ACTIVITY NARRATIVE UNCHANGED FROM FY 2008.

TITLE: MOHSW - Infection Prevention and Control (IPC) - Injection Safety (IS) program

A situation analysis of IPC-IS was conducted in five referral/consultant hospitals. Data revealed that IPC

practices were poor due to: lack of guidelines and standards for certain procedures; inadequate knowledge

and skills among health workers; lack of equipment and supplies; inadequate supportive supervision; and

lack of renovation and maintenance of infrastructure.

MOHSW, with support from the CDC, JSI-MMIS, and other partners, initiated the implementation of the IPC

-IS to foster and encourage necessary improvement within health facilities. The objectives of the program

are to: strengthen the national capacity to establish policies and standards for IPC-IS; ensure industrial

standards of quality and safety of injection devices; ensure availability and affordability of injection devices;

ensure rational, and cost effective use of injections; ensure safe and appropriate health care waste and

sharps management in all health care facilities; develop post exposure prophylaxis for HIV exposure and

vaccination of health workers at risk of hepatitis B infection.

ACCOMPLISHMENTS: Key previous accomplishments by the MOHSW regarding injection safety include:

trained 2,700 healthcare providers on IPC - IS; coordinated three stakeholders coordinating forum

meetings; conducted supportive supervision to 56 health facilities; and developed national infection

prevention and control guidelines pocket guide in both English and Kiswahili in collaboration with JHPIEGO

- ACCESS.

ACTIVITIES: In FY 2009, the MOHSW/HSIU plans to:

1. Build capacity through zonal training centers and the regions to conduct comprehensive IPC-IS trainings

at all facility levels by: conducting trainings of trainers (TOT) to establish a pool of qualified

multidisciplinary facilitators in each zone and in all regions as requested by other partners in the regions;

procuring and

distributing training materials for each zonal training center in collaboration with other USG partners.

2. Collaborate with JSI to conduct trainings of healthcare providers on recommended IPC-IS practices.

The MOHSW will: train 1500 healthcare providers and conduct refresher training for health care workers

3. Strengthen capacity of MOHSW IPC-IS to coordinate activities to improve the quality of healthcare

services provided in the health facilities by: maintaining current staff and covering fixed costs; purchasing

facilities and supplies, including fuel and vehicle maintenance, telephone charges, and postage and courier

services; and conducting an annual audit of the program. In addition, representatives from the MOHSW

will: attend international conferences and workshops to share experiences and lessons learned; conduct

quarterly stakeholders coordination forum (SCF) meetings; convene quarterly technical meetings to share

lessons and findings from the field among partners; and disseminate meeting minutes among partners for

future improvements.

4. Conduct supportive supervision to health facilities that have already received health care training. This

will involve regional health management teams (RHMT), district health management teams (DHMT) and

HMT at regional, district, and national levels conducting follow-up visits to monitor the implementation of the

IPC-IS program. Reports will be written and feedback provided to the facilities post analysis.

4a. Conduct "on the job" mentoring and supportive supervision of districts and primary health facilities by:

familiarizing HCW with the new checklist; collaborating with RHMTs and DHMTs to integrate the

checklist into the comprehensive supervision checklist for the health management teams; utilizing the

checklist to collect feedback from the field, making sure to incorporate constructive criticism into the

curricula.

5. Collaborate with JSI, to develop and implement advocacy and behavior change strategies to improve IPC

-IS practices by: reviewing IEC/BCC strategies for sensitization/orientation and training of health workers;

working with partners to develop various training packages and IEC materials for health care settings;

conducting trainings for TOT for national, zonal and hospital based settings; conducting orientation

workshops at facility levels on the different IEC/BCC approaches.

6. Disseminate guidelines regarding integration of health services to members of the RHMT and officials

from various health programs.

LINKAGES: The MOHSW, through the Health Services Inspectorate Unit (HSIU) will continue to coordinate

IPC-IS activities implementation throughout the country. The MOHSW will continue to collaborate with the

CDC, the WHO, JSI- MMIS, JHPIEGO-ACCESS, SCMS, Expanded Program for Immunization, MSD,

RCH,

Environmental Health and Sanitation Section, Directorate of Human Resource Development, Muhimbili

University College of Health Sciences , University Research Company, GTZ-Tanzania German Program to

Support Health, and College of Engineering Technology -University of Dar es Salaam - Department of

Chemical Processing Engineering in order to improve the quality of health services throughout Tanzania.

The partners will support the MOHSW's promotion of public-private partnerships and implement a global

communication and advocacy strategy to leverage and coordinate support for IPC-IS by 2009.

SUSTAINABILITY: The MOHSW will advocate for inclusion of IPC-IS activities in Comprehensive Council

HealthPlans (CCHP) and Comprehensive Hospital Plan (CHP). Each program is advised to budget for

health

care waste management in addition to integration of IPC-IS training in other programs, including routine

health care services. HMTs and CHMTs should plan for PPE, safety boxes, and other supplies and

injection devices in their CHPs and CCHPs to ensure sustainability. This will also be reiterated during

trainings of HCWs and sensitisation of HMTs that will ensure sustainability of the program activities. In

collaboration with key stakeholders, MOHSW will develop and implement advocacy and behavior change

strategies to improve IPC-IS practices.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13525

Continued Associated Activity Information

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

System ID System ID

13525 3500.08 HHS/Centers for Ministry of Health 6541 1130.08 $600,680

Disease Control & and Social

Prevention Welfare, Tanzania

7759 3500.07 HHS/Centers for Ministry of Health 4562 1130.07 $655,000

Disease Control & and Social

Prevention Welfare, Tanzania

3500 3500.06 HHS/Centers for Ministry of Health 2892 1130.06 $300,000

Disease Control & and Social

Prevention Welfare, Tanzania

Table 3.3.05:

ACTIVITY UNCHANGED FROM FY 2008 COP.

TITLE: MOHSW Laboratory Infrastructure and Capacity Building

NEED and COMPARATIVE ADVANTAGE : Research conducted by NIMR in 1995 found laboratory

services in the country to be the weakest link to provision of quality HIV/AIDS Prevention, Care and

Treatment. Through PEPFAR funding, MOHSW has developed an operational plan to improve the quality of

laboratory services in collaboration with CDC and other Development Partners. With FY 2008 funds,

MOHSW will continue to implement the plan of strengthening Laboratory capacity for HIV diagnosis,

disease staging, treatment monitoring, and strategic information. It will also continue to coordinate the

planning and execution of laboratory infrastructure activities implemented by all partners.

ACHIEVEMENTS: Coordinated and collaborated in the training of 197 lab staff on CD4, Hematology,

Chemistry, and 200 lab staff on Rapid HIV testing, three Development Partners meetings, and two

meetings on the establishment of the Infant HIV Diagnosis Program which came up with infant diagnosis

capacity assessment report and an implementation plan.

Collaborated with USG lab partners to develop and implement the Standard Lab Investigation Form, 73 Lab

Standard Operating Procedures, Planned Preventive Maintenance Guidelines for lab equipment, the

National lab Quality Assurance Framework, and paper based lab information tools.

ACTIVITIES: MOHSW will continue with the National roll out of implementation of early infant diagnosis.

The FY 09 activity will include ensuring national coverage geographically as well as to all HIV/AIDS care,

treatment and prevention programs. Manage sample transportation and. Implementation of Quality

Assurance Program through the National Quality Assurance Training Center (NHLQATC), and the National

and Zonal Subcommittees on Lab Quality Systems, recruit two facility management staff an administrator

and facility management officer; procure office supplies and for Quality assurance activities; facility

maintenance utility like power, water telephone bills and cleaning; procurement of service contracts for

equipment. Hold meetings and workshops to operationalize the NHLQATC. Strengthen the paper-based

and electronic laboratory information systems in all zonal and regional labs to reach national coverage.

Facilitate the implementation of the reviewed curriculum for the five pre-service training schools by

collaborating with ASCP Consultants mentoring the schools. Strengthen the capacity of zonal equipment

workshops to provide first and second line maintenance of laboratory equipment. Improve the capacity of

regional and district laboratory to diagnose opportunistic infections including TB, STI, etc. Strengthen the

capacity of MOHSW to coordinate lab partner's efforts.

The Ministry of Health and Social Welfare (MOHSW) will extend Early Infant HIV Diagnosis using DBS

samples to three Zonal Referral Hospitals to ensure that early infant HIV diagnostic services are available in

each zone through coordinating the establishment of an efficient DBS sample collection and transportation

system by treatment partners in all four zones on Tanzania mainland and coordinating the training of

healthcare workers on DBS sample collection and transportation. MOHSW will Conduct supportive

supervision to zonal labs to monitor and evaluate performance.

MOHSW will implement the Quality Assurance Program through the National HIV Quality Assurance

Laboratory and Training Center (NHQALTC). Ensure participation of all four zonal laboratories in the

mainland and Mnazi Mmoja in Zanzibar, 23 regional hospital laboratories in mainland as well as one in

Pemba participate on External Quality Assurance (EQA) Program for CD4 count, Rapid HIV Testing, HIV

Serology, Chemistry, Hematology, and DNA PCR. MOHSW will provide EQA panels to zonal and regional

hospital laboratories, refresher Training on laboratory quality systems to 69 laboratory staff in Public and

Private Health Laboratories. Through FY 2008, MOHSW will hire personnel to run the NHQALTC and

maintain running cost, including salaries and wages. MOHSW will start the process of providing funding for

the NHQATC through government mechanisms ideally as an executive agency of the MOHSW. MOHSW

will provide subsidy to the National and Zonal Advisory Committees on Diagnostic Services and their Lab

Quality System Subcommittees to enable them to implement, monitor and evaluate QA activities in all labs

in the country.

MOHSW will also coordinate strengthening of the paper-based and electronic laboratory information

systems in 23 regional hospital laboratories in the mainland. Up-to-date daily, monthly, quarterly, and

annual laboratory statistics available in all targeted facilities and provide computer hardware and software to

the 12 remaining phase two regional hospital laboratories. Training of 184 laboratory staff in regional

laboratories in basic computer skills and laboratory information system. will be undertaken as well as the

development of and implementation of relevant laboratory worksheets and other tools.

MOHSW will ensure the Incorporation of the HIV/AIDS in-service training modules in the pre-service

laboratory training curriculum. This will result in Pre-service graduates being equipped with laboratory skills

necessary to support HIV/AIDS care and treatment program. In order to accomplish this the pre-service

laboratory training modules will be reviewed in collaboration with the American Society for Clinical

Pathologists.

Equipment maintenance is a key element to success of laboratory programs. MOHSW will strengthen the

capacity of zonal workshops to provide first and second line maintenance of laboratory equipment. 75%

reduction in laboratory equipment downtime. MOHSW will train 15 Laboratory Equipment

Engineers/Technicians on the first line maintenance of laboratory equipment and provide essential

workshop tools to six zonal equipment workshops and subsidy to cover running cost of servicing equipment

within the zone.

MOHSW will strengthen the capacity of the Diagnostic Services Section of the MOHSW to coordinate the

implementation of Laboratory Operational Plan to support HIV/AIDS Prevention, Care and Treatment

Program by ensuring the availability of adequate staff and necessary tools. MOHSW will hire program

officers and project support staff. The activities of QA and administrative activities will necessitate MOHSW

to procure a vehicle and provide for communication, fuel and vehicle maintenance.

LINKAGES - Diagnostic Services Section of MOHSW coordinates improvement of all HIV testing sites to

Activity Narrative: support various national programs including NACP and PMTC, and work with CDC and various

implementing partners including U.S. Department of Defense (DOD), National Institute For Medical

Research (NIMR), African Medical Research Foundation (AMREF), Association of Public Health

Laboratories (APHL), Clinical and Laboratory Standards Institute (CLSI), American Society for Clinical

Pathologists (ASCP), Japanese International Cooperation Agency (JICA), AXIOS, Abbot Fund, Clinton

foundation, Track 1 ART Partners in improving laboratory infrastructure and capacity building to support

HIV/AIDS Prevention, Care and Treatment Program.

CHECK BOXES: - On Human Capacity Development, in-service training will be conducted in all testing

facility to fill the gap of the current pre-service laboratory training curriculum. At the same time, MOHSW will

work with laboratory training schools to review the current pre-service modules so as to incorporate the

inservice

training modules to support HIV/AIDS care and treatment program.

M&E: MOHSW has developed tools to be used to evaluate laboratory performance and they will be used

during supportive supervision. Laboratory performance will also be evaluated by sending out Proficiency

Testing panels and evaluating the results centrally. All training modules include pre- and post test

evaluation to measure the knowledge gain of participants. A random of HIV test samples from a testing site

will be sent to a higher level laboratory for retesting on regular basis. Approximately 10% of the budget will

be used for M&E.

SUSTAINABILITY: MOHSW will train Trainer-of-Trainees (TOT) from various programs including PMTCT,

VCT, NACP, etc. who will be tasked with rolling out trainings in their program areas. Zonal TOT will also be

trained to roll out HIV disease monitoring trainings in their respective zones. The TOT approach is designed

to provide sustainability of training activities by empowering the programs/zones with capacity to conduct

frequent trainings and hence, increasing the number of trainees.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13527

Continued Associated Activity Information

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

System ID System ID

13527 3499.08 HHS/Centers for Ministry of Health 6541 1130.08 $1,275,000

Disease Control & and Social

Prevention Welfare, Tanzania

7758 3499.07 HHS/Centers for Ministry of Health 4562 1130.07 $832,500

Disease Control & and Social

Prevention Welfare, Tanzania

3499 3499.06 HHS/Centers for Ministry of Health 2892 1130.06 $96,376

Disease Control & and Social

Prevention Welfare, Tanzania

Table 3.3.16:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

This is a continuing activity from 2008, and he activities below will be ongoing for 2009. In addition,

increased funding is requested for the position of a database administrator who will work closely with the

Health Information and Reporting Unit (HIR) at the MOHSW to ensure adequate coverage and support for

routine health systems, including the Phones for Health system.

TITLE: Strengthening HIV Reporting within Routine Health Systems

NEED and COMPARATIVE ADVANTAGE: The Health Information and Research Section (HIR), Health

Management Information Systems (HMIS) Unit of the Ministry of Health of Health and Social Welfare

(MOHSW) is the overall coordinator of routine health data system in the country, the custodians of routine

heath data system from government, parastatals, non-governmental organizations (NGOs) and private

heath facilities, and is responsible for generating indicators that track Millennium Development Goals (MDG)

and the national strategy for poverty reduction, MKUKUTA in Kiswahili. The need for quality monitoring of

the health data collected and reported at health facilities is important in ensuring that policy makers and

stakeholders can effectively monitor and evaluate health activities.

HIR is responsible for ensuring the reporting of accurate data. With the integration of HIV/AIDS into routine

health care, data quality becomes increasingly critical. There is a need for accurate dissemination of health

systems from facilities as programs including Prevention of Mother-to-Child Transmission (PMTCT) and

Care and Treatment (C&T) are scaled up to meet the expanding needs of the country.

ACCOMPLISHMENTS: 1.) To manage the data collected from health facilities, HIR/HMIS has regional and

district Health Management Information System (HMIS) focal persons at each district. This person is

already a member of the Regional or District Health Management Team, and is now tasked with reviewing

data collected from routine health activities. 2.) The current Health Statistics Abstract Report (HSAR),

produced in April 2006, provides a comprehensive health statistics summary for the health sector. It

includes health facility and resource information, morbidity and mortality statistics, disease reporting for

malaria, tuberculosis and leprosy, HIV/AIDS and Sexually Transmitted Infections (STIs), blood safety, EPI

and reproductive and health services, which includes vaccinations, antenatal care, deliveries and family

planning.

ACTIVITIES: 1.) Supportive supervision: HIR/HMIS will continue to build capacity of regional and district

HMIS focal persons on health data collection, analysis, dissemination, feedback, and use. 1a.) Conduct

orientation and retraining for regional and district Health Management Teams on new/updated data

collection tools 1b.) Conduct routine supportive supervision to regions and districts to address issues found

through visits, and to affect policy change to effectively strengthen the overall implementation and

continuation of health activities. 1c.) Conduct HMIS annual monitoring and evaluation meeting to discuss

strengths, constraints, and gaps and to build consensus on actions for policy and programmatic changes.

2.) Strengthening data quality and dissemination: HIR/HMIS will continue to strengthen its essential

responsibilities for providing key data and support for MOHSW activities to policy makers, donors and other

stakeholders, health workers, NGOs and the general population. 2a.) To process and produce an annual

Health Statistics Abstract Report 2b.) To conduct data communication and dissemination workshop for the

HSAR. 2c.) To attend short courses on monitoring and evaluation to continue to build the national capacity

to provide technical assistance for health information. 2d.) To provide technical assistance in the creation

and modification of data collection tools for routine health and to improve the comprehensiveness of

collection and reporting.

3.) Data quality assessment: In addition to routine supportive supervision, we propose as part of program

monitoring and evaluation, an annual data quality assessment and review. With the government

components with which we work - the National TB and Leprosy Program (NTLP), the National AIDS Control

Program (NACP), the National Malaria Control Program (NMCP), Reproductive Child Health Services,

Expanded Program for Immunizations (EPI), Integrated Diseases Surveillance and Response (IDSR), EHS

Unit, Vital Registration, it becomes imperative to review how data from each system have impacted the

overall health of Tanzanians. The outcomes of such an activity will be to better identify, analyze, use and

disseminate data for decision-making. 3a.) Hold a stakeholder workshop to outline the data collection and

reporting efforts of each of the units, and coordinate the activities that we expect to review and address as

part of this activity. 3b.) Conduct facility data capacity assessments, with a focus on quality of data

collection and reporting, gaps and challenges to collection and reporting, current practice of use and

dissemination, and the effects of supportive supervision activities, all to determine profound factors for

quality data.

LINKAGES: The key HMIS linkages include: the Prime Ministers Office - Regional Authority and Local

Government (PMO-RALG) as the primary owners of health facilities and governance of employed staff.

Other linkages include: IDSR, which tracks disease outbreaks in the country; Vital Registration provides

data on birth and death and migration; RCHS and EPI, provides data on mother and child services; NMCP

provides data on malaria efforts; NTLP provides data on tuberculosis and leprosy; NACP programs focus on

HIV/AIDS programs; the National Bureau of Statistics produces data on health denominators; and TACAIDS

governs Tanzania's multisectoral response for health. HMIS also links to national and referral hospitals; and

unilateral and multilateral partners.

CHECK BOXES: HIR/HMIS activities build the capacity of local health facilities to collect, report, and use

health data collected within the routine system of health. HMIS works with government entities on data

collection, tool creation and modification, and assists with the dissemination of health statistics for the

country.

M&E: HIR/HMIS works closely with other ministry counterparts, donors and stakeholders on the collection

and reporting of accurate data. MHIS will continue to promote the synthesis and use of data by district and

regional staff, which, in turn, strengthens the facilities with the skills to validate and use their data. To

Activity Narrative: strengthen the districts and regions, HIR/HMIS closely monitors the data collection at districts and regional

levels with supportive supervision visits to assess quality reports, and to be the changers of effective policy

to improve data efforts. The support reaches all 133 districts and 21 regions in mainland Tanzania, the

HMIS focal persons, and the district and regional health management teams. To that end, we see the need

for annual data quality assessments to again drive policy and infrastructure changes with, and for the

collective government of Tanzania and Tanzanians.

SUSTAINAIBLITY: HIR/HMIS is the source for health data, and has the mandate for reporting quality data

that affects how policy makers implement and coordinate program activities and make decisions. The focus

on accurate reporting impacts those who report program data, and gives the ownership of accurate data

back to the programs that report. HIR/HMIS empower the districts and regions with the ability to conduct

quality data visits to facilities, as well as empowering the districts and regions with the responsibility to

report to the national level. The reciprocal reinforcing of data quality makes for stronger programs within the

routine health system.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16379

Continued Associated Activity Information

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

System ID System ID

16379 16379.08 HHS/Centers for Ministry of Health 6541 1130.08 $120,000

Disease Control & and Social

Prevention Welfare, Tanzania

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $50,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17:

Please see activity 16365.23133.09 for activity narrative.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Workplace Programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.18: