TITLE: Scale up HIV Prevention through Abstinence and Being Faithful in Seven Regions of Tanzania and

Zanzibar

NEED and COMPARATIVE ADVANTAGE: According to reported national statistics, 93% of Tanzanians are

HIV negative and need to protect themselves from being infected. There is need to develop relevant,

focused, and appropriate prevention interventions that aim toward eventual behavior changes of social

norms regarding HIV, by creating a social and cultural climate that supports protective practices. The

cornerstone of Balm In Gilead (BIG) s program is recognizing that faith-based institutions have a great

capacity to reach community members. Religious leaders play an integral role in understanding cultural

sensitivity and providing prevention methods that fit within traditional, faith-based values. BIG's program of

AB education teaches, supports, and empowers recipients to abstain from pre-marital and multi-partner

sexual activity and delay sexual debut for youth.

ACCOMPLISHMENTS: By March 2007, BIG reached more than 75,000 people with prevention messages

that promote AB. Many of the accomplishments were the result of complementing religious teachings with

HIV prevention messaging. Focal points have included youth counseling, marital counseling, religious

classes, and prayer sessions. Capturing audiences in these situations continues to build faith-based

organization (FBO) capacities to intervene within their own institutions, and has become a unique and best

practice of the program. During FY 2007, BIG intends to expand outreach in the Shinyanga, Lindi, Mtwara,

Kigoma, and Singida Regions. Other best practice models are being adopted for replication in target

geographic communities. Trained AB promoters, peer educators, religious leaders, and teachers will be

equipped to implement these best practice models.

ACTIVITIES: BIG proposes to scale-up community outreach by reaching at least 35,000 people. It will

strengthen risk reduction messages by adapting existing best-practice models. Approaches will involve

developing and disseminating focused prevention interventions that have shown evidence of influencing

attitudes and risk behaviors in neighboring countries of sub-Saharan Africa. The models, "Families Matter"

and "A Time to Talk" are holistic and family centered by nature. These approaches offer greater

opportunities for sustained knowledge of HIV transmission, and for the adoption of safer sex practices,

including partner reduction and delay in adolescent and youth sexual debut.

In FY 2008, BIG will complete the following activities:

1. Reproduce materials and disseminate the "Families Matter Program (FMP)" in Kigoma, Shinyanga,

Dodoma, Mtwara, Iringa, Tanga and Zanzibar. This best practice is designed to increase parent/child

communication channels with the goal of promoting healthy sexual decision-making for children. The target

population is parents of pre-adolescents ages 9-12 years. A total of 12,600 parents will be trained using

FMP, benefiting an estimated 25,000 pre-adolescents. Partner organizations offer routine family-based

counseling, youth peer education and other religious gatherings. Facilitating FMP within these structured

gatherings helps to strengthen the foundation for AB prevention and further scale-up.

2. Reproduce materials and conduct adult BCC model "A Time to Talk" (ATT). ATT is designed to reach

adults over age 25 by providing them with communication skills within adult relationships. ATT focuses on

inter-related messages that instill knowledge of HIV and practices, stigma reduction, gender discrimination,

sexual violence, and safer sexual behavior. This activity will reach 12,000 people.

3. Develop and reproduce training curriculum for empowerment/negotiation skills for girls attending

religious schools and women attending religious sessions. The training curriculum will be infused in formal

settings, which include Sunday school, Catechism and Koranic classes. Trained religious teachers will

reach girls and women ages 9-24. It is estimated that 2,500 girls will be reached in seven target regions.

4. Reproduce a variety of IEC materials (e.g., posters, fliers, and audio/visual) and conduct community-

based assemblies and campaigns to targeted audiences that reinforce HIV awareness and promote

abstinence and being faithful. This activity is designed to reach wider audiences through scheduled faith-

based events.

5. Conduct refresher trainings for existing AB promoters. Each of the four national partner organizations will

train and deploy about ten AB promoters. At least 40 AB promoters will have been trained in each of the

seven target regions, representing 280 trained AB promoters deployed.

6. Conduct needs assessments in two expanded geographical areas to determine faith-based congregation

populations; knowledge of HIV transmission and risks; perceptions of HIV/AIDS; awareness and access to

CT; and sexual practices.

7. Monitor and evaluate effectiveness of behavior change models through evaluation reports. This will be

done by developing pre- and post-intervention assessments that will examine and measure participant

responsiveness, knowledge, and practice outcomes.

LINKAGES: BIG collaborates with the Ministry of Education and Vocational Training and the German

Technical Corporation (GTZ). The program will also seek opportunities to link with other appropriate

projects, including the Youth Alive Organization, PRIDE/TZ and FINCA.

CHECK BOXES: 1. Ages 9-12; "Families Matters" (parent/child focus group BCC). 2. Youth 13-24; youth

forums, religious schools; life skills. 3. Adults; marital guidance and life-coaching for PLWHA. 4. Families; "A

Time to Talk," (focus BCC for parent/parent and adult/adult). 5. Gender issues will be emphasized in the

program because of the low social status of women and girls arising from cultural norms; issues that

increase the susceptibility of women to HIV infection. 6. Human resources are developed within the

participating faith-based institution. A cadre of religious and lay AB promoters are trained and provided with

activity-based incentives.

M&E: Best practice models will be evaluated for effectiveness to deliver appropriate interventions. 1.

Conduct pre- and post-intervention evaluations 2. Conduct mid term and final intervention 3. In BIG

monitoring and evaluation has always played an important role. There are four full time employed valuators

at the partner level and one at the national level. Tools are in place for the collection of data from service

Activity Narrative: outlets to the national level. All levels are encouraged to use the data collected to improve their

performance.

SUSTAINABILITY : This program belongs to the faith-based partners who are interwoven with community

members. Families are one avenue for promoting healthy behavior, sexuality, and life skills. As the

program endeavors to equip them, it is expected that knowledge, which is accessible within families, has a

greater chance of being passed along within the family extended structure. Hence, when families are

positively impacted through imparted best practices, the results will roll up to impact the entire society.

TITLE: Scaling up Orphans and Vulnerable Children Services in Kigoma Region

NEED and COMPARATIVE ADVANTAGE: The Ministry of Health and Social Welfare (MOHSW) estimates

there are 2.5 million orphans and vulnerable children (OVC) in Tanzania, of which only about 6% receive

external support. There is need to increase access to and improve quality of essential support services for

OVC. Balm in Gilead (BIG) supports complementary services through faith-based national partner

organizations. Faith leaders are respected and trusted within their communities and they have a record of

accomplishment of giving quality support to OVC, which are in line with Tanzania's cultural norms and well

placed to serve. BIG provides support that complements the voluntary spirit already given by faith-based

community institutions. As such, BIG's technical assistance hones practical skills and brings together faith

initiatives with private and public interests in meeting the needs of OVC.

ACCOMPLISHMENTS: As of March 2007, through USG funding, The Tanzania Interfaith Partnership (TIP)

identified nearly 2,100 OVC and provided primary and supplemental direct services to children. During FY

2007, the project was funded to support at least 6,000 OVC providing education, health, spiritual, and social

support. Finally, an additional 100 family-based caregivers were trained to strengthen family structures.

ACTIVITIES: The overall goal is to scale up service provision in Kigoma region. BIG will implement the

national identification process to link the most vulnerable children for services and support in all four districts

of Kigoma. BIG estimates that the identification process will locate approximately 10,000 OVC requiring

services, of which 40% will benefit from primary direct services. All OVC under both primary and

supplementary direct support will be provided with psychosocial services in the form of spiritual counseling

and/or peer group activities. Depending on results of the identification process, which includes an OVC

needs assessment prioritizing interventions, issues regarding support for education, nutrition, basic health

management, access/referral to health services, and shelter will be addressed.

In order to provide these services effectively, BIG will train 300 caregivers, as well as sub grantees and

district social welfare officers in Kigoma on the national Data Management System (DMS) to ensure that the

DMS monitoring and evaluation (M&E) tools are used and input to the national OVC tracking system. BIG

will also support capacity building in the four Kigoma districts among the social welfare officers, the Most

Vulnerable Children's Committees (MVCC), and other partners, and support the roll out of the DMS through

the purchase of computers and training on the use of the data for decision making and to improve the

management of programs and services for OVC. In particular, BIG will work with the MVCC to strengthen

their capacity in management and coordination of community organizations providing support to OVC and

mobilizing the community-based response through existing, locally recognized, and respected faith-based

support systems. BIG will also work with the MVCC to ensure supportive M&E supervision of OVC services

through follow up, especially to be certain that OVC receive required support on a regular basis. This will

be done through joint quarterly supervision visits by the regional coordinator, social welfare officers, and

implementing partners. The supervision will also ensure data on children's needs and services available

are input and updated in the DMS in a timely manner.

BIG will ensure that they receive centrally procured vouchers so that OVC are able to access insecticide

treated mosquito nets (ITN), similar to those used under the President's Malaria Initiative (PMI). An

important priority will be to reach OVC under five years of age not covered by the PMI. It will also endeavor

to link with services in the community that can help provide nutritional support and training opportunities for

OVC.

Another critical item that will be a part of BIG's efforts will be to advocate for the needs of OVC and the

need to integrate programs into the budget and planning for communities and districts.

LINKAGES: This activity will contribute to the implementation of the NPA. It is linked to PMI and/or direct

USG procurement of bulk ITN for OVC. This activity is related to BIG, palliative care--basic healthcare,

Salvation Army, Africare, CRS, Pathfinder International, and Deloitte Consulting. As an OVC partner, this

activity will link with the national Implementing Partner Group network for OVC and the FHI program to

implement the OVC technical support..

BIG works in partnership with the Christian Council of Tanzania (CCT), National Muslim Council of

Tanzania (BAKWATA), and the Tanzania Episcopal Conference (TEC).

BIG will scale up OVC activity in line with the National OVC Plan of Action (NPA), local government of

Tanzania (GOT) structures, and will support the national identification process for OVC. BIG will also link

with the Peace Corps income generating activities (IGA) to support the nutritional and economic needs of

OVC households

.

CHECK BOXES: The project builds the capacity of local service providers and MVCC through training in the

DMS in identification and tracking of OVC and providers. BIG focuses on providing comprehensive services

supporting not only access to both primary and secondary education, but also vocational training. Efforts

will be made to ensure that female students are given opportunities for advanced education

(secondary/vocational).

M&E: Along with all other OVC partners, BIG will adopt the national DMS to be used as their monitoring and

evaluation tool. BIG will ensure that sub grantees input data about OVC and services provided for use at

the national level, and also that the data 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. BIG will build capacity

for the district social welfare officers and M&E officers for the sub grantees and purchase computers for

their use. In addition, BIG will conduct quarterly field visits-to assess the quality of services provided, to

collect data, and provide onsite refresher training as needed. When necessary, BIG will support

implementers at the district level to attend PEPFAR's M&E capacity-building trainings and meetings.

SUSTAINABILITY: Sustainability depends on the capacity of the locally based community initiative. BIG

activities demonstrate long-term capacity building through its work with religious institutions that naturally

serve as spiritual and social community catalysts. With complementary program-sponsored skill

development, OVC caregivers will be well positioned to strengthen community responses. Linking OVC and

their caregiver groups for support in vocational skills becomes a means to create opportunities to enhance

Activity Narrative: household economic standing. Youth who become educated, remain healthy and well informed about the

HIV epidemic will have future opportunity to become active and productive members of their society. They

will strengthen family structures with positive values and norms to support their communities own coping

mechanisms.

TITLE: Our Church/Mosque Lights the Way: Tanzania Interfaith Partnership HIV Counseling and Testing

Campaign and Services

NEED and COMPARATIVE ADVANTAGE: In 2006, The Balm in Gilead (BIG) conducted an assessment of

VCT needs in Kigoma, Mtwara and Iringa and found that access is an issue in these rural regions. This

confirms information from TACAIDS has revealed that most Tanzanians have limited access to counseling

and testing, especially in rural areas. The BIG program intends to increase access to counseling and testing

(CT) services in underserved, difficult to access areas by providing community-based mobile services. Faith

based institutions are uniquely equipped to fill this void because they are crosscutting in communities. For

example, nearly 50% of private hospitals and health centers in Tanzania are run by faith-based institutions.

BIG has worked in Tanzania since 2003, and has tremendous experience implementing prevention

activities and accessing individuals in need of services. Additionally, BIG brings seven health professionals

to its program - the organization is headed by an immunologist, and has the contributions of two public

health experts and four program staff medical doctors.

ACCOMPLISHMENTS: Since March 2007, our program has reached over 75,000 people with HIV

education and prevention messages. Staff has noted that with increased knowledge and understanding of

HIV, there is increased demand for CT services. The Shinyanga Catholic Diocese currently operates a

community-based health centre which includes CT services. As a partner organization, the diocese can

share lessons learned about strategies for providing CT services for faith-based congregants and the

community at large. BIG intends to initiate three mobile testing units in strategic regional locations.

Additionally, partner organizations are geared up to expand the national testing campaign in regional rural

areas using the theme, "Our Church/Mosque Lights the Way," to encourage testing. Newly created mobile

services will compliment demand created by the campaign.

ACTIVITIES: In FY 2008, BIG proposes to:

1) Establish three mobile testing units in Kigoma, Mtwara and Iringa. This will involve identifying and

training six counselors; procuring vehicles and tents; buying test kits according to the approved national

algorithm, which is suitable for testing in field conditions for testing; and marketing the newly created

services. Counselors/health care workers will be trained by AMREF.

2) Support three post-test clubs. Each testing site will support clients who have tested and received their

results to form clubs that will encourage members to adopt safe behavior practices through discussions,

drama, and sports. Staff at the units will also refer those who test positive to care and treatment services

available in the area.

3) Conduct routine monitoring and evaluation (M&E). There will be quarterly M&E visits to the three mobile

testing units by the regional coordinators from the consortium partners. Semi-annual M&E visits will also be

conducted by the BIG M&E manager. Ten persons will receive training in M&E and supportive supervision.

Supportive supervision will include checking registers completed by counselors, reviewing counseling and

testing protocols, and observing counseling sessions. A quality assurance plan will be developed in

collaboration with lab personnel in the three regions.

LINKAGES: BIG and its consortium partners will collaborate with district health services to establish a

referral system for clients who will need treatment or other social services. The consortium will work closely

with other CT providers such as AMREF to replicate the best practices in counseling and testing.

Collaboration will also facilitate suitable deployment of mobile services to avoid duplication. Mobile CT

services will link with organizations that are working on prevention of drug and alcohol abuse so that they

may lead discussions and provide learning materials to post test clubs. The BAKWATA run mobile CT

Center in Kigoma will provide outreach CT services to The International Rescue Committee in Kasulu as

need arises.

CHECK BOXES: Fewer males took an active part in the mobilization campaign; therefore, extra efforts must

be put to involve men in testing. The counselors for this program will be recruited from willing healthcare

workers who will undergo a one month counseling training course. The target group for testing will be 15 -

45 years male and female clients. Children under 15 years may be tested with parental or guardian consent

in accordance with national guidelines.

M&E: BIG has a M&E system that covers the national office and regional desks and willl adopt its M&E

system to be in line with the National Monitoring System on HIV/AIDS. Paper-based data collection tools

have been developed for the collection of data from service outlets which will be colleted at regional level by

partners and passed to the M&E manager of BIG . The program also is in line with PEPFAR monitoring and

evaluation practices.

SUSTAINABILITY: BIG has already built linkages with NGOs, CBOs and the local government in all areas

where HIV counseling and testing services will be established. The program is owned by the local

communities. They have contributed resources through voluntarism. The sustainability of the mobile

services is based on the linkages with government and other non-governmental organizations as well as the

local ownership. The FBOs will continue to maintain and manage the testing facilities as the FBOs are more

trusted by the communities in terms of confidentiality.