PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
THIS IS A NEW ACTIVITY.
Title: Male Circumcision Pilot Project in Mbeya Referral Hospital
NEED and COMPARATIVE ADVANTAGE:
At the request of the GOT, the USG will implement a pilot male circumcision (MC) program through 5
partners including: JHPIEGO, Columbia University, AED/TMARC, Pharm Access and the Mbeya Regional
Hospital (MRH). JHPIEGO will provide technical oversight, training and support with systems development
(i.e., supervision, quality improvement, etc.) to the other implementing partners as well as implement the
MC demonstration program at Iringa Regional Hospital. JHPIEGO will also conduct formative research on
traditional circumcisers in Mara. Columbia University will implement the MC demonstration program in
Kagera, the MRH will implement in Mbeya, and Pharm Access in Dar es Salaam (with the TPDF).
AED/TMARC will work closely with JHPIEGO in the development of appropriate communications initiatives
targeting health care providers as well as surrounding demonstration site communities.
MC has shown to reduce of HIV infections among circumcised males by 50 - 60% in studies conducted in
Africa. There is also an emerging consensus that 100% coverage by MC could avert about six million new
infections and three million deaths in sub-Saharan Africa alone in the next two decades. MC strategy is not
a stand-alone intervention but part of a comprehensive prevention package and in targeted studies has
been said to be relatively inexpensive, widely accepted by men and a safe method for providing partial
protection from HIV. The Tanzania Ministry of Health and Social welfare (MoHSW) responded by reviewing
the current evidence on MC and developed structures (National Task Force and an MC Technical Working
Group) to discuss the implications in terms of programmatic interventions. Further ground work has been
initiated in Tanzania by USG partners JHPIEGO and ICAP to undertake a situational analysis (ICAP) and
revised WHO developed guidelines and protocols (JHPIEGO).
As mentioned above, MRH along with other three sites (Iringa, TPDF site in Dar es Salaam, and Kagera),
will participate in the pilot of safe MC in FY 2009. Mbeya region is reported to have one of the highest HIV
prevalence rates in Tanzania (at 8%) as well as a one of the lowest rates of MC, reported at 34%. This
demonstration project will assess the capacity of HIV programs to implement safe MC, training, outreach,
message development, service delivery and client follow-up. It is hoped that the outcomes from this project
will provide evidence-based information for potential scaling up of MC services in Tanzania.
MC will not replace other known methods of HIV prevention and will always be considered as part of a
comprehensive HIV prevention package, which includes: promoting delay in the onset of sexual relations,
abstinence from sex and reduction in the number of sexual partners; providing and promoting correct and
consistent use of male and female condoms; providing HIV testing and counseling services for couples; and
providing services for the treatment of sexually transmitted infections. MC will be an entry point to
promoting shared sexual decision-making, gender equality, and improved health of both women and men.
MC Service provision shall also be used to address the sexual health needs of men.
ACCOMPLISHMENTS:
This is a pilot project for MRH for FY09 with TA support from JHPIEGO.
ACTIVITIES:
MRH will work with the JHPIEGO, MOHSW, MC Technical Working Group (MCTWG) and other
participating partners in the planning stages that would include developing the necessary resources to
support the implementation of an MC demonstration project in Mbeya along with the other three regions.
The pilot will last over a 1-year period. MRH will receive support to implement approaches to integrating
MC guidelines into the service protocols while improving the capacity for quality services and creating
demand for the intervention.
As a pilot site for MC, MRH will receive TA from JHPIEGO which will include: meetings to review results of
MC situational assessment and design a strategy for implementation of MC services; a workshop to develop
MC service delivery guidelines, review/adapt MC training package and develop reporting/recording forms;
and a workshop to develop and pilot test performance standards for quality MC service delivery.
MHR will also participate in the introductory meetings and onsite orientation workshops, site strengthening
in preparation for service delivery, identification of providers to participate in provider training from the
hospital and any specific training on follow-up counseling.
Once the pilot commences, MRH will be involved in procurement and monitoring of commodities for the
procedure; participate in quarterly MC Task Force meetings; follow up of circumcised men on adverse side-
effects post- MC as well as abstinence during the healing period; offer follow-up HIV tests and counseling;
developing a strategy to involve community leaders and village health team leaders in the catchments areas
served by the MRH in advocating for male participation in MC; developing MC IEC materials for clients,
spouses and community (in partnership with T-MARC) and local partners; and printing of IEC materials and
distribution to target groups.
MRH, working with partners within the region, will implement a communication strategy, linking with existing
IEC and community mobilization programs to deliver correct and informative MC messages to target
populations to influence positive behavior changes and risk reduction of circumcised men effectively so that
the MC efforts can be optimized. Social mobilization for ABC messaging, condom provision, prevention
counseling and STI treatment will be part of comprehensive MC package. An approach focused on couples
counseling will be utilized to provide messages that will address safe sexual behaviors and norms and
broader reproductive health issues. Information will be shared, educating men and women on
comprehensive approach to MC aiming at clearing any misconceptions surrounding MC.
LINKAGES:
The MRH under this MC activity will work closely with district hospitals to facilitate referrals; ward leaders
Activity Narrative: and other local government officials to ensure community buy in and participation; and PITC, VCT, mobile
and outreach counseling services as possible points of entry. As healthy males routinely do not seek health
and VCT services, the MRH will collaborate with community based outreach partners in Mbeya, the Mbeya
HIV Network (MHNT) and KIHUMBE who are implementing prevention activities throughout the region
among a variety of target audiences. MRH will also closely work with the ROADS/FHI program working in
Mbeya in accessing and referring high-risk males along the trans-African highway. MRH will further
collaborate with PEPFAR marketing groups STRADCOM and Academy for Educational Development,
(AED) for local advertising to encourage male participation. MRH will use the existing linkages with the
lower level facilities and home based care services for follow up of MC clients on adverse outcomes and
counseling on relevant issues surrounding MC.
TARGET POPULATION:
MC will be provided to HIV negative boys and men, aged 15 to 49, in the Mbeya region.
M&E:
Monitoring of safe MC will be done and evaluated as per developed guidelines. DOD will work with the
MCTWG, MRH and JHPIEGO to develop monitoring and evaluation tools/systems which will assist to
monitor and inform on the feasibility and potential for expansion of this intervention. MRH will also
participate in formative research to assess sexual behavior post-MC service delivery - to continue in a
follow-on year. The success of safe MC as strategy will largely depend on how effectively programs are
able to influence positive behavior changes of circumcised men so that the efforts of MC can be optimized.
MRH will routinely monitor clients for adverse effects and assess their behaviors so as to maximize
opportunity to address issues surrounding MC (male norms, unintended gender issues and gender
violence; risk compensation and reaction if a man becomes positive post MC).
SUSTAINABILITY:
Efforts will be made to ensure training of an adequate mix of health workers for conducting high quality MC.
MRH will ensure sustainability by coordinating training, providing technical assistance through other USG
partners, and forging strong linkages with outreach partners and developing linkages with the Government
of Tanzania, treatment partners, existing facility-based care programs, local partners and other key
stakeholders to ensure sustainable and collaborative initiatives.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Reducing violence and coercion
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.07:
TITLE: Expanding Adult Care and Support Services in the Southern Highlands Zone
NEED and COMPARATIVE ADVANTAGE: The Mbeya Referral Hospital (MRH) is one of five zonal
hospitals in Tanzania. It operates in the Southern Highlands to offer direct clinical service, provide training,
coordinate and oversee the quality of treatment in the zone, and to establish health service referral systems
among four regions (Mbeya, Iringa, Rukwa, and Ruvuma) serving a catchment population of over six million
people
ACCOMPLISHMENTS: The MRH began full recruitment of patients in January 2005 and now boasts a
patient load of over 4,000 on ART, with nearly 8,500 receiving care and support services. It is presently
enrolling over 200 patients each month. The MRH also provides technical supervision to the hospitals in
Mbeya, Rukwa and Ruvuma regions, contributing to quality services for over 18,000 ART patients in the
Southern Highlands. In collaboration with the National AIDS Control Programme (NACP), the MRH has
also supported the direct training of health providers through the Southern Highlands in ART services and
related care and support. In FY 2008, a Center for Infectious Disease (CID) was opened, funded both by
PEPFAR and other donor sources. The center currently accommodates an infectious disease clinic and a
training facility with a referral-level laboratory capacity. The CID supports a continued expansion of
antiretroviral therapy (ART) and related clinical care needs. It provides a forum for practical training for
medical and laboratory staff to improve adult and pediatric HIV/AIDS care and treatment services.
ACTIVITIES: All hospitals in the Mbeya Region, under the auspices of Mbeya Regional Medical Office
(MRMO under separate submission), provide ART services and facility-based care and support, but
identification of the majority of patients is still done through the MRH. At the MRH, patients undergo the
initial evaluation and are then referred to the regional and district hospital for management. This
phenomenon is due to the higher quality of service and better infrastructure provided by MRH
As part of FY 2009 activities, the US Department of Defense (DOD) and MRH will work with the MRMO to
develop strategies beyond provider initiated testing and counseling (PITC) to decentralize
identification/enrollment of patients to increase uptake of services. MRH and MRMO will strategize to build
capacity of satellite health facilities to decongest the MRH. These will be the key components of the overall
improvement of services through out the region.
In FY 2009, MRH will:
1. Provide care and support to patients, both in the main MRH care and treatment clinic (CTC) and at
satellite health centers, including cotrimoxazone prophylaxis, treatment of opportunistic infections and other
related complications of HIV/AIDS, pain and symptom relief, and psychosocial support. Coordinate with the
MRMO to provide technical support, such as training to satellite clinics, in order to decongest the MRH
CTC. Provide ongoing mentoring to satellite health center CTC staff. Continue to sensitize hospital staff
and clients in PITC as a regular part of all out patient services, including the TB clinic. Reinforce PITC
sensitization through rotation of staff from the CTCs to assist regular hospital staff in patient identification
and provision of this service. Reinforce collection of patient data and analysis to inform service
improvement. Procure commodities for services and patient monitoring when not available through central
mechanisms.
2. Provide support to zonal facilities to ensure quality services. Strengthen and reinforce implementation of
standard operating procedures for clinical services, laboratory monitoring, and maintenance of patient
records. Conduct bimonthly visits to facilities in the zone by supportive supervisory teams consisting of a
medical officer, clinical officer, and nurse. Observe service provision and provide direct technical and
material support to health facilities in the zone. Mentor Regional Medical Officer (RMO) development
and/or strengthen regional supportive supervisory teams.
3. Intensify its efforts in nutritional support for people living with HIV/AIDS (PLWHA). Specifically, MRH will
support CTCs to conduct anthropometric measurements and determine nutritional status using Body Mass
Index calculations and other appropriate measurements, such has mid-upper arm circumference (MUAC)
and weight for age. MRH will procure the necessary equipment required to carry out effective nutritional
assessment at the CID, such as weighing scales, MUAC tapes, and stadiometers. The program will
conduct training in the use of these tools, as well as in dietary assessments of patients and the provision of
nutrition counseling and education. In addition, the CID will ensure the identification of clients eligible for
the pilot therapeutic supplemental feeding program. Finally, the CID will link with other organizations
addressing household food security and economic strengthening to ensure PLWHA have access to these
services.
4. Provide prevention with positives messages to people living with HIV/AIDS, including provision of
condoms, importance of safe water and good hygiene, counseling about adherence and disclosure, and
referral for family planning or sexually transmitted diseases, as needed.
To accomplish zonal training activities, MRH will:
1. Collaborate with the NACP and conduct initial and refresher training of ART and related care and
support, TB/HIV co-management, and PITC for the regions of Mbeya, Rukwa and Ruvuma. Provide
practical training with CTC staff to reinforce classroom lectures. Work with RMOs to evaluate training
needs in the zone continually and meet those needs through both formal and informal
mechanisms/approaches.
2. Increase enrollment of adults in ART services. Promote routine counseling and testing at all contact
points. Continue to strengthen pre-ART within the CTC for evaluation and follow-up for treatment. Ensure
all TB/HIV co-infected patients are initiated on cotrimoxazole prophylaxis as appropriate.
3. Strengthen referral system between HIV service points at the MRH. Use M&E officers to conduct daily
checks on registers in outpatient clinics, inpatient wards, maternal and child health (MCH) and TB clinics to
keep track of patients referred to the CTC. Strengthen and formalize referrals to and from community-
Activity Narrative: based organizations (CBOs), non-governmental organizations (NGOs) and faith-based organizations
serving patients in their communities through facility social workers.
LINKAGES: This activity is linked to activities under this facility in TB/HIV, adult and pediatric treatment, and
pediatric care and support, as well as those of the regions in this zone (Mbeya, Rukwa and Ruvuma). It is
also linked to the DOD submission under SI other USG treatment partner submissions providing expertise
in the areas of pediatric care and TB infection control. The MRH will continue to promote outreach services
from the facilities to the communities. It has a list of NGOs, CBOs and home-based care providers involved
in HIV/AIDS support, indicating geographical coverage and types of services offered. This list is displayed
in the CTCs and other clinics/wards so health staff can refer clients to those organizations as necessary.
These referrals, as well as referrals from community organizations to the facility, will be further strengthened
through a facility social worker serving as the point of contact for the community organizations. Through
these community organizations, patients receiving care and support can access insecticide treated
mosquito nets, nutritional support, and possibly income generating activities.
M&E: The MRH is the central hub for the zonal electronic medical record system (EMRS) supported with
direct technical assistance from DOD. This EMRS is critical for patient management and program
monitoring in support of ART in the Southern Highlands. The system currently supports nine sites in the
Mbeya region and three sites each for Rukwa and Ruvuma regions. The EMRS is linked to the national
CTC2 and CTC3 databases and is capable of producing national reports and identifier stripped data for
national analyses. Patient records at the MRH CTC are entered at the clinic immediately upon completion
of the patient visit, and electronically transferred to the data center where data is synthesized and fed back
to the CTC team for use in patient management.: In FY 2008, the DOD SI team will train 60 healthcare
workers in M&E and provide technical assistance to 53 CTCs in three regions
SUSTAINABILITY: The MRH is accomplishing these activities through capacity building of other health care
facilities and its staff, sensitization of community members, and advocacy through influential leaders. These
activities are also being accomplished by strengthening "systems," such as the zonal supportive supervisory
team and the zonal weekly ART meetings as part of existing zonal support functions.
Estimated amount of funding that is planned for Human Capacity Development $139,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $20,000
and Service Delivery
Table 3.3.08:
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP.
TITLE: Expanding Adult Treatment Services in the Southern Highlands Zone
The Mbeya Referral Hospital (MRH) is one of five zonal hospitals in Tanzania. It functions in the Southern
Highlands to offer direct clinical service, to provide training, to coordinate and oversee the quality of
treatment in the zone, and to establish health service referral systems among four regions (Mbeya, Iringa,
Rukwa and Ruvuma) and serving a population of over six million people.
In 2004, under PEPFAR funding and multiple donor support a Center for Infectious Disease (CID) was
initiated and presently the center accommodates an infectious disease clinic, a training facility with a
referral level laboratory capacity . The CID supports a continued expansion of ART and clinical care
needs as well as provide a forum for practical training for medical and laboratory staff to improve adult
and pediatric HIV/AIDS care and treatment service.
The MRH began full recruitment of patients in January 2005 and now boasts a patient-load of over 4,000 on
ART. It will reach its September 2008 ART targets of 5,420, enrolling over 200 new patients each month.
The MRH also provides technical supervision to the hospitals in Mbeya, Rukwa and Ruvuma Regions,
contributing to quality services for over 18,000 ART patient population in the Southern Highlands. In
collaboration with the NACP, the MRH has also supported the direct training of health providers through the
Southern Highlands in ART services (numbers per region indicated in separate activity submissions).
All hospitals in the Mbeya Region, under the auspices of Mbeya Regional Medical Office (MRMO under
separate submission), provide ART
services but identification of a majority of patients is still done through the MRH. At the MRH patients
undergo the initial evaluation then referred to the regional and district hospital for management. This
phenomena is due to the higher quality of service and better infrastructure provided by MRH as the
development of ART expertise is being developed at the lower level facilities.
As part of FY 2008 and FY 2009 activities, the DOD and MRH will work with the MRMO in developing
strategies beyond provider initiated testing and counseling (PITC) to decentralize identification/enrollment of
patients to increase up take of services. Also MRH and MRMO will strategize to build capacity of satellite
health facilities to de-congest MRH. These will be the key components of the overall improvement of
services through out the region. Within the MRH, activities will include: Provision of ART both in main MRH
CTC and at satellite/health centers; In coordination with the Mbeya Regional Medical Office, MRH will
provide technical support such as training to satellite clinics in order to decongest the MRH CTC; Provide
ongoing mentoring to MRH and satellite health center CTC staff; Strengthen and scale-up ART services in
the zone; Continue to provide evaluation for malnutrition and nutritional counseling to all HIV+ clients as part
of treatment; Procure commodities for services and patient monitoring when not available through central
mechanism; Provide support to zonal facilities to ensure quality services; Strengthen and reinforce
implementation of SOP for CTC services, laboratory monitoring and maintenance of patient records; Bi-
monthly visits to facilities in the zone by supportive supervisory teams consisting of a medical officer, clinical
officer and nurse; Observe service provision and provide direct technical and material support to health
facilities in the zone; Mentor RMO on development and/or strengthening of regional supportive supervisory
teams; Conduct weekly zonal ART meetings with the Mbeya, Rukwa and Ruvuma Regional Medical Offices
to discuss treatment roll out, identify areas of need, determine solutions and coordinate resolution; Function
as the zonal training center in HIV related services for the Southern Highlands in support of NACP;Conduct
initial and refresher training in ART, TB/HIV co-management for Mbeya, Rukwa and Ruvuma; Increase
enrollment of Adults in ART services; Continue to strengthen TB/HIV co-management in the TB clinics and
CTC; Develop capability for monitoring ARV drug resistance; Ensure all TB/HIV co-infected patients are
initiated on cotrimoxazole prophylaxis as appropriate; Strengthen referral system between service points at
the MRH through; Use site coordinator to conduct daily checks on registers in outpatient clinics, in-patient
wards, MCH and the TB clinic to keep track of patients referred to the CTC;Strengthen and formalize
referrals to and from CBO, NGO and FBO serving patients in their communities through facility social
workers.
Laboratory Services:
Train 20 lab technicians on PMTCT lab activity such as Syphilis testing , rapid HIV test trainings and Rapid
HIV quality assurance activities; Train 20 counselors which are mainly focused on counseling and testing
lab Activities such as PITC, VCT. The training will be focused on Rapid HIV testing and Quality Assurance
of Rapid HIV testing; Strengthen TB/HIV lab activities by training 7 lab technicians on rapid HIV testing, TB
diagnosis acid-fast method, and 10 lab technicians on liquid culturing of TB; Expand MOHSW Zonal Quality
Assurance\Quality Control activities by working Regional and Facility Quality Assurance officer to support
zonal Quality assurance officer to conduct supportive supervision of all regional, district and CTC in the
zone; MRH will implement the zonal external laboratory quality assurance scheme (ZELQAS). The MRH
quality will be monitored by international EQAS system such as CAP and UNEQAS; MRH will continue to
roll out HIV Early infant diagnosis, to 60 health centers in Mbeya, Ruvuma and Rukwa by training health
workers on sample management, transportation; MRH will continue to provide direct services for zonal viral
monitoring and serve as the dry blood sample (DBS) processing center for infant diagnosis as part of the
MOHSW national roll out of these services; MRH will continue to service bi- annually hematology,
chemistry and facscount equipments in the zone by using the technical skills of DOD hired Tanzanian
medical engineer; DOD will continue to support MOHSW Health Care Technical Services Diagnostic
Section by hiring and training a medical instrument engineer; DOD will continue to procure reagents for
hematology, chemistry and CD4 and viral load for all CTC hospital lab's in Mbeya Referral Hospital; DOD
will continue to purchase laboratory instruments for Mbeya Referral Hospital laboratory.
This activity is linked to activities under this facility in TB/HIV and palliative care as well as those of the
Activity Narrative: regions in this zone (Mbeya, Rukwa and Ruvuma). It is also linked to the DOD submission under SI other
USG treatment partner submissions providing expertise in areas of pediatric care and TB infection control.
The MRH will continue to promote outreach services from the facilities to the communities. It has a list of
NGO's, CBOs and HBC providers involved in HIV/AIDS support, indicating geographical coverage and
types of services offered. This list is displayed in the CTCs and other clinics/wards so health staff can refer
clients to those organizations as necessary. These referrals, as well as referrals from community
organizations to the facility, will be further strengthened through a facility social worker serving as the POC
or the community organizations.
CHECK BOXES:
The areas of emphasis will include initial and refresher training, commodity procurement, strengthening
linkages with MCH and TB/HIV services and community organizations.
The MRH is the central hub for the zonal electronic medical record system (EMRS) supported with direct TA
from DOD. This EMRS is critical for patient management and program monitoring in support of ART in the
Southern Highlands. The system currently supports 9 sites in Mbeya region and 3 sites each for Rukwa and
Ruvuma regions. The EMRS is linked to the National CTC2 and CTC3 databases and is capable of
producing national reports and identifier stripped data for national analyses. Patient records at the Referral
Hospital CTC are entered at the clinic immediately upon completion of the patient visit and electronically
transferred to the data centre where data is synthesized and fed back to the CTC team for use in patient
management. SI Targets: In FY 2008, the DOD SI team will train 60 HCW in M&E and provide TA to 53
CTCs and three regions
The MRH is accomplishing this through capacity building of other health care facilities and its staff,
sensitization of community members and advocacy through influential leaders. This is also being
accomplished by strengthening "systems", such as the zonal supportive supervisory team and the zonal
weekly ART meetings as part of already existing zonal support functions.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13515
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13515 5507.08 Department of Mbeya Referral 6535 1027.08 $3,743,670
Defense Hospital
7747 5507.07 Department of Mbeya Referral 4556 1027.07 $3,112,500
5507 5507.06 Department of Mbeya Referral 2833 1027.06 $1,450,000
Estimated amount of funding that is planned for Human Capacity Development $314,750
Table 3.3.09:
THIS IS A NEW ACTIVITY
TITLE: Expanding Pediatric Care and support Services in the Southern Highlands Zone
hospitals in Tanzania. It operates in the Southern Highlands offering direct primary clinical services, referral
level services, zonal, and national in-service training as well as degree programs. MRH has established
health service referral systems among four regions (Mbeya, Iringa, Rukwa, and Ruvuma) serving a
catchment population of over six million people.
In 2004, under PEPFAR funding and multiple donor support, a Center for Infectious Disease (CID) was
initiated. Presently, it accommodates an infectious disease clinic and a zonal training center with a referral
level laboratory that has capacity to support early infant diagnosis (EID) and viral load monitoring. The CID
supports a continued expansion of antiretroviral therapy (ART) and clinical care needs as well as a forum
for practical training for medical and laboratory staff to improve both adult and pediatric HIV/AIDS care and
treatment services. Pediatric outpatient HIV care is presently provided at CID and Meta, the center's
maternal and reproductive health clinic postnatal clinic, while inpatient care is provided by the MRH
Pediatric Department.
The MRH is tasked with coordinating and overseeing the quality of pediatric services in the zone, but does
not have pediatricians to undertake these specialized pediatric services to include HIV/AIDS care and
treatment. In addressing the long-term need for specialists at the MRH and capacity within the zone, the
hospital has established a specialized pediatric HIV/AIDS outpatient center in partnership with the Baylor
International Pediatric AIDS Initiative (BIPAI). The center will serve as a referral center and provide pediatric
ART training for health workers in the regional zone. Also, pediatricians working within this facility will
conduct outreach services to mentor pediatric ART providers, and provide specialized services where
required. It is anticipated that progress with BIPAI in establishing this center will be completed within the FY
2009 - FY 2010 period. However, direct funding to the MRH will be required under this submission to
maintain the level of pediatric treatment and zonal support at the MRH until Baylor has completed
construction of the pediatric center, and training of needed clinical staff for this facility.
ACCOMPLISHMENTS: The MRH began full recruitment of patients in January 2005, and now boasts a
patient load of over 8,500 on care and support, 1,420 of whom are children. The MRH has provided
training, which includes a pediatric component, to all ART-certified providers and clinical staff in the zone. It
also provides technical supervision on pediatric care to the hospitals in the Mbeya, Rukwa, and Ruvuma
regions, contributing to quality services for a pediatric patient population of over 3,392.
Under existing funding, the MRH has increased efforts to identify pediatric cases early by tracking children
born to HIV-positive mothers, and through provision of provider-initiated testing and counseling (PITC) at
Meta during postnatal follow-up, as part of immunizations clinics, at outpatient clinics and inpatient wards.
These efforts will continue to be built upon with the addition of EID in the facility for improved access to
pediatric services.
ACTIVITIES: All hospitals in the Mbeya Region, under the auspices of the Mbeya Regional Medical Office
(MRMO), provide pediatric HIV care services, but identification of a majority of children in need of HIV/AIDS
treatment is primarily done through the MRH. At the MRH, children undergo their initial evaluation, and are
then referred to the regional and district hospitals for management. This is due to the higher quality of
service and better infrastructure provided by MRH, as the development of pediatric expertise is still being
developed at the lower level facilities.
As part of FY 2008 and FY 2009 activities, the US Department of Defense (DOD) and MRH will work with
the MRMO to develop strategies beyond PITC to continue decentralized identification and enrollment of
pediatric patients to district facilities and increased uptake of services. Also, MRH and MRMO will
strategize to build the capacity of five satellite health facilities to decongest the Meta Postnatal Clinic and
the MRH. These will be the key components of the overall improvement of pediatric services throughout the
region.
Specifically, the MRH will:
1. Provide care and support to pediatric patients, both in the main MRH CTC at Meta clinic and at satellite
health centers. Provide nutritional education, counseling, and support to HIV-positive malnourished
children after a Body Mass Index assessment. The initiative will include counseling services for caregivers
to prevent and manage food- and waterborne infections caused by infant and young children feeding
practices. Provide psychosocial support and counseling to include disclosure. Link with the Presidential
Malaria Initiative to distribute insecticide-treated nets to infants and HIV-positive children. In coordination
with the Mbeya Regional Medical Office, directly support satellite health centers within the municipality to
provide pediatric ART in order to help decongest the MRH CTC at Meta. Continue to sensitize hospital staff
and clients in PITC as a regular part of all pediatric outpatient services, including the TB clinic. Reinforce
pediatric record/data collection. Work with DOD and facility staff to collect, record, and analyze data to
inform quality improvement of services. Continue to provide evaluation for malnutrition and nutritional
counseling to all HIV-positive pediatric clients as part of both care and treatment programs. Procure and
distribute commodities for pediatric ART services when they are not available through the central
procurement mechanism. Ensure all HIV-exposed and infected children are initiated on Cotrimoxazole
prophylaxis, based on national guidelines.
2. Provide support to zonal facilities to ensure standard operating procedures for pediatric clinical services.
Conduct bimonthly visits to facilities in the zone through supportive supervisory teams consisting of a
medical officer, a clinical officer and a nurse. Establish an efficient dried blood specimen (DBS)
transportation system to the zone reference laboratory in the MRH. Facilitate the training of community
health workers on pediatric HIV/AIDS care and support.
Activity Narrative: 3. Increase enrollment of children in ART care and treatment services from 11% to 15% of the patient
population. Promote routine counseling and testing of mothers and their children at all contact points in the
health facility, including Meta's maternal and child health (MCH) labor and delivery wards, immunization
clinics, and female and pediatric inpatient wards. Train health care workers on pediatric HIV management.
Train antenatal clinic, postnatal clinic and CTC staff on EID with an emphasis on collection and
transportation of DBS. Train healthcare workers on identification of exposed infants and children eligible for
Cotrimoxazole prophylaxis. Train healthcare workers on infant feeding counseling and practices using the
national curriculum.
4. Increase emphasis on nutritional aspects of care by procuring the necessary equipment for effective
nutritional assessment such as weighing scales, MUAC tapes, and stadiometers. The program will conduct
training in the use of these tools, as well as in dietary assessments of patients and the provision of nutrition
counseling and education. In addition, MRH will ensure the identification of clients eligible for the pilot
therapeutic supplemental feeding program. Finally, MRH will link with other organizations addressing
household food security and economic strengthening to ensure PLWHA have access to these services.
5. Strengthen the referral system between HIV services points at the MRH. Use site coordinator to conduct
daily register checks in pediatric outpatient clinics, inpatient wards, MCH, and TB clinics to keep track of
patients referred to the CTC. Strengthen and continue to formalize referrals of children to and from
community-based organizations (CBOs), non-governmental organizations (NGOs) and faith-based
organizations (FBOs) serving OVC and HIV-positive children in their communities through the facility's
social workers.
LINKAGES: This activity is linked to activities under this facility in TB/HIV and adult care and support, as
well as those of the regions in this zone (Mbeya, Rukwa, and Ruvuma). It is also linked to the DOD
submission under SI and other USG treatment partner submissions providing expertise in areas of pediatric
care and TB infection control. It also is linked to the BIPAI activity to scale up pediatric AIDS services and
skills building in the zone.
NGOs, CBOs, FBOs, and home-based care providers involved in HIV/AIDS support, indicating geographical
coverage and types of services offered. This list is displayed in the CTCs and other clinics/wards so health
staff can refer clients to those organizations as necessary. These referrals, as well as referrals from
community organizations to the facility, are further strengthened through a facility social worker serving as
the point of contact for the community organizations.
monitoring in support of ART in the Southern Highlands. The system currently supports nine sites in Mbeya
region and three sites each in Rukwa and Ruvuma regions. The EMRS is linked to the national CTC2 and
CTC3 databases and is capable of producing national reports and identifier-stripped data for national
analyses. Patient records at the MRH CTC are entered at the clinic immediately upon completion of the
patient visit, and electronically transferred to the data center. There, the data is synthesized and fed back to
the CTC team for use in patient management. SI Targets: In FY 2008, the DOD SI team will train 60
healthcare workers in M&E and provide technical assistance to 53 CTCs in three regions
SUSTAINABILITY: The MRH is accomplishing this through building the capacity of other health care
facilities and their staff, sensitizing community members, and advocating through influential leaders. This is
also being accomplished by strengthening systems, such as the zonal supportive supervisory team and the
zonal weekly ART meetings as part of existing zonal support functions
Health-related Wraparound Programs
* Child Survival Activities
* Malaria (PMI)
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $5,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $10,000
Table 3.3.10:
TITLE: Expanding Pediatric treatment Services in the Southern Highlands Zone
NEED and COMPARATIVE ADVANTAGE : The Mbeya Referral Hospital (MRH) is one of five zonal
level services, zonal and national in-service training, as well as degree programs and has established
health service referral systems among four regions (Mbeya, Iringa, Rukwa and Ruvuma) serving a
In 2004, under PEPFAR funding and multiple-donor support, a Center for Infectious Disease (CID) was
initiated. Presently, the center accommodates an infectious disease clinic, a zonal training center with a
referral-level laboratory with capacity to support early infant diagnosis (EID) and viral load monitoring. The
CID supports a continued expansion of ART and clinical care needs. Its serves as a forum for practical
training for medical and laboratory staff to improve both adult and pediatric HIV/AIDS care and treatment
services. Pediatric out-patient HIV Care is provided at CID and Meta, the MRH post-natal clinic of MRH,
while in -patient care is provided by the MRH Pediatric Department.
not have pediatricians to undertake these specialized pediatric services including HIV/AIDS treatment and
care. Its last pediatrician left his summer to take a position with UNICEF in Dar es Salaam. In addressing
the long-term need for specialists at the MRH and capacity within the zone, the hospital is in the process of
establishing a specialized pediatric HIV/AIDS outpatient centre in partnership with Baylor International
Pediatric AIDS Initiative (BIPAI). The centre will serve as a referral centre, and provides pediatric ART
training for health workers in the zone. Additionally, pediatricians working within this facility will conduct
outreach services to mentor pediatric ART providers, and provide specialized services where required.
Though it is anticipated that progress with BIPAI in establishing this center will be completed within the
FY09/10 period, direct funding to the MRH will be required under this submission. This will maintain the
level of pediatric treatment and zonal support at the MRH until Baylor has completed construction of the
pediatric center and training of needed clinical staff for this facility.
The MRH began full recruitment of patients in January 2005, and now boasts a patient-load of over 4,000
on ART care and treatment, of which 425 are children. The MRH has provided training to all ART-certified
providers and clinical staff in the zone, which includes a pediatric component. It also provides technical
supervision on pediatric care to the hospitals in Mbeya, Rukwa and Ruvuma Regions, contributing to quality
services for a pediatric patient population of over 3,392.
Under existing funding, the MRH has increased efforts in identifying pediatric cases early through provision
of provider initiated testing and counseling (PITC) at Meta during post-natal follow up, and as part of:
immunizations clinics, at out-patient clinics and through in patient wards. These efforts will continue to be
built upon with the addition of EID at the facility for improved access to pediatric services.
All hospitals in the Mbeya Region, under the auspices of Mbeya Regional Medical Office, provide pediatric
ART services. However, identification of a majority of children in need of HIV/AIDS treatment is mainly
done through the MRH. At the MRH, children undergo their initial evaluation and are then referred to the
regional and district hospitals for management. This is due to the higher quality of service and better
infrastructure provided by MRH as the development of pediatric expertise is still being developed at the
lower level facilities.
As part of FY 2008 and FY 2009 activities, the DOD and MRH will work with the Mbeya Regional Medical
Officer (MRMO) to develop strategies beyond PITC. This aims to continue decentralization of
identification/enrollment of pediatric patients to district facilities, increasing uptake of services. MRH and
MRMO will strategize to build capacity of five satellite health facilities to decongest Meta's postnatal clinic
(PNC) at MRH. These will be the key components of the overall improvement of pediatric services through
out the region.
Within the MRH, activities will include: Continued provision of pediatric ART both in the main MRH CTC,
Meta and at satellite/health centers and counseling on ART adherence; Coordinate with the Mbeya
Regional Medical Office to directly support satellite health centers within the municipality in provision of
pediatric ART to decongest the MRH CTC; Supervise and coordinate scale-up of pediatric ART in the zone;
Train the existing counselors in the CTC to provide psychosocial support and counseling (including
adherence and disclosure) for HIV-infected children and their caregivers; Strengthen pediatric ARV
forecasting, stock management and ordering
FY 2009 Funds will also provide support to zonal facilities to ensure quality services by: Strengthen and
reinforce implementation of standard operating procedures for pediatric clinical services, laboratory
monitoring and maintenance of patient records; Conduct bi-monthly visits to facilities in the zone by
supportive supervisory teams consisting of a medical officer, a clinical officer and a nurse; Observe pediatric
service provision, and provide direct technical and material support to health facilities in the zone; Conduct
weekly zonal ART meetings with the Mbeya, Rukwa and Ruvuma Regional Medical Offices to discuss
Pediatric treatment roll out.
Further more funds will be used to support MRH function as the zonal training center in pediatric HIV-
related services; Conduct initial and refresher training in Pediatric ART and TB/HIV co-management in
children for the regions of Mbeya, Rukwa and Ruvuma
Funds will be used to Increase enrollment of children in ART care and treatment services from 11% to 15%
of the patient population through; Continue to improve upon the number of individuals trained to identify
Activity Narrative: pediatric cases early through provision of PITC at Meta during post-natal follow up, and as part of
immunizations clinics, at out-patient clinics and through in-patient wards; Continue to strengthen TB/HIV co-
management for children identified in the PNC and CTC; Roll-out HIV EID, to health centers in Mbeya,
Ruvuma and Rukwa by training additional health workers on sample management, transportation; Serve as
the dry blood specimen (DBS) processing center for infant diagnosis as part of the MOHSW national roll out
of these services
Lastly funds will be used to strengthen referral system between pediatric HIV service points at the MRH by
use of M&E officer to conduct daily checks on registers in outpatient pediatric clinics, in-patient pediatric
wards, MCH and the TB clinic to keep track of patients referred to the CTC and strengthen and continue to
formalize referrals to and from community-based organizations (CBO), NGO and faith-based organizations
(FBO) serving OVC and pediatric patients.
This activity is linked to activities under this facility in TB/HIV and palliative care, as well as those across the
other regions in this zone (Mbeya, Rukwa and Ruvuma). It is also linked to the DOD submission under SI,
and other USG treatment partner submissions providing expertise in areas of pediatric care and TB
infection control. The MRH will continue to promote pediatric outreach services from the facilities to the
communities. It has a list of NGOs, CBOs and HBC providers involved in HIV/AIDS support, including their
geographical coverage and types of services offered. This list is displayed in the CTCs and other
clinics/wards, so health staff can refer clients to those organizations as necessary. These referrals, as well
as referrals from community organizations to the facility, are further strengthened through a facility social
worker serving as the POC for the community organizations.
The areas of emphasis will include initial and refresher pediatric training, commodity procurement,
strengthening linkages with MCH and TB/HIV services and community organizations.
The MRH is the central hub for the zonal electronic medical record system (EMRS) supported with direct
technical assistance (TA) from DOD. This EMRS is critical for patient management and program monitoring
in support of ART in the Southern Highlands. The system currently supports nine sites in Mbeya region, and
three sites each for the Rukwa and Ruvuma regions. The EMRS is linked to the National CTC2 and CTC3
databases, and is capable of producing national reports and identifier-stripped data for national analyses.
Patient records at the Referral Hospital CTC are entered at the clinic immediately upon completion of the
patient visit. They are then electronically transferred to the data centre, where data is synthesized and fed
back to the CTC team for use in patient management. SI Targets: In FY 2008, the DOD SI team will train 60
HCW in M&E and provide TA to 53 CTCs in the three regions.
The MRH is accomplishing this through capacity building of other health care facilities and their staff,
accomplished by strengthening systems such as the zonal supportive supervisory team and the zonal
weekly ART meetings, (part of already existing zonal support functions).
Estimated amount of funding that is planned for Human Capacity Development $29,600
Table 3.3.11:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
TITLE: Expanding and Integrating TB/HIV activities at Mbeya Referral Hospital (MRH)
Mbeya Referral Hospital (MRH) will continue collaborate with other hospital and lower level Health facilities
to provide TB/HIV collaborative activities in the region. MRH play a major role of identification of a majority
of patients who are in need of HIV care and treatment services. Most of the patients undergo initial
evaluation after which they are referred down to the regional and district hospital for management. In FY09
MRH will focus on strengthening of referral, linkages and patients follow up make sure that patients access
HIV continuum of care. Quality of HIV care at MRH will be improved and the major activities will include
screening of TB to all People living with HIV and AIDS attending care and treatment clinic. Those who will
be found to have active TB will be referred to TB clinic to be initiated an uninterrupted treatment TB
treatment using Directly Observed Therapy (DOT). TB infection control will be implemented in all HIV
clinics. TB/HIV collaborative activities will be expanded to other HIV clinics including PMTCT. National TB
screening tool and clinical assessment forms will be printed and distributed for use in these clinics. Health
care providers from HIV clinics will be trained on TB/HIV collaborative activities including use of modified
clinical forms and screening tool for routinely screening for TB to all PLWHA receiving HIV care and
treatment. TB infection control practices will be implemented in the care and treatment settings s to prevent
transmission of TB among PLWHA as well as health providers. Using national guidelines for TB infection
control all clinics will be supported to make sure that the guidelines are available and followed. Hospital
management team will also be oriented on TB infection control activities. Staff from HIV clinic will be trained
on TB infection control practices which include ensuring good ventilation in Care and Treatment clinics.
Laboratory services including sputum smear microscopy and quality assurance will be improved to ensure
early TB diagnosis and treatment. Capacity of laboratory staff will be strengthen through training, mentoring
and supportive supervision. MRH will supplement HIV rapid test kits and supply of X-ray films.
Collaboration between health care providers from HIV and TB clinics will be improved and MRH will support
information exchange meeting for health care providers to discuss best practices, challenges on TB/HIV co-
management, patient follow up and track referrals.
NEED and COMPARATIVE ADVANTAGE: According to the National Tuberculosis and leprosy Program
(NTLP), TB /HIV dual infection contributes to 17.5 % of the total disease burden in Tanzania (Ministry of
Health and Social Welfare (MOHSW), Manual of National Tuberculosis and Leprosy Program in Tanzania,
Fifth Edition, 2006). Currently, MRH provides TB services to patients in the counseling and testing centers
(CTC) and has embarked on an integrated approach to further strengthen collaboration between TB care
and HIV/AIDS care, reducing the burden of TB among PLWHA, and reducing the burden of HIV among TB
patients, resulting in more effective control of TB among HIV-infected people.
The MRH is one of five zonal hospitals in Tanzania. Its function in the Southern Highlands is to offer direct
clinical services, to provide training, to coordinate and oversee the quality of treatment in the zone.
ACCOMPLISHMENTS: MRH began full recruitment of patients in January 2005, and now boasts a
patientload
of over 2,499 on ART and another 5,269 on care. It will reach its September 2008 ART targets of
5,420, enrolling over 200 new patients each month.
The MRH will continue to strengthen the monitoring of HIV patients who are on TB care. Monitoring TB
patients through the use of clinical forms with TB screening questions has been key to ensuring the
screening and referral of all HIV and TB patients. Patients referred both ways have been well documented
in the care and treatment clinics. Integration of HIV care and treatment and the TB diagnosis, as well as
treatment and follow up will be strengthened further in FY 2008.
ACTIVITIES: Though all hospitals in the Mbeya Region, under the Mbeya Regional Medical Office (MRMO
under separate submission), now support ART, identification of a majority of patients is still through the
MRH. Here, they undergo their initial evaluation after which they are referred down to the regional and
district hospital for management. It is believed this is due to the higher quality of services and better
infrastructure at MRH, including its large inpatient wards.
1) All HIV infected patients receiving HIV care and treatment will be screened for TB disease routinely and
those suspected will access TB diagnostic services Those found positive for TB will be immediately referred
to the TB clinic to initiate an uninterrupted treatment using Directly Observed Therapy (DOT). 1a) Support
making of the clinical forms with TB screening tool. 1b) Clinicians at each site will be trained on TB/HIV
collaborative activities including use of modified clinical forms to routinely identify underlying TB signs and
symptoms for all clients attending at CTC. 1c) Develop a referral system for access of HIV-infected TB
suspects to laboratory diagnosis and treatment for TB.
2) TB infection control practices will be implemented in the care and treatment clinics to prevent
transmission of TB among PLWHA as well as health providers. 2a) CTC staff at each site will be trained on
TB infection control practices. Ensure ventilation in Care and Treatment clinics.
3) Strengthen existing laboratory services needed to implement TB/HIV program activities. 3a) Supplement
supply of X-ray films.
4) Support outreach ART services to remote TB clinic in the regions.
LINKAGES: This activity is linked to activities under this facility in treatment and palliative care as well as
those of the regions in this zone (Mbeya, Rukwa and Ruvuma). It is also linked to the DOD submission
under SI other USG treatment partner submissions providing expertise in areas of pediatric care and TB
infection control.
Activity Narrative: types of services offered. This list is displayed in the CTCs and other clinics/wards so health staff can refer
organizations to the facility, will be further strengthened through a facility social worker serving as the point
of contact (POC) for the community organizations.
CHECK BOXES: The areas of emphasis will include: initial and refresher training of staff in TB/HIV
comanagement,
infection control, provision supplies and medications, and capacity building. Community
Health Management Teams (CHMTs) will be supported in planning and incorporating TB/HIV activities in
Council Comprehensive Plan (CCHPs).
direct technical assistance (TA) from DOD. This EMRS is critical for patient management and program
monitoring in support of ART in the Southern Highlands.
All efforts will be made to capture all the HIV care and treatment related data from both the CTCs and TB
clinics using NTLP data collection, recording, and reporting tools. Data at the CTC is collected using
standardized forms based on NACP and facility data needs. It is entered into the electronic medical record
system (EMRS) and synthesized, generating NACP and USG reports as well as providing feedback to CTC
teams for use in-patient management.
SUSTAINABILITY: The MRH is accomplishing this through capacity building of other health care facilities
and its staff, sensitization of community members, and advocacy through influential leaders. This is also
being accomplished by strengthening "systems", such as the zonal supportive supervisory team and the
zonal weekly ART meetings as part of already existing zonal support functions.
Continuing Activity: 16446
16446 16446.08 Department of Mbeya Referral 6535 1027.08 $100,000
* TB
Table 3.3.12:
TITLE: Management and Staffing for DoD
NEED and COMPARATIVE ADVANTAGE: Presently in Mbeya, Rukwa and Ruvuma there are 25,455
patients under care and 13,638 patients on ART served in over 28 hospitals. DOD through the Mbeya
Referral Hospital is working with all levels of health facilities in these regions to develop laboratory capacity
through training and supervision and ensure laboratory samples are being analyzed and results reported
accurately through the establishment of a laboratory quality system that monitors district, regional and zonal
hospital lab performance. The Department of Defense's (DOD's) management and staffing costs for
laboratory will support one laboratory engineer and five laboratory technicians. These laboratory officers will
provide technical assistance to Referral, Regional, District hospitals in the Southern Highlands of Tanzania.
This support is centrally housed at the Mbeya Referral Hospital (MRH) and covers the Mbeya, Rukwa and
Ruvuma regions.
FY 09 activity will focus on strengthening the Mbeya referral hospital laboratory instead of all laboratories in
the Southern highlands to implement a Quality Management System and develop Quality assurance center
for the Southern highlands laboratories closely linked to and in collaboration with the National Quality
Assurance and training center (NHLQATC). The FY09 funding will be used to ensure that the Mbeya
referral laboratory becomes accredited
ACCOMPLISHMENTS: In FY 2006 and FY 2007 DOD and the MRH have made tremendous strides in lab
infrastructure in Mbeya, Rukwa and Ruvuma. This includes the two laboratory trainings of over 64
laboratory personnel at a total of 16 district and regional hospitals in these regions in equipment use,
maintenance and Quality Assurance procedures. A total of 13 labs have been renovated and equipped. In
addition, the
MRH has established both an internal and zonal Quality Assurance system, a supportive supervisory team
for direct monitoring and assistance to sites as well as the "Quality District by District" program using a team
approach with regional lab managers to determine zonal training, maintenance and ordering needs.
ACTIVITIES: The Ministry of Health and social welfare (MOHSW) plans to expand antiretroviral treatment
services to 700 sites. In order to expand HIV/AIDS lab capacity and benefit from the network model for
continuum of prevention, care, and treatment services, the MOHSW has decentralized HIV/AIDS-related
trainings to zonal referral hospitals. MOHSW lab activities will be decentralized to zonal referral laboratories
at Muhimbili National Hospital (MNH), Bugando Medical Centre (BMC), Kilimanjaro Christian Medical
Centre (KCMC) and Mbeya Referral Hospital (MRH). In Zanzibar, the Ministry of Health and Social Welfare
(MOHSW) will decentralize laboratory capacity building activities to the Mnazi Mmoja hospital. These five
zonal reference laboratories in Mainland and Zanzibar will support a network of regional, district, faith-based
and private laboratories supporting HIV/AIDS prevention, care and treatment in their catchment areas. In
order to perform this task, the zonal referral hospitals will equip staff at zonal laboratories to perform
laboratory testing for HIV diagnosis, disease staging, and treatment monitoring in order to optimize
HIV/AIDS prevention, care and treatment services. The zonal referral hospitals will also train laboratory and
non-laboratory staff in other facilities on site to provide similar services, and support and help monitor
performance of HIV/AIDS related laboratory testing services.
In COP 09 DOD will be continued to be funded to support Mbeya Refferal Hospitals (MRH) laboratory's
efforts to become a center for Quality Assurance for the Southern Highland Zone covering 4 regions:
Mbeya, Ruvuma, Rukwa, Iringa. The QA activities at Mbeya center will be closely linked with those of the
National Quality assurance and training center (NHLQATC) so that there is one national quality assurance
coordination as proposed in the national laboratory services strategic plan.
The overall goal is to fully implement laboratory Quality System in the Southern Highland Zone laboratories
using Mbeya zonal laboratory as a nucleus.
In COP 2007 DOD initiated and implemented lab quality system at the MRH Laboratory and in all hospital
laboratories in Mbeya, Ruvuma and Rukwa. All lab technicians/ technologists were trained on basic lab
improvement processes such as documentation, maintaining temperature charts and basic preventive
instrument maintenance and bio-safety. In COP 2008 these trainings were expanded to include zonal
regional, district, health center laboratories. Again in 2008 Clinical and Laboratory Standard Institute (CLSI)
assessed all the five referral hospital labs for international accreditation by using ISO 15189 in which a gap
analysis was presented to the participating labs MRH lab being among them. CLSI mentors assisted MRH
referral lab by strengthening systems that were in place for internal and external QA/QC systems for: HIV
diagnosis and monitoring, opportunistic infection diagnosis tests.
In COP 09 DOD and MRH plan to continue strengthening quality systems in MRH and the whole zone in a
two prong approach. The first approach is by creating a Zonal Quality Assurance/Quality Control
department that will be staffed with a QA/QC manager, QA/QC technician and a zonal biomedical engineer.
This department primarily role will be calibration of pipettes, provide training to laboratory staff in sample
management, proper operation of the equipments, reagents/control preparation and storage, process
control , QA/QC documentation, daily user maintenance of the equipments and simple troubleshooting of
the equipment with the ultimate goal of spearheading the MRH laboratory accreditation.
The second approach will be by continuing to hold the quarterly zonal meeting with zonal laboratory with
regional lab technologist and lab managers from Mbeya, Rukwa, and Ruvuma, for the express purpose of
working together to improve the quality of services. These meetings support discussions centered on site
monitoring reports/ feedback from supportive supervision. This allows the zone to monitor not only
laboratory services through the supportive supervisory teams but also track infrastructure and equipment
maintenance requirements. It also includes identification of ongoing, in-service training needs of all levels of
health facilities, and execution of these trainings ensuring that skills are maintained and good practices
reinforced.
LINKAGES: This program is linked directly to ART, PMTCT and CT services at these same hospitals
through out the zone. The development of lab capacity is integrated into the zonal expansion plan for the
strengthening of the quality of the overall HIV services of these hospitals. The in-service and Center of
excellence (COE) training activities are coordinated with and implemented as part of a national roll out with
Activity Narrative: the MOHSW, Muhimbili National Referral Hospital and other USG lab efforts.
CHECK BOXES: The areas of emphasis will include local organization capacity building, pre-service and in
service training, infrastructure improvement to support care and treatment in the Southern Highlands of
Tanzania.
MONITORING AND EVALUATION: Through supportive supervision the Laboratory team travels to sites to
provide technical support. As part of the QA/QC activity, developing capacity of the labs in the zone, the
Zonal QA/QC team and Zonal Engineer monitor control documentation, sample processing and reporting,
corrective and preventive actions taken, and reagent accounting sheets of each lab during supportive
supervisory visits. This information is used as a site-monitoring tool with immediate feed back from the
supervisory team provided.
SUSTAINABILITY: All aspects of management and implementation are conducted by MOHSW staff at the
MRH, and regional and district hospitals. The Zonal QA/QC, the Zonal engineer, lab staff and, regional lab
technologists are MOHSW staff or local contract hires based on existing open MOHSW positions. The
"Quality District by District" program provides a locally developed mechanism within the MOHSW supported
framework to disseminate best practices to ensure the capacity for quality monitoring and services,
forecasting and equipment maintenance is transferred and constantly reinforced. This program strengthens
not only the national role of the MRH but the local level facility participation in ensuring overall service
development and delivery.
Continuing Activity: 13516
13516 3491.08 Department of Mbeya Referral 6535 1027.08 $300,000
7746 3491.07 Department of Mbeya Referral 4556 1027.07 $142,500
3491 3491.06 Department of Mbeya Referral 2833 1027.06 $100,000
Table 3.3.16:
