ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP

TITLE: Support for Orphans and Vulnerable Children (OVC) Affected by HIV/AIDS

NEED and COMPARATIVE ADVANTAGE: Since 2004, Catholic Relief Services (CRS) has implemented

PEPFAR supported programs for OVC affected by HIV/AIDS in Tanzania. CRS' technical approach

reaches out to HIV-affected families through durable indigenous institutions such as churches, parish

coordinating committees, and village Most Vulnerable Children's Committees (MVCCs), supported through

resource mobilization initiatives, program funding, financial and technical assistance. This approach has

not only demonstrated program effectiveness, but has also extended OVC wellbeing activities that

contribute to the sustainability of integrated human development of OVC in Tanzania.

ACCOMPLISHMENTS: With PEPFAR funding to CRS/Tanzania (both Track 1.0 and from the Tanzania

budget), substantial progress continues in the support of national efforts to establish sustainable programs

for OVC. CRS reinforces national coordination, partnership, and Monitoring & Evaluation (M&E)

mechanisms for OVC care and support. Notable achievements from 2004 to date include an increase in the

number of OVC receiving care and support services from 3,750 to 35,000 by the end of September 2008.

Of these, 16,500 OVC were reached in FY 2008, and a cumulative 18,500 continue to be supported since

2004. Fifty-two percent of the 16,500 OVC supported in FY 2008 have received at least three different

types of services from seven core program areas. The education-support initiative has reached 30,000 out

of 35,000 OVC with scholastic materials, uniforms, and payment of required school fees. Additionally, over

15,000 OVC have received life-skills education and 750 have acquired skills in vocational training and trade.

Other educational supports include periodic tracking of school attendance and performance of individual

children.

In health support, 15,000 OVC have been fully insured through two health insurance schemes, one focusing

on agreements with a local health fund and another accessing the newly established Community Health

Funds operated by district councils. The project has also increased community leadership in OVC care

initiatives and collaboration with local, districts and the national Department of Social Welfare (DSW). At

the community level, communities are fully engaged in resource mobilization, advocacy to address issues of

stigma and discrimination, and food support to needy households and people living with HIV/AIDS.

Regarding coordination, program review, and planning, a total of four meetings and three trainings focusing

on strengthening of OVC systems were organized. District authorities participated in these meetings and

trainings, demonstrating community leadership in OVC care and support initiatives. The number of OVC on

antiretroviral therapy (ART) has increased from 82 in 2004 to approximately 1,400 by September 2008.

Finally, the national OVC data management system (DMS) is now functional at all CRS OVC program sites

and all key program staff, field officers, and community volunteers have been trained on the national M&E

framework including periodic reporting tools.

ACTIVITIES: The proposed FY 2009 activities are based on lessons learned and the periodic reassessment

of OVC project outcomes conducted during the implementation of the FY 2008 work plan. FY 2009

outcomes will ensure that: 1) OVC are actively engaged in their own care and have the opportunity to invest

in their future; 2) community members take a leadership role in the care of OVC in their catchment areas; 3)

community-based service providers provide effective, high-quality core services to OVC and their

families/caregivers; 4) community-based service providers engage in good resource stewardship; 5) local

authorities and systems are strengthened to provide long-term programs, quality services, and resource

support needed to sustain their community partners; and 6) CRS and national HIV technical resource

institutions (such as district social welfare officers, council health management teams, local health facilities,

and diocesan leadership) provide the necessary technical and material support to parish coordinating

committees, MVCCs and the community home-based care (HBC) networks. These supports will strengthen

families, build critical capacities, provide integrated quality services, and support the capability of the

national M&E system to obtain quality and reliable data for decision-making at various levels including local,

district, and national to ensure maximum integrated human development of OVC through uninterrupted

delivery of quality services.

One major goal for FY 2009 is to enhance the quality and sustainability of services. Efforts will facilitate

local ownership and leadership for quality service programs, while transitioning CRS' role from overall

management of the portfolio to one that provides key technical assistance in programming, accounting,

administrative skills, and auditing practices. FY 2009 activities will focus on building the institutional

capacity of partners to plan, implement, evaluate, and manage OVC programs, as well as providing quality

services including community nutritional support.

Community volunteers will use mid-upper arm circumference tapes to determine the nutritional status of

OVC. OVC identified with faltered growth, or who are severely or moderately malnourished, will be referred

to health clinics for HIV testing and food supplementation, if available. For OVC identified with an

immediate need, living in a food insecure household, CRS will provide interim support, while linking the

household to a livelihood activity.

LINKAGES: This activity will link to the Tanzanian National Costed Plan of Action (NCPA) for Most

Vulnerable Children and with the entire USG-funded OVC Implementing Partner Group (IPG) network.

CRS will continue to collaborate with the Ministry of Health and Social Welfare (MOHSW), the Prime

Minister's Office for Regional and Local Government, and the Institute for Social Work through a learning

and internship program for undergraduate students. Under this program, students in their third year of

studies participate in short-term assignments and deploy to different sites where CRS implements programs

benefiting OVC. CRS will continue to collaborate with the OVC IPG and the Quality Improvement Sub-

Taskforce in the development of standards in OVC care and to share best practices and lessons learned

Furthermore, in FY 2009, health care initiatives will extend their focus to support vulnerable children whose

parents are living with HIV/AIDS. HIV-positive children will access ART services through linkages and

improved referral systems as well as through the provision of bus fare. In the Iringa region where the

Activity Narrative: current HIV prevalence rate is reported at 18.2%, the project under the Catholic Diocese of Njombe will be

linked to Njombe District Hospital, Makete District Hospital, and St.Consolata Ikonda Mission Hospital,

which are the ART service points that coordinate the HIV/AIDS continuum of care in the program area. In

Tanga Region, the program will be linked with AIDSRelief ART and HBC networks to ensure more

comprehensive and sustainable care at Bombo Regional Hospital, Muheza District Hospital, Korogwe, and

Pangani hospitals. While in Arusha region through Uhai Centre, the program will be linked to ART

programs at Mt. Meru and Selian Hospitals. In Babati and Karatu districts the OVC program will be linked to

Dareda hospital and Rhotia Health Centre, respectively. In Ruvuma Region, apart from linking the program

to Namtumbo district and regional hospitals that provide ART services, the Diocesan program management

has signed a health care agreement with 24 diocesan-owned health facilities. Most importantly, this activity

will be linked to the work of the MVCCs at the local level.

CRS OVC programs will also be linked with the national Malaria voucher scheme for insecticide treated nets

and child survival initiatives at local health facilities.

M&E: Developing strong supervisory systems is essential to maintaining the quality of services achieved

through competency-based training, which also contributes to the implementation of the NCPA. In FY 2008,

CRS adapted and harmonized supervision tools to monitor quality of services at different program levels

systematically. Under the M&E framework and standards of quality programming, CRS trained over 23 key

program staff in six geographical sites in the Data Management System (DMS), information management

skills, reporting and computer skills, and problem solving solutions. At the central level, through the DSW,

the MOHSW has requested capacity building trainings to its District Social Welfare Officers, and supports

national efforts to roll out and disseminate the NCPA, national DMS and quality standards. In order to

sustain and strengthen the capacities of partners to monitor the program effectively, CRS will invest more

resources to strengthen the overall M&E and DMS. The grant will support more M&E activities, increase

technical assistance to key government stakeholders, supportive supervision, and training of staff.

Consultancies will be included in the M&E and DMS development in order to put clear monitoring and

evaluation mechanisms into place for all programs. Inadequate staff, a lack of data processing skills and

deficient tracking systems are key impediments to effective M&E systems. CRS will address these issues

throughout the implementation of this work plan and cost extension period.

SUSTAINABLITY: In FY 2009, the CRS program team and diocesan partners will work together with local

communities, households, and district authorities to develop and market a culturally acceptable

sustainability strategy, which will promote key fundamental competencies and coping mechanisms. These

will be delivered through open dialogues among OVC, families, clans, parish-based OVC support

committees, self-help groups, and MVCCs. The FY 2009 CRS OVC programming strategy focuses on

interventions that safeguard the best interests of OVC and promote the CRS Integrated Human

Development strategy. To achieve this goal, CRS will provide comprehensive, and quality-based

interventions for OVC across the following seven core program areas; education and vocation training

support, food and nutrition, healthcare, psychosocial support, child protection, shelter and care, and income

generation. In addition to child-centered interventions, special focus will be on systems strengthening and

human capacity development. CRS has developed a vision to guide the implementation strategy: OVC are

resilient, healthy, and see purpose in their lives now and in the future and reside in self-sufficient, vibrant,

nurturing communities and households.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13448

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13448 3471.08 U.S. Agency for Catholic Relief 6502 1506.08 Track 1.0 $177,057

International Services

Development

7690 3471.07 U.S. Agency for Catholic Relief 4523 1506.07 CRS Track 1.0 $187,000

International Services

Development

3471 3471.06 U.S. Agency for Catholic Relief 2873 1506.06 Track 1 OVC $429,028

International Services Program

Development

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

* Increasing women's access to income and productive resources

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $3,147

Economic Strengthening

Estimated amount of funding that is planned for Economic Strengthening $6,245

Education

Estimated amount of funding that is planned for Education $70,150

Water

Table 3.3.13: