TITLE: Respect for human and gender rights as a foundation for abstinence and fidelity in Rukwa Region

NEED and COMPARATIVE ADVANTAGE: The estimated HIV prevalence in Rukwa region is around 6%,

and anecdotal information indicates that newly identified HIV cases are due to infidelity and the subordinate

position of women. Without strengthening the foundation of respect for human and gender rights, AB

messages cannot fully take hold. General infrastructure in Rukwa is poor. The region has no paved roads

and during the rainy season, many are impassable. There are few established NGOs providing HIV

services in Rukwa, and fewer able to manage regional service provision. RODI, registered in 2004, has

exhibited a strong record of accomplishment of capacity building and training for a variety of Rukwa projects

in just a short period. As a sub-grantee under a DOD umbrella organization in 2007, this organization has

shown the capacity necessary to coordinate service provision by a network of NGOs in Rukwa and has

graduated to prime partner status.

ACCOMPLISHMENTS: FY 2007 funding supported initiation of PEPFAR-funded HIV prevention services in

Rukwa region, including identification of appropriate sub-partners in Rukwa districts where NGOs had yet to

be identified.

ACTIVITIES: RODI will focus on service delivery through "clusters" based on the three main regions:

Sumbawanga (which includes both Sumbawanga Rural and Urban), Nkasi, and Mpanda. 1) Provide

education regarding human and gender rights and their relationship to HIV, helping to create social norms

conducive to HIV prevention. 1a) Identify educators to be trained to provide the curriculum through Mbeya

HIV Network Tanzania (MHNT), a prime partner under a separate submission. 1b) Trained educators will

provide training in Rukwa region at NGO sites, and link with community groups to host training sessions in

villages, schools, workplaces, and other settings. 2) With training from MHNT, sensitize the community and

convey AB messages through creative public presentations. 2a) Enlist volunteer artists to create and

perform motivational and educational presentations promoting AB messages. 2b) Coordinate with village

executives, schools, and other community leaders to schedule presentations throughout the community. 2c)

Perform presentations at large-scale community events including World AIDS Day and HIV testing events

organized by RODI and its sub-partners to spread the "Know the Facts" campaign. 3) Conduct a

community-wide campaign in Rukwa region to raise awareness and promote AB messages. 3a) In

consultation with MHNT, plan an effort based upon the local and long haul buses campaign, which included

production of cassette tapes and videos with AB messages, distribution and use of these tapes and videos,

especially in reception areas of NGOs and health facilities.

3b) Produce cassettes and/or other promotional materials and distribute to outlets. 3c) Coordinate among

sub-partners to promote campaign messages through community education activities. 4) Train youth and

adult peer counselors at the village level and higher to ensure a widespread and more accurate knowledge

base, encourage discussion to reduce stigma, and de-emphasize previous traditional responses to

HIV/AIDS.

4a) Consult with community leaders to identify influential individuals of all ages to be trained as peer

counselors, maximizing the potential for changing social norms. 4b) Provide initial training for peer

counselors and refresh as necessary.

4c) Convene regular meetings of peer counselors to motivate volunteers, monitor efforts, identify

challenges, and improve quality of service.

LINKAGES: Along with executing prevention activities, RODI members also provide a number of other

services, including counseling and testing (CT), OVC services, and home-based care. RODI members

collaborate to maximize impact and coverage of their collective activities and eliminate overlap. This activity

also links with the Evangelical Lutheran Church of Tanzania (ELCT) Mbeya District in training in legal and

gender issues and activities. Additionally, this activity links with: schools, faith groups and village

associations; Saturday and after school youth programs; ward leaders and other local government officials;

faith groups and other providers of counseling services; VCT sites to facilitate referrals; and PEPFAR

marketing groups STRADCOM and AED for local advertising to encourage event participation.

CHECK BOXES: Promotion of AB messages will target the general population with a particular focus on

youth with efforts designed to shift social norms toward greater respect for gender, legal, and human rights.

