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.
ACTIVITY HAS BEEN REVISED IN THE FOLLOWING WAYS:
This narrative has been modified to identify the agency selected to conduct this activity (this was a TBD in
FY08) and to reflect FY08 achievements and planned activities.
TITLE: Behavioral and Structural Interventions to Reduce HIV Risk Among IDUs, CSWs, and MSM
NEED and COMPARATIVE ADVANTAGE: In Tanzania, as in other sub-Saharan African countries, injecting
is a relatively new means of transmitting HIV. Current data indicates that injection drug use, specifically
heroin, is rapidly increasing in urban Tanzania and on the island of Zanzibar. Furthermore, injection
practices and unsafe sexual behaviors associated with selling sex to buy drugs, are contributing to HIV
transmission. Recent study data collected by university researchers in Dar es Salaam found the common
practice of unsafe behaviors such as needle sharing and a high prevalence of HIV. Risk for female IDUs is
heightened in many instances by a reliance on commercial sex, both formal and informal, to acquire the
financial resources to purchase drugs. However, commercial sex work in Tanzania extends beyond the link
with injection drug use and is related to the growing lack of employment opportunities and impoverishment.
This has resulted in an environment where urban residents of Tanzania are increasingly trading sex for
money. Another emerging risk population in Tanzania are men who have sex with men (MSM). Although
MSM tend to be a hidden population in Tanzania, a study conducted in Zanzibar identified a sizeable
population. Many of the Zanzibari MSM also injected drugs and/or traded sex for money, demonstrating the
overlapping nature of some most at risk populations (MARPS).
ACCOMPLISHMENTS: A funding announcement for FY 2007 funds was recently published and the
cooperative agreement will be awarded before the start of the new fiscal year.
ACTIVITIES: As indicated by current epidemiologic and behavioral data and anecdotal information, IDU,
commercial sex workers (CSW) and MSM are MARPS with often intertwined risks. The increase in injection
drug use, coupled with unsafe sexual behaviors associated with females and males selling sex to buy
drugs, has resulted in increased HIV transmission. The changing epidemiology of HIV/AIDS risks
associated with these MARP in Tanzania requires innovative HIV prevention approaches that are able to
address multiple and changing levels of risks and contexts (e.g., social network, dyadic, family, community
and structural).
FY 2008 funds are requested to expand the comprehensive, multi-component interventions planned for FY
2007. Planned scale-up includes enhanced efforts to develop appropriate services for men who have sex
with men and commercial sex workers, risk groups that often overlap with injection drug users in Tanzania.
Each MARP (IDUs, CSWs, and MSM) will have a separate and specialized NGO working with them. The
focus of project activities will remain on community-based outreach that engages these most at risk
populations (i.e., IDU, MSM and CSW) in risk reduction and refers them to a range of services, including
VCT and HIV care and treatment.
Specific activities will respond to the evolving epidemiology and assist most at risk populations reducing
their risk for HIV/AIDS, other sexually transmitted infections (STDs), and hepatitis B and C by: 1) conducting
community-based outreach and engaging the target populations in HIV prevention, including condom
distribution;
2) communicating appropriate prevention and risk reduction messages which will help address their HIV risk
behaviors (e.g., for IDUs this would be to reduce drug use, increase safer injection practices, and increase
utilization of evidence-based, integrated care for injection drug abuse when available);
3) providing outreach through mobile vans with HIV counseling and testing and STI services; and
4) linking members of most at-risk groups with follow-up care at STD clinics and facilities providing HIV care
and treatment for those found to be HIV-positive. In Zanzibar, additional activities tailored for MSM and
CSW (including activities targeting migratory CSWs) will be developed following the completion of ongoing
targeted evaluations conducted by the Zanzibar AIDS Control Program (ZACP) and Tulane University with
funding from USG.
An additional intent of this activity is to foster greater understanding and awareness of injection drug use in
Tanzania and provide forums for discussing opportunities, gaps, challenge,s and strategies for HIV
prevention efforts with IDU populations. To this end, the TBD partner will facilitate educational forums and
liaise with appropriate governmental bodies to increase collaboration.
LINKAGES: Programmatic linkages will be established and maintained with mobile VCT providers, condom
distributors, and treatment partners supported by USG. Collaboration with substance abuse treatment
centers in Dar es Salaam and Zanzibar will be a priority.
CHECK BOXES: Human capacity development: in-service training
Local organization capacity building
Wrap around programs: family planning
Most at risk populations (injecting drug users, men who have sex with men, non-injecting drug users,
persons in prostitution, persons who exchange sex for money and/or other goods, and street youth)
M&E: The TBD partner will develop an M&E system to track client encounters, services delivered, and
referrals (e.g., to counseling and testing, and care and treatment centers). Other variables will be explored
depending on the exact activities. Whenever possible, national tools will be used and the existing system
will be supported.
SUSTAINABILITY: Local organizations are being sought for this activity and they will receive capacity
building which will enable them to maintain activities and, should the need arise, seek additional funding
Activity Narrative: sources. Furthermore, appropriate bodies within the Government of Tanzania will be involved in forums to
promote the integration of this issue into their plans.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13415
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13415 8728.08 HHS/Centers for Columbia 6509 1221.08 $200,000
Disease Control & University
Prevention
8728 8728.07 HHS/Centers for Drug Control 8838 8838.07 DCC $100,000
Disease Control & Commission
Table 3.3.06:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
TITLE: Expansion of HIV Counseling and Testing and Building Capacity of City Health Care Workers in HIV
Counseling and Testing
NEED and COMPARATIVE ADVANTAGE: The Muhimbili Health Information Centre (MHIC) is a state of
the art service provision and capacity building entity at the largest hospital in Tanzania. Through PEPFAR
funding MHIC has expanded HIV VCT services as well as piloted PITC training for ninety nursing and
medical students at Muhimbili University of Health and Allied Sciences (MUHAS). MHIC is working towards
supporting the institutionalization of Provider Initiated Testing and Counseling (PITC) in their training
curriculum and is also offering PITC training to Muhimbili National Hospital (MNH) and city health care
workers (HCW). MHIC staff members were one of the first public health professionals in Tanzania to
pioneer PITC and, as a result, have a unique advantage to implement PITC efforts. The static VCT sevices
provided at MHIC serve as an important HIV service in a high density and higher prevalence area.
ACCOMPLISHMENTS: In the past year, MHIC tested more than 6,000 clients; conducted comprehensive
care counseling training for 138 health care workers; participated in the development of national HIV VCT
materials as well as PITC guidelines and developed curriculum and training materials in PITC. MHIC also
will conduct training for 340 health care workers in PITC; developed communication and referral strategy for
MHIC; and integrated a HIV CT monitoring and evaluation framework within the MNH HIMS.
ACTIVITIES: To work towards meeting the requirements to becoming an efficient system for HIV counseling
and testing: 1. MHIC will continue providing quality VCT services at its static facility. An emphasis will be
placed on demand creation, enhancing the skills of counselors to conduct couples and family counseling,
and supportive supervision to ensure appropriate service delivery. Supportive supervision will include
checking registers completed by counselors, reviewing counseling and testing protocols, and observing
counseling sessions. Anti-burnout techniques will also be provided to all staff, volunteers and trainees.
Another important aspect of VCT services will be the inclusion of screening on alcohol use and brief
interventions for hazardous and harmful use in all counseling interventions at MHIC. In this setting, the
alcohol screening and intervention will be implemented during post-test counseling sessions with HIV
negative individuals.
MHIC plans to use AUDIT, an alcohol screening tool developed by WHO.
2. MHIC also will continue training service providers in HIV counseling and testing. For PITC, staff from
clinical environments will receive the knowledge and skills required to support testing and counseling for
clients attending outpatient departments, inpatient departments, STI clinics and TB clinics. Additional
components of training in FY 2008 will be the inclusion of components on stigma reduction during service
delivery for HIV counseling and testing and anti-burnout techniques.
3. Working with the National AIDS Control Program, MHIC will develop an M&E framework for HIMS and
support integration of HIV CT and alcohol use and interventions in M&E for Muhimbili National Hospital and
city health care workers. Lessons learned in these settings will be shared and used to guide national
systems development.
4. MHIC will procure commodities and supplies as buffer stock for HIV counseling and testing services.
These commodities and supplies will be used during stock outs so that services are not disrupted.
*END ACTIVITY MODIFICATION*
funding MHIC has expanded HIV VCT services as well as piloted PITC training for nursing and medical
students at Muhimbili University College of Health Sciences (MUCHS). MHIC is working towards supporting
the institutionalization of Provider Initiated Testing and Counseling (PITC) in their training curriculum and is
also offering PITC training to Muhimbili National Hospital (MNH) and city health care workers (HCW). MHIC
staff members were one of the first public health professionals in Tanzania to pioneer PITC and, as a result,
have a unique advantage to implement PITC efforts. The static VCT sevices provided at MHIC serve as an
important HIV service in a high density and higher prevalence area.
care counseling training for 134 health care workers; participated in the development of national PITC
guidelines; and developed curriculum and training materials in PITC. MHIC also will conduct training for 340
health care workers in PITC; develop communication and referral strategy for MHIC; and integrate a HIV CT
monitoring and evaluation framework within the MNH HIMS.
and testing:
1. MHIC will continue providing quality VCT services at its static facility. An emphasis will be placed on
demand creation, enhancing the skills of counselors to conduct couples and family counseling, and
supportive supervision to ensure appropriate service delivery. Supportive supervision will include checking
registers completed by counselors, reviewing counseling and testing protocols, and observing counseling
sessions. Anti-burnout techniques will also be provided to all staff, volunteers and trainees. Another
important aspect of VCT services will be the inclusion of screening on alcohol use and brief interventions for
hazardous and harmful use in all counseling interventions at MHIC. In this setting, the alcohol screening
and intervention will be implemented during post-test counseling sessions with HIV negative individuals.
Activity Narrative: clinical environments will receive the knowledge and skills required to support testing and counseling for
These commodities and supplies will be used during stock outs so that services are not disrupted
LINKAGES: MHIC will maintain linkages with various national programs including NACP and others offering
HIV CT such as IntraHealth , I-Tech and JPIEGO to support the roll out of PITC and development of health
information systems. MHIC also will work with the Japanese International Cooperation Agency (JICA), ART
and TB partners to coordinate health and non health referral linkages for those in need for other services in
HIV prevention, care and treatment.
M&E: Support integration of HIV CT in MNH HIMS and train in use of M&E tools. Supervise the use of M&E
tools in day to day operations
SUSTAINABILITY: MHIC is supporting MOHSW-NACP in the roll out of PITC for all HCW and in directly
supporting the overall HIV Care and Treatment plan. MHIC will also work closely with MOHSW-Diagnostics
services to learn about new technologies for HIV testing to support the rolling out of trainings in HIV CT
program areas. As a national center of learning, MHIC is considering offering services at cost as a strategy
for long-term sustainability.
Continuing Activity: 13526
13526 8661.08 HHS/Centers for To Be Determined 8551 8551.08 Muhimbili
Disease Control &
8661 8661.07 HHS/Centers for Ministry of Health 4562 1130.07 $424,000
Disease Control & and Social
Prevention Welfare, Tanzania
Program Budget Code: 15 - HTXD ARV Drugs
Total Planned Funding for Program Budget Code: $28,190,352
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
ARV DRUGS - Program Area Context
National Context
The HIV/AIDS treatment and care services are expanding in Tanzania. As of July 2008, 234 Care and Treatment Centers (CTCs)
actively provide ART services to an estimated cumulative 160,823 ART clients. The Government of Tanzania (GoT) is ambitiously
aiming to train five hundred new CTC sites by October 2008 to distribute ARV drugs that will help the GoT reach their 2008 goal of
having 700 active sites that provide ART services to 250,000 people. The USG team advocates a more strategic approach to roll
out based on overall system capability. The USG team is participating in policy dialogue around GoT hopes to have 350,000
clients on ART by the end of 2009, and 440,000 by the end of 2010.
Management of the Supply Chain and Procurement Program
The USG team recently hired a full time Commodities and Logistics Advisor to provide additional support to the national program.
This advisor will coordinate with other donors in supply planning and managing the main USG procurement partner. In addition,
the USG provides technical assistance through SCMS to the National AIDS Control Program (NACP) in conducting and updating
forecasts of national requirements for ARV drugs, and developing procurement plans. This is done in collaboration with the
Medical Stores Department (MSD), the NACP, and other donors.
Product Selection
The main sources of funding for ARV drug procurement are the GoT through funds from the Global Fund (GFATM), CHAI, and
USG. Based upon the Memorandum of Understanding between the United States Government (USG) and GOT signed in March,
2005, the GoT will procure first line ARV drugs for adult programs. USG will procure ARVs for first line alternatives, second line
adult, and pediatric regimens. The USG team procures ARVs through a single partner which buys Food and Drug Administration
(FDA) approved or tentatively approved ARVs that are registered in Tanzania and are selected based on the national standard
treatment guidelines. There are currently five manufacturers of generic and original formulations registered in Tanzania that are
also FDA approved or tentatively approved. In 2007, six out of 12 ARVs procured by the USG in Tanzania were innovator
products, all of which were second line drugs. In calendar year 2008, only one product out of the seven procured is an innovator
drug (this innovator ARV is a second line drug).
The new treatment guidelines call for the following five adult first line regimens to be used: AZT-3TC with NVP or AZT-3TC with
EFV or d4T 30mg plus 3TC with EFV or TDF-FTC with either NVP or EFV. The three adult second line regimens are: ABC with
ddI and LPV/r; or ABC with TDF and LPV/r (in two different dosages). Tge twi pediatric regimens are: ABC with ddI with LPV/r; or
AZT with ddI and LPV/r.
Forecasting/Procurement
In February 2008, GoT, with assistance from SCMS, conducted a national quantification of ARVs. The current cumulative number
of people on treatment is estimated at 160,823. Given the projected scale up rate of 34% per year, and the attrition rate of 10%,
the number of people enrolled on ART by the start of the COP 2009 period is estimated at 190,000. The quantification projects
90% of those on treatment will be adults. It is estimated that 99% of the adults will be on a first line ARV treatment regiment. It is
believed 57% of these will be first line alternative regiments. The USG team, along with NACP, is looking at the overall cost
implication for GoT resulting from increasing alternative first line regiment use which is significantly more costly.
In 2007, USG procured $8,936,985 USD worth of ARV drugs through SCMS, while $18,650,970 USD worth of ARV has been
delivered to date in 2008. The main challenge in the procurement of ARVs is filling the national pipeline to appropriate levels of
stock for all ARVs. The February 2008 national quantification identified the appropriate stocking levels for each level within the
national system. SCMS is now working with GoT and MSD to plan appropriate procurements of ARVs based on a GoT
anticipated Global Fund Round 8 award. USG support for ARV drug procurement in COP 2009 totals 21,068,743 USD. This
funding provides 100 percent coverage for adult and pediatric second line ARVs and 28 percent of adult alternative first line ARVs
during the COP 2009 period.
Security
The USG, through SCMS, secures ARVs and other commodities through customs clearance up to the point where the
commodities are consigned to the Medical Stores Department. SCMS is responsible for monitoring and auditing the security and
freight companies' compliance with the standard operating procedures for security. SCMS also determines the state of
communication lines between the freight and security companies and the recipient of ARV drugs. Additionally, SCMS records any
dysfunctional occurrences and takes appropriate action, and provides on-the job-training as needed. Upon transfer of ARVs and
commodities ownership to GoT, MSD becomes responsible for security during storage and shipment within the national
distribution system.
Freight Forwarding
SCMS is responsible for clearing all its procured ARV drugs through customs and Tanzania Revenue Authority. SCMS is also
responsible for arranging for the physical transport of the products from the port of entry to MSD's central warehouse. MSD is
responsible for overland movement of most of the GoT's ARV drugs through its fleet or contracted vendors.
In-country Warehousing and distribution
All USG procured ARV drugs are stored at MSD central or zonal warehouses before being shipped to regional and district
hospitals. Currently, the MSD fills approved orders from the service delivery points and distributes drugs directly to ART sites and
to the district and regional hospitals which in some instances serve as a transit point for ARV deliveries to Health Centers. The
MSD is committed to the plan of decentralizing functions to zonal warehouses. In the coming years, MSD zonal warehouses will
begin to receive direct shipments from suppliers thereby reducing the storage and packing capacity needed at the central
warehouse while improving delivery time of product to treatment sites. In addition, the new system, the development of which was
supported by the USG, will allow the MSD to simultaneously distribute ARVs with other essential medicines, which will further
maximize MSD's distribution resources and capacity.
Inventory Management
The GoT ambitious goal of scaling up to 700 sites will require NACP to reengineer the current ARV drug distribution system. For
instance, the need for MSD to do monthly deliveries to all care and treatment centers (CTCs) constitutes significant logistical
challenges. The difficulties introduced by late and non-reporting sites, the lack of synchronization of reporting and delivery times,
and the introduction of ARV drug refilling services in health centers and dispensaries require continued focus on improving and
strengthening MSD's system-wide capacity. To strengthen the MSD system, the USG, under the leadership of NACP, has
supported the redesign of the logistics system used to manage ARV drugs across all programs (ART, PMTCT, and PEP). The
procedures for managing and tracking consumption, ordering, and re-supply of ARV drugs are clearly defined. All CTCs are now
required to order on a quarterly basis through the new forced ordering system which maintains the appropriate maximum-
minimum stock level. This system has built-in buffer stock levels and accommodates delivery timelines that include ordering time,
district approval, processing and delivery by MSD, and unforeseen delays.
SCMS currently collaborates with NACP and other partners, including EGPAF, ICAP, MDH, MSH, and CHAI, to roll out the new
system to all ART enrolling and follow up sites. As part of this process, USG also supports the use of tools for collecting and
reporting logistics data for management decision making.
Capacity Building
The USG works very closely with NACP and MSD at the central level to manage the ARV supply chain. The USG works primarily
through SCMS to provide technical leadership and capacity building in logistics management functions including forecasting,
procurement planning, and inventory management. SCMS will continue to work with MSD to build national and regional human
capacity in warehousing and inventory management through sponsorship of MSD staff participation in training sessions on
warehouse and logistics management. Physical distribution capacity will be strengthened through the installation of packing lines
and other efficiency and labor saving technologies that may be appropriate.
SCMS will continue to support the roll out of the new ordering system in new sites and will provide on-the-job training and
coaching to existing sites as needed. SCMS will continuously monitor the performance of the system at the zonal level through
Supply Chain Monitoring Advisors (SCMA) who will be positioned in all eight MSD zonal stores. The SCMA will work with MSD
Zonal Stores Managers to ensure timely resupply of ART sites with ARV drugs. SCMA will also provide the sites with support in
managing ARV drugs, on-site training, and coaching of zonal MSD staff.
Table 3.3.15:
The program will continue to offer pilot and short courses for students. In addition in FY 2009 the program
will also focus on faculty development, curriculum enhancement, and classroom renovation to improve
quality of pre-service training at the Muhimbili University of Health and Allied Sciences (MUHAS). Based on
an assessment of faculty done in FY2008, staff will be provided with additional training on teaching methods
and HIV/AIDS knowledge as needed. In addition, new staff will be recruited for those areas most in need.
Following recommendations from a review of curricula done in FY 2008, the curricula for the training of
different cadres will be improved; this will include updating the HIV/AIDS sections, as well as the areas
dealing with overall leadership and management. Two classrooms will be renovated to provide extra
teaching space. The library will be enhanced through linkages with the zonal and national resource centers.
To increase the number of health care workers who have adequate management and leadership skills,
three students will be supported to complete the masters in public health course.
The funding for this activity has changed from clinical services (HTXS) to OHSS, and as a result the targets
have also changed to reflect their contribution to OHSS targets. In FY 2008, this activity did not contribute
to HTXS targets.
TITLE: Building Capacity at Muhimbili University of Health and Allied Sciences (MUHAS)
NEED and COMPARATIVE ADVANTAGE: The Muhimbili University of Health and Allied Sciences
(MUHAS) has a School of Medicine and a School of Public Health. In order to strengthen the human
capacity development in these schools, funds will be provided to ensure that pre-service training is able to
accept additional students and that the types of courses offered build institutional capacity and analytic skills
for public health evaluations. As MUHAS has agreements with the National Institute of Medical Research
(NIMR) and the Ministry of Health and Social Welfare (MOHSW), skills in epidemiology methods and
analysis will be strengthened to ensure data for decision making and use of information.
ACCOMPLISHMENTS: New Activity
ACTIVITIES: Funds in FY 2008 will be used to develop, pilot, and implement short-courses for students in
the School of Public Health to build capacity in analytic skills and institutional capacity building. Graduates
of the Fogarty International Training Program will be requested to participate in training students by
teaching short courses or giving lectures on specific topics.
Linkages among MUHAS, NIMR, and MOHSW, including FELTP will be strengthened through seminars
and short courses. Students at MUHAS will have the opportunity to conduct their pre-service training in
HIV/AIDS related activities
LINKAGES: Linkages with NIMR, MOHSW, and FELTP will be of importance to build the capacity of the
students at MUHAS and give as much technical support as required through the agreement.
CHECK BOXES: This activity is to develop human capacity through pre-service training in public health
evaluation, strategic information, and institutional capacity building. Students at MUHAS will have the
opportunity to work with non-governmental organizations, Government of Tanzania, and PEPFAR in their
pre-service training program.
M&E: A comprehensive M&E plan will be developed once the program begins. This plan will capture
information on who receives training, what they have been trained on, and how their skills have improved
SUSTAINAIBLITY: By building the capacity at MUHAS, future public health workers will have the expertise
to work in HIV/AIDS interventions with solid backgrounds in public health programs and institutional
capacity building. Short courses or lectures will ensure that all that are available are trained.
Continuing Activity: 16975
16975 16975.08 HHS/Centers for Muhimbili 9308 9308.08 MUHAS $350,000
Disease Control & University College
Prevention of Health Sciences
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $350,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Program Budget Code: 19 - HVMS Management and Staffing
Total Planned Funding for Program Budget Code: $13,887,978
Management and Staffing Program Area Context
Budget - approximately $15.0 million
Character (with spaces) count - 8476
In Tanzania, the President's Emergency Plan for AIDS Relief (PEPFAR) is implemented through the following departments and
agencies: Defense/Walter Reed Army Institute for Research (WRAIR), Health and Human Services/Centers for Disease Control
and Prevention (HHS/CDC), State (DOS), Peace Corps, and the U.S. Agency for International Development (USAID). The
HHS/Health Resources and Services Administration (HHS/HRSA) also funds PEPFAR activities in Tanzania; however, they do
not have an on-the-ground presence but instead rely on HHS/CDC to provide in-country monitoring.
The Chief of Mission, Ambassador Mark Green, is responsible for overall leadership of the PEPFAR/Tanzania (PEPFAR/TZ)
program. He is supported by the Deputy Chief of Mission (DCM), the PEPFAR Country Coordinator and four Heads of Agency.
The Ambassador, DCM and Head of Agency jointly comprise the Interagency HIV/AIDS Coordinating Council (IHCC) - a strategy
and policy-making body. Chaired by the COM or DCM, the IHCC meets bi-monthly to outline overall program direction and
strategy. The PEPFAR Country Coordinator also chairs a weekly management and operations (M&O) meeting to address
program implementation issues and interagency coordination and collaboration. The M&O team is comprised of one senior
management advisor from each agency and each of the four Strategic Unit leads (Clinical Services, Community Services,
Prevention and Testing and Program Strengthening.)
STAFFING FOR RESULTS UPDATE
During fiscal year (FY) 2008, the PEPFAR Tanzania team marked its first year anniversary operating under the interagency
Strategic Unit team structure. The structure is maximizing our interpretation of the "leave your uniform at the door" philosophy - a
commitment to working together as a USG team that acknowledges, respects and leverages the strengths and tools of each
implementing agency. In addition, senior interagency leadership agreed on the principles and guidelines that frame how the
structure works - from the interagency technical teams up through the Ambassador. The philosophies, agreements and related
processes have been documented and distributed to the PEPFAR Tanzania team (see upload document: PEPFAR Interagency
Operations Manual.)
Building on our commitment to the Staffing for Results principles, each implementing agency has moved forward in filling critical
staff vacancies and previously approved new positions. An additional duel-assessment exercise was completed in May 2008 to
determine if any additional staff was required in FY 2008. Each Strategic Unit assessed technical gaps across the interagency
team, while the implementing agencies re-evaluated their capacity to fulfill fiduciary duties with existing technical and program
staff. The two assessments were presented to the Management and Operations team and technical gaps were matched with
agency fiduciary needs. This process resulted in interagency approval of 13 new technical/programmatic positions, allocated
across the implementing agencies as follows:
Agency PositionMechanism/Location
DOS Budget AnalystFSN/Embassy budget and finance office
USAID Prevention in High Risk Groups CTOFSN/USAID
USAIDPrevention in Wrap-Around Programming CTOFSN/USAID
USAIDStigma and Enabling Environment CTOFSN/USAID
USAIDOVC Specialist CTOFSN/USAID
USAIDClinician - Pediatrician CTOFSN/USAID
WRAIRTPDF CTOFSN/Embassy
WRAIRFinance/Grants OfficerFSN/Embassy
CDC HCDContractor/CDC
CDCMARPS program officerFSN/CDC
CDCNEW: HBC/OVC officerFSN/CDC
CDCFacilities ManagerFSN/CDC
CDCC/T program officerFSN/CDC
Peace CorpsNo requests presented
As the interagency team process matures, we are mindful that our staffing alignment decisions must result in each agency
becoming fully equipped to complete its primary tasks, while maintaining its commitment to be an active, engaged interagency
player in planning and implementation. As in FY 2008, each level of interagency coordination (i.e., IHCC, M&O, SU, and ITTs) will
continue to be strengthened in order to further encourage team-work, increase collaboration and yield mutual successes across
agencies. Staff retreats and staff development plans are ongoing tools that enable the growth and improvement of current team
dynamics and facilitate the evolution to even higher functioning working groups.
Finally, under the leadership of each Strategic Unit lead, the Interagency Technical Teams undertook a Partner Performance
Review and Improvement process. In addition, both HHS/CDC and USAID have invited interagency team members to participate
in reviewing program announcements and responses.
DOS RIGHTSIZING EXERCISE
In FY 2009, Embassy Dar es Salaam will undergo a DOS rightsizing review. Based on the work under Staffing for Results, the
PEPFAR interagency team remains hopeful that this review will support the DOS's maintenance and potential expansion of key
ICASS-funded positions, in order to better serve the PEPFAR implementing agencies.
MANAGING THE PROGRAM IN PEPFAR PHASE II
In FY 2008, PEPFAR Tanzania received approval to undertake a PEPFAR building project. Approximately $5.8 million was set-
aside in FY 2008, and was slated to be matched in FY 2009; however, with a flat-lined budget and team dynamics strong, the
heads of agency agree that interagency collaboration can be maintained and enhanced by continued investment in co-location
and interagency team space at USAID and HHS/CDC. Ambassador Green has accepted the following proposal regarding the FY
2008 building funds:
** Expand office space at HHS/CDC to incorporate additional HHS/CDC staff and interagency team space.
** Hire space planners to work with USAID, WRAIR and DOS for internal space renovations, e.g., building internal walls for new
space configuration.
** Continue to have OGAC hold the funds as unallocated until estimates are complete.
** Make FY 2009 building funds available for use by the program.
PEPFAR Tanzania is in accord that if a significant growth in resources is realized through a Partnership Compact, a new building
for the entire PEPFAR team (HHS/CDC PEPFAR, WRAIR, USAID HIV/AIDS team and the Coordination office) will be a
significant need. In addition, in Phase II, new program and support staff may be needed to manage the program, especially if
additional resources are received and as more local-indigenous organizations are brought on as prime partners.
Growth envisioned under a Partnership Compact would be concentrated in the following areas: service maintenance and scale-
up; prevention; leadership and management; sustainable and secure HIV drug and commodity supply; human resources; and
evidence-based and strategic decision-making.
Please note that PEPFAR Tanzania's formal response to Cable 112759 is an appendix in Ambassador Green's submission letter
to Ambassador Dybul.
FY 2009 NEW STAFF REQUEST
For fiscal year (FY) 2009, the PEPFAR budget is $309 million, a modest decrease from FY 2008. Two new staff positions have
been requested for inclusion in the FY 2009 Country Operational Plan (COP). The positions, one for WRAIR and one for
HHS/CDC, have been identified by these agencies as necessary positions to more effectively manage their portion of the
PEPFAR resource envelope. The positions have been reviewed, discussed and endorsed by the interagency team as well as
Ambassador Green. The positions are as follows:
WRAIRUSDH in Mbeya to co-manage PEPFAR and vaccine program activities
HHS/CDCUSDH to serve as Deputy Director of Programs
EXISTING VACANCIES AND ANTICIPATED TURNOVER
During FY 2008, all implementing agencies experienced significant leadership changes and staff rotations. HHS/CDC, USAID
and PC have received new country directors, DOS has a new DCM and each agency has hired a number of new senior technical
members. In addition, the HHS/CDC SI team recently lost numerous staff members, and they are actively recruiting locally
engaged staff for these vacancies. Ambassador Green remains committed to maintaining a high-functioning interagency team
and personally plays a central role in ensuring ideal interagency patterns of collaboration and coordination.
In FY 2009, anticipated turnover is low across the implementing agencies. However, in FY 2010, several key positions will turn
over, including the PEPFAR Country Coordinator, USAID HIV/AIDS team lead, and the HHS/CDC Deputy Director.
Table 3.3.19:
