package and wraparound possibilities in the community: 2a) carry out a

situation analysis of palliative care; 2b) initiate consultation with government structures on establishing HBC

services and parameters for work in the region; 2c) map out possible collaborators in training and provision

of HBC services; 2d) establish an operational base through office set-up, staff recruitment and orientation.

3) Support the continuum of care by strengthening the link between CTCs and the communities to facilitate

improved communication between the treatment provider HBC provider, and act as referral hubs between

clinic-based and community level initiatives: 3a) set up and support four new patient support centers, one

each in Rombo and Same districts of Kilimanjaro, and two in Tabora; 3b) continue support for three

patient support centers in Kilimanjaro;

3c) provide supervisory and technical support to home-based palliative care workers; 3d) provide 39 sub

grants to health workers trained on care and management of PLWHAs to establish home-based palliative

care initiatives within their facility's catchment area.

4) Strengthen district-level HIV/AIDS coordination mechanisms to help create a conducive environment at

the management level, ensuring that the trained health workers are supported in their development of the

home-based care programs and that HBC is integrated into existing local healthcare activities for quality

improvement: 4a) convene three workshops (one in Kilimanjaro and two in the Tabora Region) for senior

managers of partner organizations; 4b) facilitate an exchange visit of policy makers to the Mildmay

programs in Uganda.

5) Scale up greater involvement of PLWHA: 5a) provide support and training to registered groups of

PLWHA for initiatives aimed at community sensitization to reduce stigma and promote prevention

messaging, adherence, and self-empowerment for positive living.

LINKAGES: Mildmay works closely with the Ministry of Health and Social Welfare (MOHSW) in Tabora to

ensure compliance with the national health strategy. Because Elizabeth Glaser Pediatric AIDS Foundation

(EGPAF) is the lead partner treatment partner in Tabora providing the facility based care, Mildmay works

closely with EGPAF, as well as other providers in the same region to broaden the level and

comprehensiveness of the palliative care services. Health workers from various health facilities in Tabora

will benefit from Mildmay training and technical expertise in the design and delivery of HBC. In Kilimanjaro,

Mildmay works closely with Pathfinder, the lead palliative care partner for the region, in addition to EGPAF,

the lead treatment partner. In addition, they link with other palliative care providers in Kilimanjaro. Mildmay

will link with the bulk arrangements made by the USG for insecticide treated mosquito nets, nutritional

support, and home-based care kits. Mildmay also works with PLWHA groups to promote empowerment,

stigma reduction, food security, and income generation.

CHECK BOXES: Renovation may be necessary to prepare health facilities where the patient support

centers will be sited. Training enhances the skills of health workers and the capacity of District Health

Management Teams and other partners to provide HBC services. Adolescents and adults are targeted as

carers, HBC volunteers, to support for PLWHA and for prevention. PLWHA are direct beneficiaries of HBC

services and IGAs, potential HBC providers, and support group members.

M&E: Mildmay has developed monitoring tools for use by the community health workers, facility based

health workers who supervise HBC services in their catchment areas. Mildmay uses the aggregated

information for organisation decision making, donor reporting and feeding into the national reporting system.

The data generated monthly is plotted against targets to monitor performance and inform program decision.

Once the National AIDS Control Programme completes their new monitoring system, Mildmay will use the

national system. An M&E Officer will be recruited to oversee this program component.

To measure the program outcomes especially the improvement in the quality of life of PLWHAs, Palliative

Care Outcome Scale will be used. Localised surveys will measure others such as stigma and behavioural

change. Baseline surveys carried out by short courses and diploma students provide the baseline against

which to measure these outcomes.

Activity Narrative: SUSTAINAIBLITY: Mildmay activities aim at strengthening the health care system through capacity

development and establishing HBC models that are replicable and self-sustaining. By involving CBOs/FBOs

and volunteers, HBC services are integrated within communities that require minimal input after the initial

training and resource injection.