Individuals of all ages will be targeted in an effort to exert broad influence on community norms. Training is

a key component of this program area, as volunteers constitute the primary human resources delivering HIV

prevention education throughout Rukwa region.

M&E: RODI has considerable M&E expertise, having supported a number of projects in efforts to improve

M&E practices. In addition to instituting standard processes for monitoring indicators on a quarterly basis,

RODI will ensure implementation of standardized tools for collecting detailed data on service delivery.

Compiling data from sub-partners will allow for identification of major service needs and gaps. These data

will be shared with local leaders to highlight key needs and enlist community support in meeting these

needs. Data collected regarding client referral routes to VCT will help refine and better target community

education efforts.

SUSTAINABILITY: RODI is a local, grassroots Tanzanian-run NGO that has cultivated capacity-building

expertise in the health, environmental, and agricultural arenas. Its holistic approach to health addresses

HIV, malaria, and water-borne diseases. RODI has expanded activities slowly within the southern

highlands zone, so as not to exceed current capacity and therefore compromise quality of service. Few

local entities in Rukwa have experience managing service delivery on a regional scale, yet RODI has the

background and skill base for this responsibility. Nurturing RODI in this role will not only help to ensure

quality services, regional coverage, and fiscal oversight of sub-partners, but will also lend needed

administrative capacity to Rukwa. RODI and its sub-partners will become increasingly well positioned to

apply for and administer additional funding for this under-served region.

TITLE: RODI promoting safer choices to reduce sexual transmission of HIV in the Rukwa Region.

NEED and COMPARATIVE ADVANTAGE: The estimated HIV prevalence in Rukwa region is around 6%.

While abstinence and faithfulness are important to stemming the HIV/AIDS epidemic, it is also critical to

empower sexually active individuals to make safer choices to protect themselves and their partners from

HIV infection. General infrastructure in Rukwa is poor; the region has no paved roads, and during the rainy

season, most dirt roads are impassable and many areas are reached only by boat year round. There are

few established NGOs providing HIV services in Rukwa, and fewer able to manage regional service

provision to unique populations of farmers, fishermen, and miners. RODI, registered in 2004, has a strong

record of accomplishment of capacity building and training for a variety of Rukwa projects. RODI has the

capacity necessary to coordinate service provision by a network of NGOs in Rukwa.

ACCOMPLISHMENTS: FY 2007 funding supported initiation of PEPFAR HIV prevention services in Rukwa

region, including identification of appropriate sub-partners in Rukwa districts where NGOs had yet to be

identified especially among the miners and fishermen.

ACTIVITIES: RODI will focus on service delivery through "clusters" based on the three main regions:

Sumbawanga (which includes both Sumbawanga Rural and Urban), Nkasi, and Mpanda.

1. Continue to train youth and adult peer counselors at the village level and higher to provide community

HIV prevention education, reduce stigma, encourage consistent and correct condom use by sexually active

individuals, and promote dialogue as well as utilization of permanent and mobile VCT services.

1a. Consult with community leaders to identify influential individuals of all ages to be trained as peer

counselors, maximizing the potential for changing behavior.

1b. Provide training for peer counselors, both initially and on a refresher basis as necessary.

1c. Convene regular meetings of peer counselors to motivate volunteers, monitor efforts, identify

challenges, and improve quality of service especially in workplace venues (e.g., fisheries, mines).

2. Convene post-test clubs of PLWHA to share experiences and discuss disclosure and HIV prevention

issues, including safer sex.

2a. Continue to convene existing post-test clubs, and communicate with PLWHA served by a given NGO to

identify meeting times and venues favorable to PLWHA participation.

2b. In addition to providing a support group environment for sharing feelings and experiences, identify

and/or develop and implement mini-curricula designed to assist PLWHA (including members of discordant

couples) in preventing further transmission of HIV.

3. Coordinate with permanent and mobile VCT services to convene post-test safe choices discussion

groups for individuals who test HIV negative, supporting them to sustain their HIV negative status. Focus

efforts on empowering individuals to identify for themselves the safe choices they wish to make, and

developing the skills each individual needs in order to implement those choices consistently.

3a. Explore national and/or international resources to identify and/or develop a mini-curriculum that

addresses empowerment, assertiveness, and communication skills, including condom negotiation skills.

3b. Address alcohol use as an obstacle to making safer sexual choices, and encourage individuals to

consider safer choices regarding alcohol consumption.

3c. Establish a referral system with permanent and mobile VCT service sites, whereby all individuals

testing HIV negative are encouraged to participate in post-test discussion groups.

4. Coordinate with other prevention efforts to ensure provision of education about safer sex to sexually

active individuals, including members of discordant couples.

4a. Work with the Evangelical Lutheran Church of Tanzania (ELCT) through MHNT to provider gender,

human and legal rights training to incorporate education about condom use and condom negotiation as

appropriate.

4b. Collaborate with providers of educational performances to prepare and perform presentations

encouraging correct and consistent condom use by sexually active individuals.

4c. With guidance from KIHUMBE (a prime partner under a separate submission), and in collaboration with

marketing and radio groups, develop and implement a community-wide media campaign, ensuring

messages include encouraging sexually active individuals to use condoms consistently and correctly and to

avoid preventable risky behaviors.

LINKAGES: Along with executing prevention activities, RODI members also provide a number of other

services, including CT, OVC services, and home-based care. RODI members collaborate to maximize

impact and coverage of their collective activities and eliminate overlap. This activity also links with: the

ELCT Mbeya District in training in legal and gender issues and activities; KIHUMBE, a prime partner under

a separate submission, which provides training on OP services throughout the Southern Highlands Zone -

schools, faith groups and village associations; secondary schools, faith groups and village associations;

Saturday and after school youth programs; ward leaders and other local government officials; other

providers of counseling services; VCT sites to facilitate referrals; PEPFAR marketing groups such as

STRADCOM and AED for local advertising to encourage event participation.

CHECK BOXES: These services focus on sexually active individuals, including members of discordant

couples, as well as adults and youth who may become sexually active. Activities designed to empower

individuals (particularly women) to make safer choices regarding sexual behavior, address gender norms,

and promote gender equality. These approaches also encourage risk reduction among persons engaging

in prostitution or transactional sex, who cannot or will not abstain from sex. Training of peer educators and

group facilitators is a key component of this program area, as volunteers constitute the primary human

resources delivering HIV prevention education.

M&E: RODI has considerable M&E expertise, having supported a number of projects in efforts to improve

M&E practices. In addition to instituting standard processes for monitoring indicators on a quarterly basis,

RODI will ensure implementation of standardized tools for collecting detailed data on service delivery.

Compiling data from sub-partners will allow for identification of major service needs and gaps by the M&E

staff person. These data will be shared with local leaders to highlight key needs and enlist community

support in meeting these needs. Data collected by the network regarding clients' referral routes to VCT will

help refine and better target community education efforts, and test results via mobile VCT services will help

identify sites to reach high-risk groups.

Activity Narrative:

SUSTAINABILITY: RODI is a local, grassroots Tanzanian-run NGO that has cultivated capacity-building

expertise in the health, environmental, and agricultural arenas. Its holistic approach to health addresses

HIV, malaria, and water-borne disease. RODI has expanded activities slowly within the Southern Highlands

Zone, so as not to exceed current capacity and therefore compromise quality of service. Few local entities

in Rukwa have experience managing service delivery on a regional scale, yet RODI has the background

and skill base to continue this responsibility. Nurturing RODI in this role will not only help to ensure quality

services, regional coverage, and fiscal oversight of sub-partners, but will also lend needed administrative

capacity to Rukwa. RODI and its sub-partners will become increasingly well positioned to apply for and

administer additional funding for this under-served region.

TITLE: Rukwa Community Home-based Care to Support Health and Self-sufficiency

NEED and COMPARATIVE ADVANTAGE: Care and Treatment Clinics (CTCs) were established in the

Rukwa region beginning in late 2005/early 2006. The general infrastructure in Rukwa is poor; the region

has no paved roads, and during the rainy season, many are impassable. There are few established non-

governmental organizations (NGOs) providing HIV services in Rukwa, and fewer still are able to manage

regional service provision. RODI, registered in 2004, has exhibited a strong track record of capacity

building and training for a variety of Rukwa projects in a short period of time. As a sub-grantee under a

DOD umbrella organization in 2007, RODI has shown the capacity necessary to coordinate service

provision by a network of non-governmental organizations (NGOs) in Rukwa and has graduated to prime

partner status.

ACCOMPLISHMENTS: FY 2007 funding supported initiation of PEPFAR-funded home-based care (HBC)

services in Rukwa region for people living with HIV/AIDS (PLWHA). Under this funding, RODI conducted a

thorough needs assessment of HBC capacity in early 2007, and is currently working to identify appropriate

sub-partners in Rukwa districts where NGOs have yet to be identified. The findings of the needs

assessment will help to shape service provision and capacity building efforts in the region.

ACTIVITIES: Working in a coordinated and cooperative manner, members of RODI, the Mbeya HIV

Network Tanzania (MHNT), KIHUMBE, and SONGONET (see other submissions for these partners) will

ensure similar packages of services are available for clients in the Mbeya, Rukwa and Ruvuma Regions. In

addition, implementation of services has been standardized across these partners, though allowing for

some flexibility in focus/approach depending on regional conditions. With FY 2008 funding, RODI will:

1. Expand provision of community HBC to additional in the Rukwa Region to include nutrition counseling

and assistance, psychosocial/spiritual support, opportunistic infection (OI) and pain management,

cotrimoxizole/malaria prevention, referrals for malaria and TB diagnosis and treatment, access to safer

water, training in income generating activities (IGAs), legal and human rights education and ART adherence

counseling. 1a. Supply nutrition evaluation and counseling as well as food (to those who qualify) and

vitamin supplements to clients during their first six months of ART. 1b. Link clients to agriculture activities

where available in the region for training in home gardens for both personal food production and as an

income generating opportunity. 1c. Link to USG procurement programs for distribution of insecticide treated

nets (ITN) and water purification supplies to clients. 1d. Provide training and support for IGAs for caregivers

and able PLWHA, and help to develop sustainable associations for income generation. 1e. Assist with short

-term nutrition for malnourished children of HIV-positive clients unable to work. 1f. Identify and refer

pediatric and adult cases of TB, malaria, and/or HIV to health care providers.

2. Convene monthly education and support group meetings for CHBC clients. 2a. Establish and inform

community HBC clients of regular client meeting times. 2b. Develop a schedule of presentations and

activities to augment support group meetings, addressing issues such as nutrition and other topics of

interest identified by participants. 2c. Inform clients of IGA opportunities and trainings.

3. Train clients' caregivers in basic palliative care to increase community capacity and enable community

HBC providers to prioritize clients with the most need. These efforts will foster community responsibility as

well as expand program capacity to reach more PLWHA. 3a. Community HBC providers will provide

ongoing training to caregivers as part of regular visits, creating a plan for reducing visits to longer intervals

and, as appropriate, ceasing visits except as needed/requested by the caregiver. 3b. Identify and address

special training needs for elderly caregivers with literacy, health, or other barriers.

4. Incorporate prevention for positives and partner/child VCT referral into community HBC visits wherever

appropriate. 4a. Ensure community HBC providers are trained to discuss HIV prevention with clients.

Modify the existing HBC curriculum in prevention for positives approaches based on USG findings in FY

2007. 4b. Include prevention for positives and partner VCT referral as part of in all visits as appropriate. 4c.

Discuss themes, successes, and challenges of HBC prevention efforts as part of organizations' regular HBC

provider meetings to evaluate and improve services on an ongoing basis.

5. Pilot using solar-powered handheld electronic devices to connect community and facility levels for

palliative care referrals, linkages, and back-up support. In remote areas, this will allow data on patients to

be transferred more effectively.

LINKAGES: Community HBC services are provided by five sub-partner NGOs, using the national HBC

guidelines. The NGOs refer clients to one another based upon clients' areas of residence, need, and

specific area of expertise of a member organization. RODI convenes community HBC provider meetings to

exchange ideas and support. RODI will also coordinate with other HBC providers in other regions of the

country to work under the guidelines set by the National AIDS Control Programme (NACP).

RODI and its sub-partners link with: KIHUMBE; ward leaders and other local government officials; NGOs

providing training and access to income-generating activities; faith groups and other counseling service

providers; VCT sites and dispensaries; water safety projects and water purification commodities; and district

and/or regional hospitals for treatment and provision of cotrimoxazole and morphine as necessary for care

on a case by case basis.

CHECK BOXES: Home-based care allows for an integrated approach to the health and well-being of the

patient and his/her entire family, addressing malaria and TB, child survival, and family planning in addition

to HIV/AIDS. IGAs will promote women's access to income, as well as foster economic strengthening and

food security. Training is a key component of the community HBC program area, through coordination with

KIHUMBE, as volunteers constitute the primary human resources delivering community HBC services.

M&E: RODI has considerable M&E expertise, having supported a number of projects in efforts to improve

M&E practices. RODI will have a staff member dedicated to monitoring and compiling all data collected by

member organizations in collaboration with the data system to be rolled out in the future by NACP. The

Henry Jackson Foundation Medical Research International (HJFMRI) will spot check the present tools for

collecting detailed data on service delivery to assure transparency and completeness of HBC services.

These tools, developed by the MHNT (separate submission), will serve as a visit checklist which includes a

menu of services to be provided to each patient based on individual need. Use of the tools will ensure

Activity Narrative: documentation of which services are provided for patient and program management. Compiling data from

sub- partners will allow for identification of major service needs and gaps within community HBC services.

All new and active HBC providers will be provided refresher courses regarding this paper based system so

it may efficiently be transmitted to an electronic system. This system will thus measure successful linkages

with care and treatment clinics, TB, counseling and testing, PMTCT, prevention, safe water, nutritional

programs and livelihood programs and highlight innovative program linkages. These data will be shared

with local leaders to highlight needs and enlist community support in meeting these needs. Once the

national palliative care monitoring system is ready for implementation, RODI will switch to this system for

program monitoring.

SUSTAINABILITY: RODI is a local, grassroots Tanzanian-run NGO that has cultivated capacity-building

expertise in the health, environmental, and agricultural arenas. Its holistic approach to health addresses

HIV, malaria, and water-borne disease. RODI has expanded activities slowly within the Southern Highlands

Zone, so as not to exceed current capacity and therefore compromise quality of service. Few local entities

in Rukwa have experience managing service delivery on a regional scale, yet RODI has the background

and skill base for this responsibility. Nurturing RODI in this role will not only help to ensure quality services,

regional coverage, and fiscal oversight of sub-partners, but will also lend needed administrative capacity to

Rukwa. RODI and its sub-partners will become increasingly well-positioned to apply for and administer

additional funding for this under-served region.

TITLE: Expansion and Improvement of Orphans and Vulnerable Children (OVC) Services in the Rukwa

Region

NEED and COMPARATIVE ADVANTAGE: The Rukwa Region has suffered from a lack of services for

orphans and vulnerable children (OVC) due to the limited number of organizations that can provide these

services. Of those that implement in the region there is generally poor capacity to execute quality

programs. General infrastructure in Rukwa is poor, as the region has no paved roads. During the rainy

season, most dirt roads are impassable. Research Oriented Development Institute (RODI), formally

registered in 2004, has exhibited a strong record of accomplishment of capacity building and training for a

variety of Rukwa projects in a short period. As a sub-grantee under a DOD umbrella organization in 2007,

this organization has shown the necessary capacity to coordinate service provision by a network of NGOs in

Rukwa and has graduated to prime partner status.

ACCOMPLISHMENTS: FY 2007 funding supports establishment of PEPFAR-funded OVC support services

in Rukwa region, including identification of appropriate sub-partners in Rukwa districts where NGOs had yet

to be identified.

ACTIVITIES: Working in collaboration, members of RODI, the Mbeya HIV Network Tanzania (MHNT),

KIHUMBE, and SONGO-NET (see other DOD submissions for these partners) will strive to ensure a

standard packages of services are available for clients in the Mbeya, Rukwa, and Ruvuma regions. In

addition, implementation of services has been standardized across these partners, while allowing for some

flexibility in focus and approach depending on regional conditions. Key activities will:

1) Provide support to 2,580 OVC with educational support, shelter, nutrition assistance and psychosocial

and spiritual support, according to their needs: work with local government and Most Vulnerable Children

Committees (MVCCs) to identify OVC and their needs and ensure against duplication of service and

maximize coverage; provide all OVC with psychosocial support through individual and group counseling;

prioritize services for the individual for educational support (fees, uniforms, and supplies), shelter, and

nutrition assessment and assistance; provide training in income-generating activities for OVC caregivers

and older OVC; link OVC and caregivers to agriculture activities where available in the region for training in

home gardens for both personal food production and as an income generating activity (IGA); and link to

USG bulk procurement programs for distribution of insecticide treated nets (ITNs), nutritional support, and

water purification supplies to clients.

2) Coordinate with Mbeya HIV Network Tanzania (MHNT), a prime partner under a separate submission, to

ensure training of OVC caregivers by communicating with MHNT to schedule initial comprehensive training

and organize attendance of volunteers serving OVC; and plan refresher trainings with MHNT as necessary

(particularly to coincide with any changes to local or national OVC policy) for volunteers who previously

received comprehensive training.

3) Establish a referral system for OVC to ensure a comprehensive approach to meeting individual needs to

include follow-up with the entity to which the client is referred. This will include: establishing standardized

referral process for assessing service needs and linking OVC to services (including medical care, VCT and

HIV prevention, as appropriate); training OVC service providers and caregivers in identification and care for

HIV related illnesses and referrals for HBC and facility based clinical services to increase treatment of HIV

infected OVC; building capacity of districts and continue to cultivate relationships with municipal and NGO

service providers to facilitate referral follow-up; and including referral activities, follow-up on standardized

forms to facilitate monitoring, evaluation, and quality improvement.

LINKAGES: This activity will contribute to the implementation of the OVC National Plan of Action, and will

link with other OVC programs through the National Implementing Partners Group. RODI will link with the

Mbeya HIV/AIDS Network and OVC services will be provided by five sub-partner NGOs, all of which refer

clients to one another based upon client's area of residence, need, and strength of the organization. RODI

members also link with: district and/or regional hospitals to facilitate referrals; MVCC, ward leaders and

other local government officials to identify and register OVC and comply with data reporting requirements;

NGOs working to establish village OVC funds to collaborate and reduce duplication; primary and secondary

schools and the vocational training institute (VETA); NGOs providing income-generating activities including

agricultural programs; faith-based groups and other providers of counseling services: and USG and other

donor sources of ITNs and safe water commodities.

CHECK BOXES: OVC services support HIV-positive and HIV-negative OVC as well as their caregivers.

Linkages to healthcare address child survival, malaria, and other health issues in addition to HIV/AIDS.

Education assistance and psychosocial/spiritual support promote OVC skills and well-being, while income-

generating activities foster economic strengthening and food security for OVC caregivers and older OVC.

Training is a key component of the OVC program area, as volunteers constitute the primary human

resources delivering OVC services. The developing program in Rukwa will particularly benefit from training

by MHNT.

M&E: RODI has considerable M&E expertise, having supported a number of projects in numerous efforts to

improve M&E practices. RODI will monitor OVC care services using the OVC National Data Management

System, storage, and reporting system. Sub-partners will use service providers' register and referral forms

to track services provided to OVC in addition to entering the data into their database. RODI will build the

capacity of the sub grantees on data collection, use, and reporting. Additionally, the program will purchase

computers to be provided to district social workers. All reports will be shared with the local government,

compiled data from sub-partners will allow for identification of major service needs and gaps within OVC

services, and highlight key needs in order to enlist community support in meeting these needs.

SUSTAINABILITY: RODI is a local, grassroots Tanzanian-run NGO that has cultivated capacity-building

expertise in the health, environmental, and agricultural arenas. It has a holistic approach to address health

issues such as HIV, malaria, and water-borne diseases. RODI will play a facilitative role to ensure the

incorporation of its OVC work plan, budgets, and reports in the overall district response plans as a

sustainability measure. At the household level, OVC family members will be mentored to adopt caring roles

and supported with IGAs. RODI will ensure involvement of district leaders, MVCC, and community leaders

in developing a viable response to OVC and elderly headed households. Few local entities in Rukwa have

Activity Narrative: experience in managing service delivery on a regional scale, therefore, RODI will support individuals in all

social welfare offices in Rukwa region (in addition to key OVC focal persons) to assume this responsibility.

Nurturing RODI in this role will not only help to ensure quality services, regional coverage, fiscal oversight,

and capacity building of sub-partners, but it will also support necessary administrative and coordination

capacity to Rukwa through supporting and facilitating replication of the national OVC implementing Partners

Group at the districts and region.

TITLE: MHNT voluntary counseling and testing (VCT) to further prevention and treatment goals.

NEED and COMPARATIVE ADVANTAGE: The estimated HIV prevalence in Rukwa region is 6%, but few

are aware of their HIV status. General infrastructure in Rukwa is poor. The region has no paved roads and

during the rainy season many are impassable. There are few established NGOs providing HIV services in

Rukwa, and fewer able to manage regional service provision. RODI, registered in 2004, has exhibited a

strong track record of capacity building and training for a variety of Rukwa projects in just a short period of

time. As a sub-grantee under a DOD umbrella organization in 2007, this organization has shown the

capacity necessary to coordinate service provision by a network of NGOs in Rukwa and has graduated to

prime partner status.

ACCOMPLISHMENTS: FY 2007 funding supported initiation of PEPFAR-funded HIV counseling and testing

services in the Rukwa Region. RODI conducted a thorough needs assessment of home-based care and

VCT capacity in early 2007, and is currently working to identify appropriate sub-partners in Rukwa districts

where NGOs have yet to be identified. The findings of a needs assessment conducted by RODI will help to

shape service provision and capacity building efforts in the region through clusters focusing on the three

large districts in the region (Sumbawanga Urban/Rural, Nkasi and Mpanda).

ACTIVITIES:

In an effort to deliver a consistent packages of services across the three region Zone, RODI, in collaboration

and cooperation with KIHUMBE and members of SONGONET-HIV and the Mbeya HIV Network Tanzania

(MHNT) (see other submissions for these partners) will ensure VCT services are available for as many

clients as possible in the Rukwa Region. In addition, implementation of services has been standardized

across these partners through cross-training of each other and shared lessons learned, but allowing for

some flexibility in focus/approach depending on regional conditions. All VCT activities will include

distribution of information to clients on appropriate referral for services depending on sero-status and

residence.

1) Mobilize test counselors from Rukwa NGOs and MOHSW sites to provide VCT at large-scale community

events, capitalizing upon opportunities to reach many individuals in a single setting.

1a) Provide VCT at the annual regional World AIDS Day event sponsored and executed by the Regional

AIDS Control Office.

1b) Plan, advertise and provide VCT for monthly "HIV Testing Day" events to be held in each of the three

Rukwa "clusters".

2) Provide VCT services at member organizations' and community sites in accordance with national

standards and using NACP tools to document service delivery.

2a) Provide VCT at NGOs' service sites.

2b) Coordinate with local entities to provide VCT at non-HIV-specific NGOs, youth centers, workplaces and

other community sites.

2c) Work with local leaders, District Health Management Teams (DHMT) and health facility directors to

identify sites in which to provide mobile.

2d) Use data gathered as part of mobile VCT to prioritize return visits to villages based upon identified

prevalence and or risk behaviors.

2e) Maintain RODI network offices and an adjacent VCT site to house network records and serve as venue

for regional meetings and trainings.

3) Expand VCT provision in Rukwa, ensuring thorough regional coverage by establishing additional VCT

sites where services are not available.

3a) Identify new sites for VCT by reviewing mobile VCT statistics and through communication with local

government, DHMT and service organizations.

3b) Ensure training of new VCT counselors in accordance with national standards.

3c) Promote awareness of newly established sites, and include sites in informational materials about

available services.

4) Produce and distribute pamphlets of all sub-partner services, to increase community awareness of

available services and facilitate referrals.

4a) Create a list of service sites to receive pamphlets (e.g., NGOs' sites, CTCs) and contact sites monthly to

monitor need to replenish supply.

4b) Evaluate effectiveness of this information & referral strategy by documenting client self-report of referral

mechanism to a given service.

5) Establish a formal referral system for individuals accessing VCT services, incorporating follow-up with the

entity to which the client is referred.

5a) Establish standardized referral process for linking individuals testing HIV-positive to services, to include

at minimum medical services and home-based care "prescription" to RODI members.

5b) Provide prevention education depending upon the client's sero-status and identify and refer individuals

testing HIV-negative to HIV prevention resources to help maintain their HIV-negative status.

5c) Include these referral activities and follow-up on standardized forms to facilitate monitoring and

evaluation and quality improvement.

LINKAGES: VCT services will be provided by five sub-partner NGOs which refer clients to one another

based upon clients' areas of residence, need and specific area of expertise of a member organization (see

entries under this partner in HBHC, HKIC and HVAB/OP). Each of these members links with: District and/or

regional hospitals to facilitate referrals, secure test kits and distribute pamphlets; Ward leaders and other

local government officials; Faith groups and other providers of counseling services; and PEPFAR marketing

groups, STRADCOM and AED, to encourage event participation.

CHECK BOXES: VCT services target the general population. Coordination with home-based care (among

network members and with those outside the network) and other services ensures smoother referral of

PLHA, their spouses and children to VCT. Relationships with business entities provide VCT opportunities at

workplace settings, reaching more members of the population in the highest risk age groups. Funding

supports commodity procurement, vehicle maintenance, trainings, staff support and advertising and

participation in community events.

M&E: RODI, having supported a number of projects in efforts to improve M&E practices, has considerable

M&E expertise. In addition to instituting standard processes for monitoring indicators on a quarterly basis,

RODI will ensure implementation of standardized tools for collecting detailed data on service delivery.

Compiling data from sub-partners by a designated M&E staff person will allow for identification of major

Activity Narrative: service needs and gaps. Supportive supervision of these sites includes data collection, management and

storage of data (registers and forms) reporting of data to district-level. National CT guidelines and training

materials will be used to strengthen M&E capacity in these facilities. This data will be shared with local

leaders to highlight key needs and enlist community support in meeting these needs. Assessment of clients'

referral routes to VCT will inform RODI outreach and identification efforts, and test results via mobile VCT

services will help identify sites with high-risk groups requiring particular focus. Data will be provided to

NACP and USG for reporting purposes.

SUSTAINABILITY: RODI is a local, grassroots Tanzanian-run NGO that has cultivated capacity-building

expertise in the health, environmental and agricultural arenas. Its holistic approach to health addresses HIV,

malaria and water-borne disease. RODI has expanded activities slowly within the Southern Highlands Zone,

so as not to exceed current capacity and therefore compromise quality of service. Few, local entities in

Rukwa have experience managing service delivery on a regional scale, yet RODI has the background and

skill base for this responsibility. Nurturing RODI in this role will not only help to ensure quality services,

regional coverage and fiscal oversight of sub-partners, but will also lend needed administrative capacity to

Rukwa. RODI and its sub-partners will become increasingly well positioned to apply for and administer

additional funding for this under-served region.