TITLE: Scaling-up HIV Prevention, Care, and ART services to Primary Health Centres

NEED and COMPARATIVE ADVANTAGE:

To support scale-up of universal access to HIV prevention, care, treatment, and support services, WHO

proposed collaboration with the USG to implement the integrated management of adolescent and adult

illness (IMAI) approach for delivery of HIV services to primary health centers. WHO has supported the

Ministry of Health and Social Welfare (MOHSW) to adapt IMAI tools and conduct training of 30 national

trainers using IMAI tools. For the year 2007, the MOHSW has planned to reach 400-500 primary level

facilities with services for HIV prevention, care, treatment, and support with the ultimate goal of scaling-up

the services to all primary health facilities. WHO is supporting the MOHSW to develop guidelines and

training packages for implementation of HIV workplace interventions in the health sector to strengthen

access to all HIV related services, and provide care, treatment, and support to workers infected with

HIV/AIDS and their families. WHO continues to support the MOHSW to implement IMAI approach, and

intensify its efforts to get health care workers (HCWs) to access these services. IMAI is coordinated through

the National AIDS Control Program (NACP) while the special program for HCWs is coordinated through the

occupational health unit of the MOHSW, both under the director for preventive services.

ACCOMPLISHMENTS:

The MOHSW, in collaboration with WHO and other partner,s adapted IMAI documents that were field tested

in Arusha in November 2005. In March 2007, MOHSW conducted national training of the trainers (TOTs) for

20 regions on the mainland. WHO in collaboration with the Clinton HIV/AIDS Initiative (CHAI) conducted

IMAI training in Mtwara in July 2006. A total of 23 health care providers from health centers have been

trained on the IMAI approach and are now providing ART services. IMAI approach is being implemented in

Mtwara and Lindi as a rural initiative.

ACTIVITIES:

1) Strengthen support to the MOHSW to implement the IMAI approach to accelerate universal access to

HIV prevention, care, treatment, and support services. 1a) Assist the MOHSW to print and disseminate IMAI

guidelines and training packages. 1b) Conduct quarterly supportive supervision visits to the selected

primary health facilities. 1c) Support biannual national meetings with all partners implementing care and

treatment services to share experiences and document best practices. 1d) Attend international HIV and

AIDS conferences. 1e). Hire and pay salary to one national program officer to be seconded to the NACP. 1f)

Support the National Council for People Living With HIV/AIDS (NACOPHA) to coordinate activities of expert

patients trainers.

2. Build capacity of zonal training centres to conduct training for regional TOTs and teachers from the health

training institutions using the IMAI approach 2a) Conduct training for multidisciplinary zonal TOTs (18

trainers from 4 zones including Zanzibar) 2b) Conduct training for regional facilitators (20 facilitators from

each region including Zanzibar). 2c) Conduct TOT for PLHA as zonal and regional expert patients trainers

(12 from each zone and 15 from each region). 2d) Conduct orientation IMAI training to 200 teachers from

the health training institutions for nurses, assistant medical officers and clinical officers as a strategy

towards inclusion of IMAI trainings in the pre-service curriculum. 2e) Procure training equipment for each

zonal training centre in collaboration with other USG partners.

3) Support the MOHSW to build capacity for clinical mentoring and supportive supervision of districts and

primary health facilities. 3a) Support the MOHSW to adapt, print, and disseminate WHO guidelines and

training packages for clinical mentoring and supportive supervision. 3b) Conduct TOTs for the 40 national,

120 zonal, and 243 regional clinical mentors and supportive supervisors.

4) Support the MOHSW to update IMAI guidelines, training packages, patient monitoring tools, and the

operational manual. 4a) Support workshop to review and update IMAI guidelines, training packages, patient

monitoring tools for HIV care/ART, and TB-HIV operational manuals. 4b) Translate the IMAI guidelines and

training packages into Kiswahili 4c) Print and distribute updated tools and guidelines.

LINKAGES:

The World Health Organization is a multi-lateral agency to which Tanzania is a member state. In Tanzania,

WHO Country Office (WCO) is providing technical support to the MOHSW to adapt and implement the IMAI

approach; develop guidelines, training packages, and IEC materials; and build capacity to implement

HIVand AIDS programs for health care workers. WCO has three national professional officers (NPOs)

seconded to NACP as technical advisors to the care and treatment unit, laboratory services, home-based

care, provider-initiated testing and counseling (PITC) and community support services. WHO and USG

have established collaboration to develop the operational manual for care and treament. WHO, in

collaboration with MOHSW will work with and provide technical support to the regional, zonal, and district

authorities. In addition, WHO will work with the USG and non USG care and treatment partners like the

Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Harvard University, Columbia University, Family

Health International (FHI), AIDS Relief, PATH and Clinton Foundation in the implementation of IMAI and the

scale-up of ART services in Tanzania mainland and Zanzibar.

CHECK BOXES:

The areas of emphasis are chosen because WHO provides technical support to the MOHSW to build

capacity to implement all HIV and AIDS related components including IMAI approach, and HIV and AIDS

programs for health care workers.

M&E:

Since WHO technically supports the MOHSW to develop and update all relevant monitoring tools, the same

tools will be used for this collaboration.

SUSTAINABILITY:

WHO supports the MOHSW to build capacity for implementation and inclusion in the medium term

expenditure framework (MTEF) and districts work plans and budgets. Moreover, all the supported activities

are part of the HIV strategy for the health sector for the period of 2008-2012.

TITLE: World Health Organization Monitoring and Evaluation Technical Support to NACP

NEED and COMPARATIVE ADVANTAGE: The National AIDS Control Program's (NACP) Surveillance and

Monitoring and Evaluation Unit develops and manages information systems for HIV/AIDS programs

including Care and Treatment, Counseling and Testing (CT), Prevention of Mother to Child Transmission

(PMTCT), and Home Based Care (HBC). NACP also coordinates with other units in the Government of

Tanzania on monitoring of crossing cutting HIV issues including the Ministry of Health and Social Welfare

(MOHSW) Health Management and Information System (HMIS) Unit, the National Tuberculosis and

Leprosy Program (NTLP), and the Department of Social Welfare for monitoring of activities for orphans and

vulnerable children.

The Tanzania NACP Surveillance/M&E Unit needs technical assistance and support in the coordination and

use of all national HIV/AIDS program monitoring systems. With the increase in the number of people being

served by HIV/AIDS program, comes an increase in the need to manage and use the data that are

generated by the national reporting systems. Also, NACP is charged with coordinating all the partners who

using the national systems that report to NACP.

As an independent technical organization, the World Health Organization (WHO) is well-placed to provide

this assistance and support to NACP. The NACP has agreed to this technical assistance and the WHO

Resident Advisor will be able to play a key role in NACP work at the national level.

ACCOMPLISHMENTS: This activity builds upon efforts in FY 2006 and FY 2007 to support HIV/AIDS

information systems at the NACP/MOHSW by hiring a resident advisor and providing short term technical

assistance to work hand-in-hand with NACP/MOHSW Surveillance/M&E unit. MOHSW and WHO have

approved the Scope of Work. Previous years' funds have been allocated recently for the Resident Advisor

who will begin work in Tanzania by the end of 2007.

ACTIVITIES: With FY 2008 funds, WHO will provide a Resident Advisor for 12 month period and short term

technical assistance as specified by NACP. WHO will provide technical assistance (TA) to NACP to

coordinate, maintain, and use existing national HIV/AIDS information systems. The Advisor will support

NACP in development of the Home Based Care system.

The Resident Advisor and short term technical assistance will:

a) Assist NACP to update and operationalize the health sector M&E framework and strategy;

b) Assist NACP to monitor all current systems concerning HIV/AIDS information;

c) Assist in coordination and training of trainers, and sub-national trainers on the systems and use of data

from the systems, particularly when many partners are involved;

d) Assist NACP in developing supportive supervision protocols for data quality, data use and data feedback;

e) Assist in setting up systems at the national level that ensure data quality at all levels of the system

including data and report flow from sub-national to national levels;

f) Advocate for the utilization of electronic information to generate and disseminate reports for program

improvement;

g) Assist NACP's efforts to increase demand and use of data for program planning and feedback, including

setting up systems to assure timely and useful feedback of the information;

h) Liaise with representative from USG, the World Bank, the Global Fund, and other donors that have direct

and indirect interest in HIV/AIDS monitoring systems.

LINKAGES: The Resident Advisor will liaise with technical staff in NACP HIV/AIDS units and M&E staff, and

with donors on national monitoring systems.

CHECK BOXES: This is an SI activity that involves in-service training.

SUSTAINAIBLITY: The WHO Resident Advisor will develop capacity in national and sub national staff and

build sustainable systems for the current and future use in HIV/AIDS monitoring.