THIS IS AN ONGOING ACTIVITY FROM FY 2008. ACTIVITIES LISTED HAVE BEEN INITIATED AND

WILL PROCEED DURING FY 2009 AS IN THE PREVIOUS YEAR. ACCOMPLISHMENTS WILL BE

REPORTED IN THE FY 2008 APR. PLEASE NOTE THAT THE ACTIVITY NARRATIVE REMAINS

UNCHANGED FROM FY 2008.

*END ACTIVITY MODIFICATION*

TITLE: TUNAJALI PMTCT Services in Dodoma, Iringa, Morogoro and Singida

NEED AND COMPARATIVE ADVANTAGE: Women constitute a significant proportion, nearly 60%, of

patients treated for HIV/AIDS in Tanzania. Therefore, enrolling HIV positive pregnant women into programs

providing ART is essential, specifically because administering treatment to pregnant women also offers

critical opportunity to address pediatric HIV infection and to reduce the prevalence of perinatally acquired

HIV. Of the women tested and counseled at PMTCT facilities in 2005 in Tanzania, 6.7 % were HIV positive

and were offered nevirapine (NVP) and infant feeding (IF) counseling. Full adherence rates of completion

of the antiretroviral prophylaxis course by these women are not known. HIV prevalence in targeted regions

is: 4.9% in Dodoma; 13.4% in Iringa; 5.4% in Morogoro; and 3.2% in Singida. Without adequate

interventions, it is expected that one-third of children born to these women will become infected with HIV.

ACCOMPLISHMENTS: PMTCT is a new initiative for TUNAJALI, however, Family Health International (FHI)

(Deloitte's technical partner under TUNAJALI), has established more than 280 PMTCT sites globally, and is

providing PMTCT support to 6 districts in Dodoma with support from the Abbott Fund.

ACTIVITIES: In keeping with the PMTCT regionalization efforts, TUNAJALI will expand its services to

support PMTCT services in Dodoma, Iringa, Morogoro, and Singida regions by supporting current

operational sites and establishing services in 38 facilities to enable more pregnant women to have greater

access to services, thereby reducing the risk of transmission from infected mothers to newborns in

Tanzania.

The minimum package of PMTCT services provided at these sites will include ‘opt-out' HIV counseling and

testing, referrals of positive women to a care and treatment center (CTC) for assessment of antiretroviral

therapy (ART) eligibility and care, ARV prophylaxis for HIV positive mothers Zidovudine (AZT) and

Nevirapine (NVP) or Single dose (SD) NVP) based on facility capacity and according to national guidelines

and infant feeding counseling. In order to build capacity and infrastructure, TUNAJALI will: purchase

medical supplies and laboratory equipment; train health workers using the nationally approved PMTCT

curriculum, and provide supportive supervision; effectively supplement MSD, Abbott, and other donor

supplies by procuring and delivering NVP, reagents, and other supplies to prevent disruption of services.

Additionally, TUNAJALI will train midwives in handling and staging HIV positive mothers and exposed

infants to reduce stigmatizing behavior and improve perinatal care skills.

In order to successfully increase the number of women who receive counseling and testing, TUNAJALI is

committed to scaling-up provider-initiated counseling and testing at labor and delivery wards and

implementing a pilot program involving lay counselors in the provision of counseling services to alleviate the

burden of overworked staff. Furthermore, TUNAJALI will train community-based volunteers to sensitize

communities and promote PMTCT services.

Follow-up care and support for mother-infant pairs and their families is essential to ensure the continuum of

comprehensive care. TUNAJALI will facilitate implementation of referral systems at sites to link motherinfant

pairs with CTC sites providing facility-based care and treatment. To develop linkages, maternal and

child health (MCH), PMTCT and CTC sites will engage in joint planning and budgeting to ensure integration

of services. Furthermore, establishing provider-initiated counseling at Maternal Child Health clinics to

ensure infants with HIV positive mothers are tested according to national guidelines and, if HIV positive

themselves, referred to a CTC.

Fostering capacity building among regional and district health authorities to plan and monitor PMTCT

activities will ensure that PMTCT services are integrated with district and regional systems thereby

maximizing resources, creating ownership, and building sustainability. In order to accomplish this,

TUNAJALI will provide technical support to regional and district authorities to conduct supportive

supervision, data collection, and reporting of PMTCT activities. To maximize sustainability, health

authorities will include PMTCT activities in council health plans.

LINKAGES: To ensure comprehensive care for mothers and infants, the project will link with TUNAJALI

home-based care/OVC initiatives, TB/HIV projects, prevention for positives initiatives, reproductive health

(RH), and maternal and child health (MCH) programs, in addition to other partners, to provide additional

community-based support services including home-based palliative care, nutritional, psychosocial, and legal

support. TUNAJALI will link with partners who have more experience in PMTCT to ensure access to

optimal services and coordinated support. To this effect, the project will partner with ENGENDERHEALTH

in Iringa, AXIOS (TBD) in Morogoro and Singida, and Abbott/FHI's PMTCT and pediatric AIDS program in

Dodoma. TUNAJALI will also work closely with USG partners to ensure the promotion of PMTCT and will

continue to work toward sensitizing communities, while mobilizing to increase uptake of PMTCT services.

At the national level, TUNAJALI will work with the National AIDS Control Program (NACP) to inform national

PMTCT policies and contribute to the development/adoption of standard operating procedures (SOPs) and

national guidelines focused on testing and counseling approaches, and to deliver services to women who

choose to give birth outside of a health facility.

CHECK BOXES: The main goal is to increase women's access to counseling and testing, thereby

facilitating their entry into the HIV/AIDS continuum of care. The project will work with ANC and

labor/delivery wards to improve these services. Linkages to services such as RH, Family Planning (FP),

under-age-5 child services, and malaria programs will be emphasized and encouraged. Renovation of

sites, training health workers, utilizing lay counselors, and providing technical support to facilities will all

Activity Narrative: exist within TUNAJALI's mission. The main target populations are pregnant women and PLWHA, but

realistically, community mobilization activities will target the general population as a whole.

M&E :TUNAJALI will work with regional health and council health management teams (RHMT and CHMT)

in supportive supervision and quality assurance. TUNAJALI will support the National AIDS Control Program

(NACP) in developing an electronic data collection system by the end of FY 2008. Meanwhile, sites will

utilize national PMTCT paper-based tools to capture data. Data compiled at the facility level will be sent to

the district reproductive and child health coordinator (DRCHC) for aggregation, then forwarded to NACP

and TUNAJALI to provide feedback to the sites, implementing partners, and donors. TUNAJALI will also

build the capacity of facility based staff and DRCHC in data entry, management, reporting, and use of data

for decision-making. Additional tools, including the national logistic management information system

(LMIS), also referred to as the indent system, will be adapted to collect data tracking drugs and

commodities to ensure effective and efficient management of resources. Internal audits will be carried out

regularly to ensure quality. By establishing and strengthening facility-level supervision, improving quality

assurance, bolstering health information systems, and ensuring activities conducted are carried out

according to national guidelines, the project will maintain continuous improvement in the quality of care and

promote sustainability.

SUSTAINABILITY: The project will establish PMTCT services as an integral part of the existing health

system, executed in conjunction with sites offering testing, counseling, and clinical care. TUNAJALI will

work with the district councils to include PMTCT activities in their comprehensive council health plans and

increase funding from additional sources such as basket funding and Global Fund (GF). Sustainability will

be ensured by the complete integration of PMTCT in reproductive and child health (RCH) services, and by

providing the necessary health infrastructure and staffing to ensure success. The project will build local

ownership by working through local government, while building human capacity through training, mentoring,

and supportive supervision.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13461

Continued Associated Activity Information

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

System ID System ID

13461 12380.08 U.S. Agency for Deloitte Consulting 6510 1197.08 Fac Based/RFE $2,000,000

International Limited

Development

12380 12380.07 U.S. Agency for Deloitte Touche 4532 1197.07 $450,000

International Tohmatsu

Development

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Malaria (PMI)

* Safe Motherhood

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $420,000

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 $20,000

Economic Strengthening

Education

Water

Table 3.3.01:

THIS IS AN ONGOING ACTIVITY FROM FY 2008. ACTIVITIES LISTED HAVE BEEN INITIATED AND

WILL PROCEED DURING FY 2009 AS IN THE PREVIOUS YEAR. ACCOMPLISHMENTS WILL BE

REPORTED IN THE FY 2008 APR. PLEASE NOTE THAT THE ACTIVITY NARRATIVE REMAINS

UNCHANGED FROM FY 2008. USG WILL CONTINUE TO WORK WITH DELOITTE TO ENSURE THAT

ITS ACTIVITIES REINFORCE THE USG PREVENTION STRATEGY. ENGENDERHEALTH CHAMPION

WILL COLLABORATE IN PROVIDING TECHNICAL ASSISTANCE TO SUBGRANTEES.

TITLE: The Rapid Funding Envelope for HIV/AIDS (RFE) Public-Private Partnership Initiative in Tanzania

NEED AND COMPARATIVE ADVANTAGE: To increase participation of civil society, 10 donors and

TACAIDS co-operated in creating a "Rapid Funding Envelope for HIV/AIDS" on mainland Tanzania and in

Zanzibar. RFE is a competitive mechanism for projects on HIV/AIDS in Tanzania. RFE supports not-for-

profit civil society institutions, academic institutions in compliance with national policy and strategic

framework with the goal of contributing to longer-term objectives of the national response and encouraging

projects that promote institutional partnerships. To date, although the private sector is involved in the fight

against HIV/AIDS, services tend to be limited to their employees, and often lack the continuum of care and

sustainability due to lack of commitment at higher level. This program seeks to use the RFE mechanism to

inform the private sector of the need to expand workplace programs, and establish partnerships with private

organizations to strengthen these interventions, leveraging resources from existing medical structures within

these private institutions to make care and treatment available to employees and their communities who

would otherwise not have access to these services.

ACCOMPLISHMENTS: To date, RFE has conducted seven rounds of grant making and approved $11.2

million from pooled funds, for 78 projects. In FY 2007, RFE successfully held a 4th round, providing awards

worth $3.5 million to 23 CSOs (seven had OVC activities); monitored and managed existing sub grantees;

created a reliable base from which donors can utilize without duplicating efforts; continued to strengthen

CSOs, financially and technically, thus laying a solid foundation for further funding; and facilitated increased

resources for CSOs via disbursement of significant funding in a short timeframe.

ACTIVITIES: Ongoing activities will include management of the RFE-Public-Private Partnership initiatives to

be established with FY 2007 plus-up funds focusing on strengthening collaboration with private

organizations; selecting and providing grants for workplace organizations for treatment and care activities in

support of the continuum of care efforts in the workplace and neighboring communities. In particular this will

involve oversight of projects worth $800,000 in grants to approximately 20 organizations. The 20 companies

will be awarded matching contribution grants for creating or extending their workplace programs. The

companies will be paired with our in-place partners to ensure that their programs adhere to best practices

and national standards. The focus of the activities will include: 1) Support the implementation of workplace

AIDS policies. 2) Support the development of peer counselors. 3) Provide materials, training, and other

components needed to support prevention-related personnel. These funds will be used to expand

prevention services in the companies while leveraging corporate resources to expand HIV/AIDS treatment

and care services beyond the workplace, and using the family centered approach, include family and

community members who may otherwise not have been able to access services in these private facilities.

Specific activities will include: 1) Grants and financial management of sub grantees, including

disbursements of grants, liquidation reviews of sub grantee financial reports and monitoring & evaluation of

projects; 2) Technical monitoring and management of sub grantees, including review of project work plans

and progress reports, review of project deliverables and monitoring & evaluation of projects; 3) Financial

administration of the RFE-PPP fund, including preparation of financial reports and engaging project audits;

4) Grants/Project administration including external RFE-PPP communications/correspondence, convening

of meetings with the donor/partners and preparation of (ad-hoc) reports. The program will strengthen

collaboration with private organizations to find unique alternatives to which private-for-profit companies can

contribute towards alleviating the burden caused by HIV/AIDS (a) RFE-PPP program will solicit and review

short-listed private-for-profit organizations, conducting pre-award assessments to determine organizational,

financial, technical management competency of the existing medical programs and identify potential

weakness that may be mitigated towards improving the continuum of care; b) At least five successful

organizations will be contracted and funded directly with USG funds; c) Supportive supervision will be

provided to the projects, including monitoring & evaluation, guidance & oversight of the projects through

regular site visits); 2) Capacity building towards graduation towards direct funding from donors will be

provided through training and coaching/mentoring; and 3) Additional support will be sought from multi-

donors to fund similar workplace programs. If successful, non-pooled USAID funds will support

management of these grants.

LINKAGES: In keeping with previous arrangements, Deloitte Consulting Limited as the Prime, also the lead

for grants and finance management will link with a partner (TBD) as the lead technical partner for supporting

the RFE-PPP, and will work closely with donors, keeping within the mandates of the AIDS Business Council

of Tanzania (ABCT). RFE-PPP will also develop formal linkages with large funding mechanisms; including

regional facilitating agencies (TMAP) to feed into the development information networks system, a common

database of organizations funded to avoid duplication of efforts. In effort to encourage organizational

development, RFE-PPP will share funding experience with potential donors/organizations to create

awareness and encourage buy-in.

CHECK BOXES: RFE-PPP will seek to fund organizations with existing medical programs, building capacity

as needed to afford the continuum of care to their employees, as well families and surrounding

communities. The RFE will support capacity building through various steps including the pre-award

assessment that highlights key areas of weakness to be strengthened in the capacity building plan;

technical assistance/training on programmatic (HIV) issues and finances; and ongoing mentoring and

technical assistance.

M&E: Annual work plans will be developed and will include built-in M&E processes for which the relevant

staff member takes responsibility. Management of the RFE-PPP will include conducting the following

monitoring & evaluation activities: regular update of project through participation in activities; review

quarterly technical reports for performance against work plan; monitoring through field visits; collection of

Activity Narrative: data; and preparation of site visit reports and progress reports. These reports will be shared with private

organizations concerned, and donors, to enable improvement and development of the program. Best

practices and lessons learned will be captured and shared.

SUSTAINABILITY: The private organizations involved will be encouraged to foster local community

networks, and continue to leverage their own resources that will assist in continued operations of the project

once RFE-PPP funding has ended. RFE-PPP requires projects to consider sustainability during proposal

development, and ensures that a realistic plan has been developed to integrate the project into existing

programs. RFE-PPP supported organizations will also be provided with institutional capacity building

support enabling them to grow/graduate towards receiving accreditation as care and treatment centers, and

allow them to receive direct funding and/or increase the level of funding from other donors, post RFE-PPP

funding. The new management structure at Deloitte has been designed to better manage the function of the

RFE to include capacity for managing the RFE-PPP, since the original mandate of the RFE has changed

from its original form and size of projects funded.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16389

Continued Associated Activity Information

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

System ID System ID

16389 16389.08 U.S. Agency for Deloitte Consulting 6510 1197.08 Fac Based/RFE $200,000

International Limited

Development

Table 3.3.02:

THIS IS AN ONGOING ACTIVITY FROM FY 2008. ACTIVITIES LISTED HAVE BEEN INITIATED AND

WILL PROCEED DURING FY 2009 AS IN THE PREVIOUS YEAR. ACCOMPLISHMENTS WILL BE

REPORTED IN THE FY 2008 APR. PLEASE NOTE THAT THE ACTIVITY NARRATIVE REMAINS

UNCHANGED FROM FY 2008. USG WILL CONTINUE TO WORK WITH DELOITTE TO ENSURE THAT

ITS ACTIVITIES REINFORCE THE USG PREVENTION STRATEGY. ENGENDERHEALTH CHAMPION

WILL COLLABORATE IN PROVIDING TECHNICAL ASSISTANCE TO SUBGRANTEES.

TITLE: The Rapid Funding Envelope for HIV/AIDS (RFE) Public-Private Partnership Initiative in Tanzania.

NEED AND COMPARATIVE ADVANTAGE: To increase participation of civil society, ten donors and

TACAIDS co-operated in creating a "Rapid Funding Envelope (RFE) for HIV/AIDS" on mainland Tanzania

and Zanzibar. RFE is a competitive mechanism for projects addressing HIV/AIDS in Tanzania, and supports

not-for-profit civil society institutions, academic institutions in compliance with national policy, and strategic

framework. The goal is to contribute to longer-term objectives of the national HIV/AIDS response and

encourage projects that promote institutional partnerships. To date, although the private sector is involved in

the fight against HIV/AIDS, services tend to be limited to their employees, and often lack the continuum of

care and sustainability due to lack of commitment at higher level. This program seeks to use the RFE

mechanism to inform the private sector of the need to expand workplace programs and establish

partnerships with private organization to strengthen these interventions. By leveraging resources from

existing medical structures within these private institutions, it is possible to enable employees and their

communities to access care and treatment.

ACCOMPLISHMENTS: To date, RFE has conducted seven rounds of grant writing and has approved $11.2

million from pooled funds for 78 projects. In FY 2007, RFE successfully held a 4th round, providing awards

worth $3.5 million to 23 CSOs (seven of which had OVC activities); monitored and managed existing sub

grantees; created a reliable base from which donors can utilize without duplicating efforts; continued to

strengthen CSOs, financially and technically, thus laying a solid foundation for further funding; and

facilitated increased resources for CSOs via disbursement of significant funding in a short timeframe.

MAJOR ACTIVITIES: Ongoing activities will include management of the RFE-Public-Private Partnership

initiatives to be established with FY 2007 plus up funds, RFE funds will be focused on strengthening

collaboration with private organizations and selecting and providing grants to workplace organizations for

treatment and care activities in support of the continuum of care, These efforts will be focused in the

workplace and neighboring communities. In particular, this will involve oversight of projects worth $200,000

in grants to approximately 20 organizations. The 20 companies will be awarded matching contribution

grants for creating or extending their workplace programs. The companies will be paired with Deloitte's in-

place partners to ensure that their programs adhere to best practices and national standards. The focus of

the activities will include: to support the implementation of workplace AIDS policies; support the

development of peer counselors; and provide materials, training, and other components needed to support

prevention-related personnel.

Additionally, these funds will be used to expand prevention services while leveraging corporate resources to

expand HIV/AIDS treatment and care services beyond the workplace. This will include using the family

centered approach, which provides programs to family and community members who may otherwise not

have been able to access services in these private facilities. Specific activities will include; disbursements of

grants; liquidation reviews of sub grantee financial reports; and monitoring & evaluation of projects.

Additionally, RFE will provide technical monitoring and management of sub grantees including review of

project work plans and progress reports, review of project deliverables, and monitoring & evaluation of

projects. Financial administration of the RFE-PPP fund will be supported including preparation of financial

reports and engaging project audits. RFE will develop grant/project administration including external RFE-

PPP communications/correspondence, convening of meetings with the donor/partner, and preparation of

(ad-hoc) reports.

The program will strengthen collaboration with private organizations to find unique ways in which private-for

profit companies can contribute toward HIV/AIDS initiatives in order to alleviate the burden caused by

HIV/AIDS. A RFE-PPP program will solicit and review short-listed private-for-profit organizations, conduct

pre-award assessments to determine organizational, financial, and technical management competency of

the existing medical programs, and identify potential weakness that may be mitigated towards improving the

continuum of care. At the very least, five successful organizations will be contracted and funded directly with

USG funds. Supportive supervision will be provided to the projects, including monitoring and evaluation,

guidance, and oversight of the projects through regular site visits. Additional support will be sought from

multi-donors to fund similar workplace programs. If successful, non-pooled USAID funds will support

management of these grants.

LINKAGES: Deloitte Consulting Limited will serve as the prime partner and will collaborate closely with

donors, such as a TBD partner as the lead technical partner. RFE-PPP will also develop formal linkages

with large funding mechanisms; including Regional Facilitating Agencies (TMAP) to feed into the

development information networks system, a common database of organizations funded to avoid

duplication of efforts. In effort to encourage organizational development, RFE-PPP will share funding

experiences with potential donors/organizations to create awareness and encourage buy-in.

AREAS OF EMPHASIS: RFE-PPP will seek to fund organizations with existing medical programs, building

capacity as needed to afford the continuum of care to their employees, as well families and surrounding

communities. The RFE will: support capacity building through various steps including the pre-award

assessment that highlights key areas of weakness to be strengthened in the capacity-building plan;

technical assistance/training on programmatic (HIV) issues; finances; and ongoing mentoring and technical

assistance.

M&E: Annual work plans will be developed and will include built-in M&E processes for which the relevant

staff member takes responsibility. Management of the RFE-PPP will include: conducting the following

monitoring & evaluation activities; regular update of project through participation in activities; review

Activity Narrative: quarterly technical reports for performance against work plan; monitor through field visits; Collect data;

prepare site visit and progress reports; these reports will be shared with private organizations concerned,

and donors, to enable improvement and development of the program, Best lessons learned will also be

captured and shared.

SUSTAINABILITY: The private organizations involved will be encouraged to foster local community

networks and continue leveraging their own resources in order to assist in continued operations of the

project once RFE-PPP funding has ended. RFE-PPP requires projects to consider sustainability during

proposal development; and ensure that a realistic plan has been developed to integrate the project into

existing programs. RFE-PPP supported organizations will also be provided with institutional capacity

building support enabling them to grow/ graduate towards receiving accreditation as care and treatment

centers (CTC), and allow them to receive direct funding and/or increase the level of funding from other

donors post RFE-PPP funding. The new management structure at Deloitte has been designed to better

manage the function of the RFE, to include capacity for managing the RFE-PPP, since the original mandate

of the RFE has changed from its original form and size of projects funded.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16375

Continued Associated Activity Information

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

System ID System ID

16375 16375.08 U.S. Agency for Deloitte Consulting 6510 1197.08 Fac Based/RFE $200,000

International Limited

Development

Table 3.3.03:

ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP

TITLE: Tunajali Facility-based Adult Care and Support

NEED and COMPARATIVE ADVANTAGE: The Deloitte Consulting Limited, Family Health International

(FHI), and Emerging Markets Group (EMG) partnership has worked to strengthen health care systems and

HIV/AIDS services in Dodoma, Iringa, Morogoro, and Singida since FY 2007 under the Tunajali (Kiswahili

for "we care") Program. The 2008 Tanzania HIV/AIDS Survey reported slightly decreased prevalence rates

since 2004 in Dodoma, Morogoro, and Singida (4.2%, 3.3% and 2.6% respectively), though the increase in

prevalence in the Iringa region to 14.7% is alarming. The Tunajali program supports 52 Care and

Treatment Clinics (CTC) in these four regions; however, these sites have only reached approximately 50%

of the people living with HIV/AIDS (PLWHA) estimated to need care services. Testing results also indicate

that the prevalence rate in urban and semi-urban areas is generally much higher than regional figures. The

Deloitte/FHI/EMG partnership has gained respect among regional and district Government of Tanzania

(GOT) authorities as a result of its emphasis on working through government systems; therefore, it is well

placed to support the healthcare systems and service delivery in the aforementioned regions.

ACCOMPLISHMENTS: By September 30, 2008, the 52 Tunajali-supported CTC sites provided HIV/AIDS

care services to an estimated cumulative total of 63,000 clients, of which approximately 57,330 are adults.

Of the total number of adult clients, approximately 50% received Cotrimoxazole prophylaxis. The facility-

based program also continued to work collaboratively with the Deloitte/FHI-led Tunajali home-based care

(HBC) and orphans and vulnerable children support projects, resulting in more than half of all patients

attending the CTC enrolled in an HBC program by the end of September 2008. Moreover, approximately

60% of CTCs involve PLWHA in the provision of care services.

Tunajali has equipped all CTC laboratories to ensure that CTCs routinely assess patients before initiation

on ART and monitor responses and adverse effects of the treatment. Tunajali support to laboratories

included: minor renovations; procurement of relevant equipment including CD4, automated hematology and

biochemistry machines; and emergency buffer stock of reagents and other supplies to complement the

often erratic supplies from GOT sources. Finally, during FY 2008, a video that demonstrates simple and

efficient Permaculture gardening techniques was created for patients waiting at CTCs that will be distributed

to all partners.

ACTIVITIES: Tunajali will provide care and support care to registered patients at CTCs, including patients

who are on ART as well as those not yet eligible for treatment. Patients receive WHO staging; provision of

Cotrimoxazole in accordance with national guidelines; diagnosis and management of opportunistic

infections, including TB screening and referral and cryptococcal infection; nutritional assessments,

counseling and referrals for nutritional support (where possible); symptom and pain management (for

outpatients, pain management is currently restricted to non-opioid medicines such as ibuprofen and

paracetamol); and psychosocial support. They also receive elements of the positive prevention package,

which includes: sexually transmitted infection syndrome management, condoms, access to insecticide-

treated nets (ITNs) for CTC attendees, effective referral to family planning services when relevant, and

prevention counseling. General counseling addresses disclosure of HIV status, adherence to care and

treatment, behavior change counseling for prevention of HIV transmission, and other individual issues, as

appropriate. The program also ensures that Provider-initiated Testing and Counseling occurs in various

wards of the hospital.

In FY 2009, Tunajali will focus on expanding services to 73 additional health centers, while continuing to

support existing services at 52 CTCs. Tunajali will work closely with the Regional Health Management

Teams (RHMTs) and the Council Health Management Teams (CHMTs) to be strategic in identifying,

initiating, and monitoring services at heath centers in areas with higher prevalence. Tunajali will provide

grants to support minor renovation; procure furniture and equipment; purchase emergency buffer stocks of

lab reagents, opportunistic infection (OI) drugs and other commodities to complement the often erratic

supplies from the Medical Stores Department (MSD); procure motorcycles for supportive supervision and

transporting samples; and train and mentor staff in care provision, adherence counseling, and monitoring

and evaluation (M&E), using the national guidelines and curriculum.

The provision of care and treatment services requires access to reliable laboratory services. Therefore,

Tunajali will continue to support laboratory services in all CTCs. To avoid disruption of laboratory services,

Tunajali will also support the procurement of solar panels for remote sites lacking electricity, and the regular

maintenance and repair services of laboratory equipment at all sites. In addition, induction and refresher

training will also be provided for lab technologists. Tunajali will provide technical assistance in laboratory

services to ensure use of quality control systems and CTC collaboration with the MOHSW Diagnostic

Services Department. Partnerships will continue with organizations such as the AIHA, whose ongoing

support includes volunteer lab specialists at two sites. Also, collaboration with the MOHSW lab

subcommittee and CDC lab support group will continue.

In FY 2009, Tunajali will intensify its efforts in nutritional support for PLWHA. Specifically, Tunajali 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. Tunajali will procure the necessary equipment required to carry out 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, Tunajali will ensure the identification of clients eligible for the pilot therapeutic

supplemental feeding program. Finally, Tunajali will link with other organizations addressing household

food security and economic strengthening to ensure PLWHA have access to these services. A

Permaculture gardening video shown in the CTC waiting room will demonstrate simple and efficient

gardening techniques that patients can apply. Those interested in learning more will be linked with

volunteers trained in the techniques.

Activity Narrative: Tunajali will continue to focus on improving the quality of services through regular supportive supervision,

clinical mentoring, training and technical assistance. In collaboration with RHMT, CHMT, and key CTC

staff, Tunajali will expand on quality improvements (QI) measures initiated in FY 2007 to monitor key facility-

based indicators. Tunajali employs a participatory approach to QI, which contributes to improved morale

among local health authorities and health workers. The project will also continue to work with partners,

including University Research Center, PharmAccess, and the Capacity Project on the collaborative QI

initiative.

Tunajali will place particular emphasis on ensuring adequate human resources at facilities, though the lack

of qualified staff continues to hinder the quality of services and poses a significant barrier to scale-up in

many sites, particularly those in the more remote areas. Tunajali will expand a successful pilot of using

retired clinical officers to alleviate this crisis, and will explore task shifting at the CTC; nurse attendants will

triage patients; lay counselors and HBC coordinators will assist in referral to and from HBC, adherence

counseling, and follow-up of missed appointments; and PLWHA will work at CTCs assisting with clerical

duties. Tunajali will also continue to explore ways to deploy final-year students from Allied Health Schools

to rotate in CTCs using the Mufindi District Initiative as a learning model.

Tunajali will continue to conduct regular meetings with senior regional and district authorities, including the

RHMT and CHMT, to orient and update them on achievements and challenges. This includes supporting

district-level Continuum of Care Committees that will provide an important forum for district-level

stakeholders to exchange information and strengthen linkages. In addition, Tunajali will continue to build

the capacity of the RHMT/CHMT in planning, coordination, and monitoring through joint supervision visits

and refresher trainings. These strategies aim to improve the capacity of government authorities to

maximize resources and create ownership.

Tunajali will continue to work with PLWHA groups, volunteers, and community members to assist in

escorted referrals between various units in the facility and the CTC. Tunajali will further expand the

establishment of HIV-positive health worker groups to assist in promoting stigma reduction, encourage

health staff to access care and assist in treatment adherence.

Despite comparable prevalence rates, males continue to be under-represented in accessing care. Tunajali

will increase focus on male participation by encouraging family-centered services and promoting testing

services for males. This will include designating a family day at the CTC for HIV-positive individuals and

their partners. To reduce stigma, the video developed by I-TECH will be used to sensitize providers. In

collaboration with the Muhimbili Health Information Center, Tunajali will start specific training of trainers in

stigma reduction within healthcare settings, and cascade this training to health staff working at Tunajali-

supported facilities.

An important feature of the Deloitte/FHI/EMG partnership is the financial management technical assistance

provided to health facilities. This is critical as grants are provided to faith-based organizations and through

regional/district health authorities to the facilities. Deloitte will continue to ensure close financial

management of sub-grantees. This financial management will be achieved by strengthening financial

control systems by employing regional financial management teams. These teams will encourage timely

spending and liquidation. They will minimize the opportunity for fraud, abuse, and mismanagement of

funds. They will monitor disbursements of grants, conduct financial assessments and periodic reviews and

build capacity in fiscal accountability. These measures will also help to build transparency and

sustainability, and accelerate the possibilities for graduation toward direct funding in appropriate cases.

LINKAGES: An important linkage is between facility-based care and support and community HBC services.

This link is critical as all care and support cannot be done at the facility. Linkages between these services

will strengthen two-way referrals between CTCs and the HBC program. The district-based Continuum of

Care Committees, which is supported by Tunajali, chaired by the District AIDS Coordinator and includes

community-based organizations providing HBC, will ensure an effective referral system in each district. In

FY 2009, the program will strive to achieve the referral of all patients registered at the CTC to a community

HBC program. (NOTE: total care and support targets are de-duplicated at the national program level for

patients who receive facility-based services from this partner and HBC services from either this or other

USG-supported partners).

Tunajali will continue to involve PLWHA support groups to involve PLWHA as peer counselors providing

psychosocial support and referrals to community services such as nutritional support, income generating

activities and legal service. In addition, PLWHA support groups will actively engage communities in

outreach activities and promote awareness of care services.

In addition, Tunajali will work with the Strategic Radio Communication Program (STRADCOM) and other

media organizations to develop and disseminate accurate messages about care services.

Tunajali will also link with the national malaria program supported by the Presidential Malaria Initiative and

the Global Fund at regional and district levels to extend provision of ITNs.

M&E: Tunajali will continue to collaborate with the NACP to implement the national M&E system for care

and treatment, focusing on continuing efforts in transitioning from the paper-based tools to electronic

versions for all CTCs. Funds will be provided to each initiating CTC to purchase a computer. Tunajali will

ensure quality of data through supportive supervision by trained CHMT/RHMT members and Tunajali staff.

To facilitate collection and timely submission of reports to the NACP, the program will support installation of

internet or fax services and technical assistance. Tunajali will also continue to share regional data reports

with the Regional AIDS Control Coordinators.

Tunajali will work with individual CTCs to assist with generation of simple additional data reports for use in

planning and quality improvement at each site. Currently, all initiating CTCs are using the national Microsoft

Access-based CTC2 database; however, many do not have experienced data clerks, which has led to

Activity Narrative: significant data entry backlogs. Tunajali will support sites to employ temporary data clerks, who will assist

the newly-trained data clerks to enter patient information in a timely manner. In addition, to alleviate the

frequent stock-outs of CTC2 patient forms, Tunajali will provide technical assistance to improve the supply

system of paper-based tools at the CTCs. In FY 2009, Tunajali will support the training of 250 healthcare

workers in M&E and electronic data management; and provide technical assistance to 125 health facilities,

four regional offices, and 27 DHMT/CHMTs.

SUSTAINABILITY: Tunajali is committed to sustainability and will continue to work through local authorities

to put the responsibility for sustainability into their hands. Training and mentoring of CTC staff, RHMTs, and

CHMTs to build technical and management capacity, and to continue using national standards and

guidelines will also help ensure sustainability. Authorities will be continually informed of lessons learned

and innovative approaches, facilitating the adoption and updating of national norms, standards, and

guidelines. Tunajali will participate in the GOT's budgeting and planning cycles at district and regional levels

to ensure integration of HIV treatment services in Comprehensive Council Health Plans.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18377

Continued Associated Activity Information

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

System ID System ID

18377 18377.08 U.S. Agency for Deloitte Consulting 6510 1197.08 Fac Based/RFE $200,000

International Limited

Development

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $534,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.08:

ACTIVITY UNCHANGED FROM FY 2008.

TITLE: The Rapid Funding Envelope for HIV/AIDS (RFE) in Tanzania

NEED AND COMPARATIVE ADVANTAGE: To increase participation of civil society, ten donors and the

Tanzanian Commission for AIDS (TACAIDS) cooperated in creating a "Rapid Funding Envelope (RFE) for

HIV/AIDS" to assist with the HIV/AIDS response in mainland Tanzania and Zanzibar. The RFE is a

competitive mechanism to support not-for-profit civil society institutions, academic institutions, and

partnerships on projects up to a maximum of 12 months. The RFE allows Civil Society Organizations

(CSOs) to implement projects, build capacity, and improve project coordination and management skills,

while gaining experience and lessons learned on HIV/AIDS interventions. Projects funded by the RFE are

required to comply with national policy and the strategic framework for HIV/AIDS as set by TACAIDS and

the Zanzibar AIDS Commission (ZAC), with goals of contributing to longer-term objectives of the national

response and encouraging projects that promote institutional partnerships and have potential for scale up.

ACCOMPLISHMENTS: To date, the RFE has conducted seven rounds of grant making and approved $11.2

million for 78 projects. In FY 2007, the RFE successfully held a fourth round, providing awards worth $3.5

million to 23 CSOs; monitored and managed existing sub-grantees; created a reliable base for donors to

reference without duplicating efforts; continued to strengthen CSOs, financially and technically, thus laying a

solid foundation for further funding; and facilitated increased resources for CSOs via disbursement of

significant funding in a short timeframe. Generally, funding leveraged from other donors cover the cost of

the grants, and the USG funds are used for management of the funds. Ongoing activities for FY 2008 will

include:

1. Grants and financial management of existing sub-grantees including disbursements of grants, liquidation

reviews of sub-grantee financial reports, and M&E of projects.

2. Technical monitoring and management of existing sub-grantees, including a review of project work plans

and progress reports, review of project deliverables, and M&E of projects.

3. Completion of the fifth open round of funding including conducting pre-award assessments and sub

contracting to about 40 CSOs,

4. Financial administration of the RFE fund (USG and multi-donor accounts) including management of

donor receipts, preparation of financial reports, and engaging project audits.

5. Grants and project administration including external RFE communications/correspondence, convening of

donor meetings, and preparation of (ad-hoc) reports.

This component of the funding for the RFE will support management of palliative care activities. The

management funds are maintained in a non-pooled account, which will leverage an approximately additional

$2 million of funding through multi-donor support of palliative care projects.

LINKAGES: In keeping with previous arrangements, Deloitte Consulting Limited is the prime partner and the

lead for grants and finance management. They will link with Management Sciences for Health (MSH) as the

lead technical partner for supporting the RFE, and Emerging Markets Group (EMG) for initiating capacity-

building initiatives to CSOs. The RFE will work closely with the TACAIDS and ZAC in all aspects of work;

ensuring that they champion decisions made, including the path that each RFE round makes. RFE will also

develop formal linkages with large funding mechanisms including Foundation for Civil Society and Regional

Facilitating Agencies (World Bank T-MAP funding agents) to develop information networks and a common

database of funded CSOs to avoid duplication of efforts. In efforts to encourage organizational

development, RFE will share funding experiences with each donor to ensure that the right level of funding

and capacity support is provided to the CSO. With a special round under the proposed PPP initiative,

linkages will be formed with private organizations and workplaces to create partnerships in support of

workplace facilities providing HIV-related services to local communities.

CHECK BOXES: The RFE will fund organizations that support OVC within the national guidelines,

specifically targeting young girls, to provide them access to income-generating opportunities. The RFE will

support capacity building through various steps including the pre-award assessment that highlights key

areas of weakness to be strengthened in the capacity plan, technical assistance/training on programmatic

(HIV) issues and finances, and ongoing coaching from the grant manager and technical advisor.

M&E: The RFE will develop annual work plans, which will include built-in M&E for which the relevant RFE

staff member takes responsibility. RFE management will continue to conduct the following M&E activities:

regular update of project through participation in activities; quarterly reviews of technical reports for

performance against work plan; monitoring through field visits; collection of data; preparation of site visit

reports; and progress reports. The progress reports will be shared with concerned CSOs and donors, to

enable improvement and development of these organizations. Best lessons learned will be captured and

shared, publicized on the RFE website, and processed in a database according to the plans of TACAIDS

and ZAC. They will also be shared through the OVC Implementing Partners Group.

SUSTAINABILITY: RFE will encourage CSOs to foster local community networks that will assist in

continued operations of the project once RFE funding has ended. RFE requires projects to consider the

issues of sustainability during the proposal development and ensures that a realistic plan has been

developed to integrate the project into existing programs. RFE supported CSOs will also be provided

institutional capacity-building support enabling them to graduate to direct funding and/or increase the level

of funding from other donors post RFE funding. A new management structure will be proposed to the

donors to better manage the function of the RFE, whose mandate has changed from its original form due to

the number and size of projects funded.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13463

Continued Associated Activity Information

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

System ID System ID

13463 8707.08 U.S. Agency for Deloitte Consulting 6510 1197.08 Fac Based/RFE $300,000

International Limited

Development

8707 8707.07 U.S. Agency for Deloitte Touche 4532 1197.07 $275,000

International Tohmatsu

Development

Table 3.3.08:

ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP

TITLE: TUNAJALI HIV/AIDS Treatment Program

NEED AND COMPARATIVE ADVANTAGE:

The Deloitte Consulting Limited, Family Health International (FHI) and Emerging Markets Group (EMG)

partnership has worked to strengthen health care systems and HIV/AIDS services in Dodoma, Iringa,

Morogoro, and Singida since FY 2007 under the Tunajali (Kiswahili for "we care") Program. The 2008

Tanzania HIV/AIDS Survey (THIS) reported slightly decreased prevalence rates since 2004 in Dodoma,

Morogoro, and Singida (4.2%, 3.3% and 2.6% respectively), though the increase in prevalence in Iringa

Region to 14.7% is alarming. The Tunajali partnership supports 52 Care and Treatment Clinic (CTC) sites

in these four regions; however, the sites have only reached approximately 50% of the People Living with

HIV/AIDS (PLWHA) estimated to need care services. Testing results also indicate that the prevalence rates

in urban and semi-urban areas is generally much higher than regional figures. The Deloitte/FHI/EMG

partnership has gained respect among regional and district Government of Tanzania (GoT) authorities as a

result of its emphasis on working through government systems; therefore, it is well placed to support the

health care systems in the aforementioned regions.

ACCOMPLISHMENTS:

By September 2008, Tunajali supported a total of 52 CTCs, of which 13 are new CTCs within health centres

(HC). The program reached a total cumulative number of clients on Anti-Retroviral Therapy (ART) of

36,225 clients, 33, 758 of which are adults; an estimated 22,300 clients are current patients, who will

continue to receive ART. Tunajali has trained 247 staff in basic ART management; 58 in-depth refresher;

126 in adherence counseling; and 38 in monitoring and evaluation (M&E). In addition, Tunajali expanded

the recruitment of retired clinical staff officers at the regional hospitals, bringing the recruitment total to 30

officers. Continued collaboration with the Tunajali Community Home-based Care (HBC) and Orphans

Vulnerable Children (OVC) program has resulted in HBC enrollment of more than 50% of all patients on

treatment.

In the area of laboratory support, Tunajali equipped all CTC laboratories to assess patients routinely before

initiation of ART and to monitor the response to therapy. Tunajali support to laboratories included: minor

renovations; procurement of relevant equipment including CD4; automated hematology and biochemistry

machines; and emergency buffer stock of reagents and other supplies to complement the often erratic

supplies from the Ministry of Health and Social Welfare (MoHSW).

ACTIVITIES:

In FY 2009, Tunajali will continue to support ongoing treatment services in CTCs and will expand to reach

additional HC. In each district, Tunajali will work closely with the Regional Health Management Teams

(RHMT) and the Council Health Management Teams (CHMT) to be strategic in identifying, initiating, and

monitoring services at HC in areas with higher prevalence. Tunajali will provide performance-based grants

to health facilities, ensuring that CTCs in hospitals and HCs meet the minimum standards of care. Tunajali

will support minor renovations to accommodate expansion of services to initiate or improve ART services;

procurement of laboratory equipment; purchase of buffer stocks of lab reagents and other commodities

when Medical Supplies Department (MSD) supplies are unavailable; procurement of motorcycles for

supportive supervision and transport of samples to district-level laboratories; training and mentoring staff in

ART provision; and facilitating Provider-initiated Testing and Counseling (PITC), adherence counseling, and

M&E.

The provision of ART services requires access to a reliable supply of ART drugs. Weaknesses in the

government's supply chain system lead to an erratic supply of commodities for the facilities, periodically

resulting in stock-outs of reagents and drugs, including Anti-Retroviral (ARV) drugs. Therefore, an

important area of Tunajali support will be in building the capacity of regional, district, and health facility staff

in logistics management of drug and laboratory supplies. The project will continue to support the

emergency purchase of supplies and other commodities when circumstances require it.

Tunajali will ensure reliable laboratory services. It will ensure that at least 250 counselors are trained in

PITC, VCT using rapid HIV testing, and quality assurance using the national training module as

recommended by WHO/CDC. It will expand MoHSW zonal quality assurance/control activities by working

with zonal, regional, and facility-level quality assurance officers in the supportive supervision of all CTC in

the zone. Additionally, Tunajali will support zonal external laboratory quality assurance activities by

supporting the quarterly meetings and ensuring enrollment and participation of 38 labs in national and

international quality assurance programs.

Tunajali will support equipment service and maintenance, and will train approximately 200 lab staff and four

zonal equipment engineers on planned preventive maintenance. It will ensure the zonal equipment engineer

performs quarterly supervision visits. Tunajali will ensure that quarterly reports on equipment status are

submitted to the zonal director and the equipment engineer at MoHSW Diagnostic Services Department.

Tunajali will work with SCMS and the USG lab team to build the forecasting and logistics capacity of

approximately 200 CTC laboratory staff, ensuring uninterrupted quality laboratory services. If unavailable

through GoT sources, Tunajali will procure hematology, chemistry, CD4 count, and DNA PCR for early

infant diagnosis reagents. It will also procure 35 additional laboratory devices (CD4, chemistry and

hematology analyzer) for hard-to-reach CTCs.

Tunajali will continue to focus on improving the quality of services through regular supportive supervision,

clinical mentoring, training, and technical assistance. In collaboration with RHMT, CHMT and key CTC staff,

Tunajali will expand on quality improvement (QI) measures initiated in FY 2007 to monitor key facility-based

indicators. Tunajali employs a participatory approach to QI, which contributes to improved morale among

local health authorities and health workers. The project will also continue to work with partners, including

University Research Center (URC), PharmAccess, and the Capacity Project on the collaborative quality

improvement initiative.

Activity Narrative: Tunajali will place particular emphasis on ensuring adequate human resources at facilities, though the lack

of qualified staff continues to hinder the quality of services and poses a significant barrier to scaling up in

many sites. Therefore, Tunajali will periodically train back-up teams to ensure provision of safe and effective

ART. Tunajali will continue the successful pilot of using retired clinical officers to alleviate this crisis, and

exploring task shifting, for example: nurse attendants will triage patients; lay counselors and HBC

coordinators will assist in referral to/from HBC, adherence counseling and follow-up of missed

appointments; and PLWHA will assist with clerical duties. Tunajali will also explore ways to deploy final-

year students from Allied Health Schools to rotate in CTCs.

Tunajali will continue to conduct regular meetings with senior regional and district authorities, including the

RHMT and CHMT, to orient and update them on achievements and challenges. Tunajali will support district

-level Continuum of Care Committee meetings where stakeholders can exchange information and

strengthen linkages. Tunajali will continue to build the capacity of the RHMT/CHMT in planning,

coordination, and monitoring to ensure that planning for HIV treatment is integrated into ongoing health

service delivery. This will include assisting local authorities to prioritize care and treatment activities and to

leverage support from other donors. This strategy aims to improve the capacity of government authorities to

maximize resources, while also creating ownership since many health authorities view CTC activities as a

vertical program and not part of the health facilities' general services.

Tunajali will intensify its efforts to follow up patients who miss treatment appointments, given that a

substantial number of clients (24%) are lost to follow- up for various reasons, which contributes to low

numbers of clients registered as currently on treatment and increases the chance of developing resistance

to first-line ARVs. Tunajali will work with CTCs and existing PLWHA groups and volunteers supported by

the Tunajali Community Care for PLWHA and OVC project to support active follow-up home visits to

patients who miss appointments. PLHWA will also be given supportive roles as counselors and role models

to promote ART literacy, focusing on treatment preparedness and enhancing adherence. In addition,

Tunajali will continue to promote the establishment of HIV-positive health worker groups and involve them in

addressing stigma in the health care setting and adherence of clients on ART.

Despite comparable prevalence rates, males continue to be under-represented in accessing care and

treatment. Therefore, Tunajali will increase focus on male participation by encouraging family-centered

services, and promote testing services for males. This will include designating a family day at the CTC for

infected individuals and their partners. To reduce stigma, the video developed by I-TECH about stigma in

the health care workplace will be used to sensitize providers; and Tunajali, in collaboration with the

Muhimbili Health Information Center (MUHIC), will start training of trainers in stigma reduction within health

care settings, and then cascade this training to health staff working at health facilities.

An important feature of the Deloitte/FHI/EMG partnership is the financial management technical assistance

provided to health facilities. This support is critical as grants are provided to faith-based organizations and

through regional/district health authorities to the facilities. One of the main challenges has been the lack of

financial staff with the required competency to manage and account for the CTCs' finances. Deloitte will

continue to ensure close financial management of sub grantees by: monitoring disbursements of grants;

conducting financial assessments and periodic reviews; and providing capacity building in fiscal

accountability. These measures will help to build transparency and sustainability, and accelerate the

possibilities for direct funding in appropriate cases.

LINKAGES:

To ensure comprehensive care, Tunajali will strengthen linkages between communities and health facilities,

and within each health facility between the CTC and various units (pediatric wards, TB and PMTCT) through

existing district-based Continuum of Care committee meetings, regular feedback sessions between facility

and HBC programs, and regular health facility staff meetings. Through these mechanisms, Tunajali will

ensure implementation and monitoring of two-way referrals.

Tunajali will continue to work in partnership with EngenderHealth in Iringa and the FHI/Abbott Fund project

in Dodoma to strengthen linkages between PMTCT and CTC facilities. Tunajali will ensure coordination of

activities between partners and integration of PMTCT with treatment activities. Close linkages with CTC

activities are already being addressed through regular CTC and Maternal and Child Health staff meetings,

where discussions address commodity supply issues, referrals, supportive supervision, and monitoring of

activities.

Tunajali will continue to collaborate with the National AIDS Control Programme (NACP), National

Tuberculosis and Leprosy Programme (NTLP), and the National Reproductive Health Programme,

informing them of lessons learned and facilitating piloting of innovative approaches in collaboration with the

FHI USG-supported Systems Strengthening Project. In addition, Tunajali continues to work closely with

other partners implementing treatment activities to coordinate and harmonize treatment efforts. To increase

case finding, Tunajali will link with USG partners charged with scaling up PITC.

Tunajali will continue to work with Strategic Radio Communication Program (STRADCOM) to develop and

disseminate accurate messages about HIV treatment and services. It will continue to involve PLWHA

support groups, such as NETWO+, to engage communities in outreach activities and promote awareness of

treatment services. Tunajali will also collaborate with local clerics and dioceses to strengthen partnerships

with faith-based networks and organizations in the community.

M&E:

Tunajali will continue to collaborate with NACP to implement the national M&E system for Care and

Treatment, focusing on continuing efforts in transitioning from the paper-based tools to electronic versions

for all CTCs. Funds will be provided to each initiating CTC to purchase a computer. Tunajali will ensure

quality of data through supportive supervision by trained CHMT/RHMT members and Tunajali staff. To

facilitate collection and timely submission of reports to NACP, the program will support installation of

Activity Narrative: internet or fax services and technical assistance. Tunajali will also continue to share regional data reports

with the Regional AIDS Control Coordinators (RACC).

Tunajali will work with individual CTCs to assist with generation of simple data reports for use in planning

and quality improvement. Currently, all initiating CTCs are using the national MS Access-based CTC2

database, however many do not have experienced data clerks, which has led to significant data entry

backlogs. Tunajali will support sites to employ temporary data clerks, who will assist in entering patient

information in a timely manner. In FY 2009, Tunajali will support: training of 250 health care workers in

M&E and electronic data management; and provide technical assistance to 125 health facilities, four

regional offices, and 27 CHMT.

SUSTAINABILITY:

Tunajali is committed to sustainability and will continue to work through local authorities to create

ownership, putting the responsibility of sustainability into their hands. Training and mentoring of CTC staff,

technical and management capacity building of RHMTs and CHMTs, as well as continued use of national

standards and guidelines, will also ensures sustainability. Authorities will be continually informed of lessons

learned and innovative approaches, facilitating the adoption and updating of national norms, standards, and

guidelines. Tunajali will participate in the GoT budgeting and planning cycles at the district and regional

levels to ensure integration of HIV treatment services in Comprehensive Council Health Plans.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13467

Continued Associated Activity Information

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

System ID System ID

13467 3443.08 U.S. Agency for Deloitte Consulting 6510 1197.08 Fac Based/RFE $11,760,554

International Limited

Development

7701 3443.07 U.S. Agency for Deloitte Touche 4532 1197.07 $8,500,000

International Tohmatsu

Development

3443 3443.06 U.S. Agency for Deloitte Touche 2857 1197.06 $2,845,000

International Tohmatsu

Development

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $300,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $100,000

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Estimated amount of funding that is planned for Economic Strengthening $400,000

Education

Water

Table 3.3.09:

THIS IS A NEW ACTIVITY

TITLE: Tunajali Care and Treatment - Pediatric Facility-based Care and Support

NEED and COMPARATIVE ADVANTAGE: Deloitte Consulting Limited, working in partnership with Family

Health International (FHI) and Emerging Markets Group (EMG) is the primary care and treatment partner in

Dodoma, Iringa, Morogoro and Singida. Under the Tunajali (Kiswahili for "we care") program, this

partnership endeavors to strengthen existing structures in sites accredited as Care and Treatment Centers

(CTCs) in order to scale-up access to care and treatment. Although sustained treatment is the primary

objective, this cannot happen in isolation of the basic care and support services that ensures

comprehensive pediatric HIV care. Tunajali aims to ensure that at least 10%-15% of patients on care are

children. Since inception in FY 2007, the Deloitte/FHI/EMG partnership has gained significant recognition

and respect in the regions served, and established strong working relationships with the regional and district

Government of Tanzania (GOT).

ACCOMPLISHMENTS: The program will have enrolled an estimated 63,000 cumulative clients on care by

the end of September 2008. Of these, 5,670 will be pediatric clients, and an estimated 75% will be

receiving Cotrimoxazole prophylaxis. All patients attending CTCs are routinely assessed for pain and

nutritional status. In addition, the program will train 78 healthcare workers in pediatric antiretroviral care and

support and 10 healthcare workers per region in Early Infant Diagnosis (EID).

Initiatives that contribute to the provision of pediatric treatment include regular supportive supervision visits

that focus mainly on 1) the importance of EID with suspected cases of exposed infants and infants/children

with suspected HIV referred for Provider-Initiated Testing and Counseling (PITC), and 2) promotion of a

family-centered approach to services at CTCs and other clinics. This is achieved by establishing family

clinics on a specific day of the week in five of the large hospitals, allowing for more focused management for

parents and children, and convenient access to Prevention of Mother-to-Child Transmission (PMTCT)

services. At health centers and dispensaries, successful adherence to pediatric care has been earned by

ensuring that parents and children have same-day appointments; promoting child-friendly environments

through play areas and refreshments; and ensuring that a pediatric nurse or clinician is available.

Training of healthcare workers using the national pediatric care and treatment curriculum has contributed to

raising awareness and making staff more receptive to PITC. Additionally, referrals from targeted pediatric

entry points including PMTCT, Maternal and Child Health (MCH), pediatric wards, pediatric outpatient

(OPD) clinics and home-based care (HBC) testing at pilot sites in Tunajali regions also contributed to

reaching more children. In two major hospitals, establishing testing corners in the pediatric ward was very

productive. This was made possible by offering pediatric management training of at least two health care

workers from all sites using the national curriculum, as well as EID training of 20 MCH and hospital nurses

from Iringa. This training resulted in raising awareness to care and treatment opportunities for children and

PITC resulting in referral increase at sites. Linking with American International Health Alliance (AIHA)

Twinning preceptor program, through which pediatricians specialized in antiretroviral therapy (ART) are

attached to three hospitals, has ensured availability of pediatric care and support services and contributed

to the accomplishments of Tunajali. Finally, establishing strong linkages with FHI's Abbott-funded PMTCT

Plus Program in Dodoma yielded a significant increase in referrals of children to CTCs.

Strengthening linkages with the Tunajali HBC program increased the number of orphans and vulnerable

children (OVC) referred for care and treatment. Two mission hospitals provided comprehensive care,

including nutritional assessments, counseling and supplements (through donations) for children registered

on-site as well as for those referred from neighboring government CTCs.

ACTIVITIES: FY 2009 funding will be used to scale up ongoing pediatric care and support services in 39

CTCs, with the goal of reaching at least 86 health centers providing ART services. Tunajali will work closely

with local authorities to prioritize health centers in high prevalence areas. The program will provide grants

to support activities that will specifically target children, ensuring that services for this population meet the

minimum standards of care as defined by the national guidelines. Activities supported will include: minor

renovations to accommodate expansion of services to include and improve ART services; procurement of

furniture and equipment; purchase of buffer stocks of Cotrimoxazole, pediatric formulations, lab reagents

and other commodities to complement Medical Stores Department supplies; procurement of motorcycles for

supportive supervision visits and transporting samples; and training of health center staff in ART provision,

PITC, adherence counseling, and Monitoring and Evaluation (M&E), using national guidelines and

curriculum.

The program will also focus on encouraging the establishment of a family-centered approach to care for

those sites which have not already adopted this practice. This includes the establishment of family clinics

on a specific day in the week to facilitate a more focused-care approach targeting the entire family; where

not possible, the program will continue to promote scheduling of same-day appointments for mothers and

children, ensuring the availability of clinical staff to provide care services, including Cotrimoxazole

preventive therapy, access to insecticide-treated nets (ITNs) through vouchers, nutritional assessments

(anthropometry, Body Mass Index), referrals for supplements, health education to mothers or guardians,

including dosages, adherence, hygiene and nutrition. Emphasis will also be placed on treatment of

opportunistic infections and other HIV/AIDS-related complications, including malaria and diarrhea, and pain

and symptom management. The program will also expand the initiative of establishing testing corners within

the pediatric wards; this has shown to be an effective means of PITC as reported by the two sites where this

is already established. Tunajali will also participate in planned food by prescription pilot programs for

patients who qualify.

Linkages with PMTCT, MCH, under-five clinics or pediatric/OPD clinics to CTCs will continue to be an

integral approach in the program where patients identified mainly through PITC will then be referred to the

CTC, using nurse escorts to ensure accompanied referrals to the CTC. Due to staff shortages, this initiative

will be expanded to an additional four district hospitals in this year.

Activity Narrative: Expansion of pediatric care services to health centers is a challenge not only because only a very small

number of health center staff has had specific pediatric care and treatment training, but also because most

sites are only just starting on adult HIV care and treatment in general, which hampers them from focusing

on pediatric care. The program will continue to train healthcare workers in the provision of pediatric care,

since this area is now commanding the special attention that was lacking toward encouraging PITC and

increasing enrollment of children and adolescents on treatment. In addition, at least 20 healthcare workers

from each region will undergo EID training in Mbeya, and to the extent possible, Deloitte will partner with

Baylor's Pediatric AIDS Initiative to train health workers through attachments. This year, the program will

also make concerted efforts towards the provision of on-site mentoring and supportive supervision by

Tunajali teams working in collaboration with health management teams. The program will also link with

both the Baylor program and the AIHA Twinning program for clinical mentors to ensure specialized

approaches for children.

LINKAGES: The program will continue to focus on strengthening linkages with programs aimed at

increasing the number of children accessing ART and improving the quality of treatment. An important

linkage is between facility-based care and support and HBC. This link is critical as all care and support

cannot be done at the facility. Tunajali will strengthen referrals between the CTC to the community HBC.

The district-based Continuum of Care Committee, which is chaired by the District AIDS Coordinator and

whose membership includes community-based organizations providing HBC, will ensure an effective

referral system within each district. The program will also strengthen its links with the Tunajali HBC/OVC

program, planning together in order to target some of their sub-grantees who run day cares for OVC,

providing an opportunity for counseling and referral to CTCs for appropriate management.

Tunajali will continue to collaborate with partners offering PMTCT, namely EngenderHealth in Iringa and

FHI/Abbott in Dodoma. Follow-up care and support for mother-child pairs who access PMTCT services is

essential to ensure the continuum of comprehensive care. In Morogoro and Singida, Tunajali will implement

PMTCT activities and facilitate referrals between CTC and PMTCT clinics for additional supportive services.

In addition, Tunajali will link with the Baylor Pediatric AIDS Initiative, particularly in the hard-hit HIV

prevalence areas of Iringa.

Where possible, patients will be referred to other services that exist in some communities for nutritional

support, ITNs, and safe water, as Tunajali aims to ensure that resources are optimized so that as many

children as possible have access to the comprehensive package of care. Presently resources are

leveraged by linking with programs that already are available in communities (e.g., nutrition programs

already operating in Iringa, or the under five campaign for ITNs throughout Tanzania).

Lab support:

The provision of care and treatment services requires access to reliable laboratory services for initial

assessment prior to initiation of ART, and monitoring for response to treatments and/or toxicity. Tunajali will

continue to support lab services at all CTCs by funding minor renovations when necessary; purchasing

solar panels for remote sites lacking electricity; supporting the upkeep of equipment at all sites through

regular maintenance and repair services; procuring essential equipment and commodities, including CD4

machines, automated hematology and biochemistry machines where lacking; and stocking surplus reagents

and other supplies to complement supplies from the Ministry of Health and Social Welfare (MOHSW). The

program will also support transporting samples for testing for facilities lacking adequate lab services.

Induction and refresher training for personnel involved in the program will also be supported. A lab

technician has been hired, whose role is to ensure that all sites maintain good links and collaboration with

the MOHSW Diagnostic Services Department for troubleshooting, whilst also ensuring that quality

assurance and control systems are maintained. Partnerships with referral labs for service delivery and

organizations such as AIHA (which provides lab technical assistance) will continue. The program will also

set up systems for all sites for the transportation of dried blood samples for DNA Polymerase Chain

Reaction testing at sites that offer these services, such as Village of Hope for sites in Dodoma and

Morogoro, and Mbeya for sites in Iringa and Singida.

M&E: Tunajali will continue to collaborate with the National AIDS Control Programme (NACP) and MOHSW

to implement the national M&E system for care and treatment in its four regions. Efforts will continue to

focus on transitioning from using the national paper-based tools to electronic versions in all CTCs. The

program will provide funds for each, initiating the CTC to purchase a computer that will be used to store

patient monitoring data. Quality of data will be assured through supportive supervision by Tunajali regional

M&E officers working in collaboration with trained Council and Regional Health Management Teams (CHMT

and RHMT) members where possible.

Tunajali will continue to collect reports from sites to be submitted to the NACP as requested by the

MOHSW. Tunajali will also continue to share regional data reports with Regional AIDS Coordinators.

Tunajali will work with CTCs to assist with generation of simple data reports for use by the sites in planning

(e.g., to improve appointment scheduling and drug forecasting) and for feedback and quality improvement.

Currently, all initiating CTCs are using the national Microsoft Access-based CTC2 database. In addition to

encouraging timeliness of reports, the program will support installation of internet services (and fax where

this is not possible) in CTCs to facilitate report submissions. The program will also provide technical

support to all sites that have a computer and internet connection. In FY 2009, Tunajali will support training

of 250 healthcare workers on M&E and electronic data management, provide technical assistance to 125

health facilities, four regional offices, and 27 RHMT and CHMT.

SUSTAINABILITY: Tunajali is committed to sustainability and plans to continue to work through local

authorities to create ownership, putting the responsibility of sustainability into their hands. Training and

mentoring of CTC staff, RHMTs, and CHMTs to build technical and management capacity, and continuing

to use national standards and guidelines also helps ensure sustainability. Authorities are continually

informed of lessons learned and innovative approaches, such as the family-centered approach to treatment

Activity Narrative: and facilitating the adoption and updating of national norms, standards and guidelines. Tunajali will

participate in the GOT budgeting and planning cycles at district and regional levels to ensure integration of

all programs.

Geographic Coverage Areas: (Regions) Iringa, Morogoro, Dodoma, Singida

New/Continuing Activity: Continuing Activity

Continuing Activity: 18377

Continued Associated Activity Information

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

System ID System ID

18377 18377.08 U.S. Agency for Deloitte Consulting 6510 1197.08 Fac Based/RFE $200,000

International Limited

Development

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

* Malaria (PMI)

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $15,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $5,000

and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $40,000

Economic Strengthening

Education

Water

Table 3.3.10:

THIS IS A NEW ACTIVITY.

Title: Deloitte Tunajali - Pediatric Treatment Program

Need and Comparative Advantage: In the recently published THIS report, the average prevalence rate is

reported to be at 16.8% in Iringa, 6.1% in Morogoro, 4.0% in Dodoma and 2.8% in Singida. In urban and

semi-urban areas, however, the prevalence rate is estimated to be higher than the average reported figures.

Deloitte Consulting Limited serves as the primary treatment partner, working in partnership with Family

Health International (FHI) and Emerging Markets Group (EMG) in the aforementioned regions. The

program, called Tunajali ("we care" in English), endeavors to strengthen existing structures in sites

accredited as Care and Treatment Centers (CTCs) in order to scale up access to pediatric care and

treatment. Tunajali aims to ensure that at least 10-15% of the patients on ART are children. Since its

inception in FY 2007, Tunajali has gained significant recognition and respect in the regions served, and

maintains strong working relationships with the Government of Tanzania (GoT) at district and regional

levels.

Accomplishments

By September 2008, 40 CTCs supported by Tunajali will have enrolled a cumulative 36,225 clients on

antiretroviral therapy (ART), of which about 2,500 were pediatric clients. Based on the program's most

current report, Tunajali estimates that 1,940 of these clients will be current pediatric patients who continue

to receive ART. In addition, the program aims to have trained 78 health workers in pediatric ART

management and 10 health workers per region trained in early infant diagnosis (EID).

Initiatives that have contributed to the provision of treatment for children include: regular supportive

supervision visits that focused mainly on the importance of early diagnosis to children at various entry points

and referring suspected exposed or infected children for treatment eligibility assessment; and promoting a

family-centered approach to services at the CTC and other clinics, including Prevention of Mother-to-Child

Transmission (PMTCT), by establishing family clinics on a specific days of the week in five of the large

hospitals, thus allowing for more focused management for parents and children. In sites where this was not

feasible, ensuring that parents and children have same day appointments has also been productive.

Promotion of child friendly environments by providing play corners, refreshments, and ensuring that a

pediatric nurse/clinician is readily available encouraged patient attendance.

Training of health workers using the national pediatric care and treatment curriculum contributed to raising

awareness and making staff more receptive to provider-initiated testing and counseling (PITC). Referrals

from targeted pediatric entry points including PMTCT, Maternal Child Health (MCH) Clinics, pediatric wards,

pediatric outpatient departments (OPDs), and home-based care (HBC) testing at pilot sites in Tunajali

regions also contributed to reaching more children. Similarly, linking with the AIHA twinning preceptors'

program in three hospitals, where a pediatrician specialized in ART was attached, ensured availability of

pediatric ART services and contributed to the accomplishments of Tunajali in this area.

Activities:

The funding requested for FY 2009 for pediatric ART services will be used primarily to scale up ongoing

services in CTCs currently supported, and scale up to reach more Health Centres accredited by the Ministry

of Health and Social Welfare to provide ART services. Tunajali works in collaboration with local authorities

to prioritize those health centres in higher prevalence areas. The program will ensure that ART services for

this population meet the minimum standards of care as defined by the national guidelines, irrespective of

location. Specific activities will include strengthening the family-centered approach to care, encouraging

especially larger facilities to establish family clinics on a specific day of the week to facilitate a more focused

approach that would benefit the entire family. The program will also encourage testing of family members of

patients enrolled on ART. Where this is not feasible, the program will promote scheduling of same-day

appointments for adults and infected children, ensuring the availability of clinical staff to provide ART

services for parents and children.

To promote enhanced efforts for pediatric case finding, Tunajali will actively promote PITC in pediatric

wards, immunization clinics, and will liase with the Tunajali home-based care and OVC program for home

testing of families. EID for exposed children under 12 months who qualify for treatment will be performed at

Tunajali-supported labs in Ifakara Research Laboratory, Village of Hope Mission Centre, and Dodoma

Regional Hospital to increase access to treatment for the very young. Linkages with zonal laboratories in

Mbeya and Muhimbili Referral Hospitals will also facilitate EID through the transport of dried blood spot

samples.

Expansion of pediatric ART services to the HC setting is a challenge, not only because only a very few HC

staff have had specific pediatric care and treatment training, but also because most sites are only just

beginning to provide adult HIV care and treatment in general, which hampers them from focusing on

pediatric treatment. The program will continue to train health workers in the provision of pediatric ART. It

will particularly encourage PITC for children and increasing enrolment of children/adolescents on treatment.

In addition, this year, the program will make concerted efforts towards the provision of on-site mentoring

and supportive supervision by Tunajali teams working in collaboration with regional and district experts. The

program will also maintain linkages with the AIHA twinning preceptor program, leveraging additional staff

(pediatricians specialized in providing ART), and will collaborate with the new pediatric AIDS Centres of

Excellence to be initiated by the Baylor International Pediatric AIDS Initiative, especially for training and

referrals. Exchange learning visits with well-established pediatric ART sites, such as KCMC, will be

conducted with possible attachments of staff at Baylor Clinical sites in surrounding countries.

The complex preparation of correct dosages (preparing liquid formulation) and ensuring adherence on

pediatric treatment requires training of guardians which can be difficult in many instances. The program will

identify best practices used in other settings to prepare materials for the care givers.

More general activities that will be supported include minor renovations to accommodate expansion of

Activity Narrative: services to include/improve ART services; procurement of furniture and equipment; purchase of buffer

stocks of lab reagents and other commodities to complement the Medical Stores Department supplies;

procurement of motor cycles for supportive supervision and transporting samples; and training staff in ART

provision, PITC, adherence counseling, and monitoring and evaluation (M&E) using national guidelines and

curriculum.

Linkages: The program will continue to focus on strengthening linkages with different programs aimed at

increasing the number of children accessing ART and also improve the quality of treatment, especially

programs with established and successful pediatric ART programs. Linkages with PMTCT, MCH, Under

Five clinics or pediatric/OPD clinics to CTC will continue to be an integral approach in the program where

patients identified mainly through PITC will be referred to the CTC, using nurse escorts to accompany

referrals to the CTC. This initiative will be expanded to an additional four district hospital in this year.

The program will also strengthen its links with the Tunajali HBC/OVC program, planning together in order to

target some of their sub grantees who run day cares for orphans, providing an opportunity for counseling

and referral to CTCs for appropriate management.

Lab support:

The provision of pediatric treatment services requires access to reliable laboratory services for initial

assessment prior to initiation of ART and monitoring for response to treatments and/or toxicity. The

program will therefore continue to support lab services at all CTCs by funding minor renovations when

necessary, purchasing solar panels for remote sites lacking electricity, supporting the upkeep of equipment

at all sites through regular maintenance and repair services to avoid disruption of services, procuring

essential equipment and commodities, including CD4 machines, automated hematology and biochemistry

machines where lacking, and buffer reagents and other supplies to complement supplies from the Ministry

of Health and Social Welfare (MOHSW). The Program will also support transporting samples for testing for

those facilities lacking adequate lab services, though the logistics of transporting samples to few zonal sites

performing Early Infant Diagnosis has proven to be particularly challenging for remote sites.

Induction and refresher training for personnel involved in the program will also be supported. The program

has hired a Senior Technical Officer, Laboratory Specialist, whose role is to ensure that all sites maintain

good links/collaboration with the MOHSW Diagnostic Services Department for trouble shooting, while also

ensuring that QA/QI and control systems to guarantee the accuracy of test results are maintained.

Partnerships with organizations such as AIHA, whose ongoing support includes volunteer lab specialists at

two sites, will continue. The program will also set up systems for all sites for the testing of dried blood

samples by PCR at sites that offer these services, namely Village of Hope for sites in Dodoma and Singida;

Ifakara Health Institute for Morogoro, and Mbeya Zonal Laboratory for sites in Iringa.

M&E: Tunajali will continue to collaborate with the NACP/MOHSW to implement the national M&E system

for Care and Treatment in Dodoma, Iringa, Morogoro, and Singida. Efforts will continue to focus on

transitioning from using the national paper-based tools to electronic versions at all CTCs. The program will

provide funds for each initiating CTC to purchase a computer that will be used to store patient monitoring

data. Quality of data will be assured through supportive supervision by the Tunajali regional M&E officer

working in collaboration with trained Council Health Management Teams (CHMT) and Regional Health

Management Team (RHMT) members, where possible.

Tunajali will continue to collect reports from sites to be submitted to the NACP as requested by the

MOHSW. Tunajali will also continue to share regional data reports with regional AIDS Control Coordinators.

Tunajali will work with CTCs to assist with generation of simple data reports for use by the sites in planning

(for example to improve client appointment making, drug forecasting, etc.) and for feedback and quality

improvement. Currently, all initiating CTCs are using the national MS Access-based CTC2 database,

however many do not have experienced data clerks and consequently many have significant data entry

backlogs. The program will support clearing of backlogs by using temporary data clerks to assist with

entering patient information in a timely manner. In addition to addressing report lateness, the program will

support installation of internet services (and phone/fax where this is not possible) in CTCs to facilitate report

submissions. The program will also provide IT support to all sites that have computer and internet

connection.

Currently Tunajali supports 39 initiating CTCs; this number is set to increase to 125 facilities with the

addition of health centers by Sept 2009. In FY 2009, Tunajali will support training of 250 health care

workers on M&E and electronic data management, and provide technical assistance to 125 health facilities,

four regional offices, and 27 District Health Management Teams (DHMT) or Council Health Management

Teams (CHMT).

SUSTAINABILITY: Tunajali is committed to sustainability and plans to continue to work through local

authorities. Tunajali will empower local authorities to create ownership and put the responsibility of

sustainability into their hands. The program will also continue to work with CTC staff, RHMTs and CHMTs to

build technical and management capacity, and to continue using national standards and guidelines also

ensures sustainability. Authorities are constantly informed of lessons learned and innovative approaches,

such as the family-centered approach to treatment, facilitating the adoption and updating of national norms,

standards and guidelines. Tunajali will participate in the GOT FY2009/10 budgeting and planning cycles at

district and regional levels to ensure integration of HIV treatment services in Comprehensive Council Health

Plans.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13467

Continued Associated Activity Information

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

System ID System ID

13467 3443.08 U.S. Agency for Deloitte Consulting 6510 1197.08 Fac Based/RFE $11,760,554

International Limited

Development

7701 3443.07 U.S. Agency for Deloitte Touche 4532 1197.07 $8,500,000

International Tohmatsu

Development

3443 3443.06 U.S. Agency for Deloitte Touche 2857 1197.06 $2,845,000

International Tohmatsu

Development

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $141,200

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $50,000

and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $100,000

Economic Strengthening

Education

Water

Table 3.3.11:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

TITLE: TUNAJALI (We care) Integrating ART and TB Services in 4 Regions of Tanzania

In collaboration with the Ministry of Health and Social Welfare (MOHSW) through the National Tuberculosis

and Leprosy Program/National AIDS Control Program (NTLP/NACP) and the Regional Health Management

teams (RHMT)/Council Health Management Teams (CHMT) Deloitte Consulting Limited will continue to

provide support to collaborative TB/HIV activities initiated in the Country Operational Plan 2008 (COP08).

The focus for FY2009 will be to provide technical assistance to strengthen intensified TB case finding and

carry out a pilot for Isoniazid Preventive Therapy (IPT) within the framework of the MOHSW plans for pilot

and roll out. Intensified TB Case Finding (ICF) at Care and treatment clinics (CTC) will be strengthen,

ensuring that all PLWHA attending care and treatment clinics are screened for TB. Deloitte Consulting

Limited will also ensure availability, regular and proper use of the National TB screening tools, print and

distribute National TB/HIV guidelines, job aids and SOPs for collaborative TB/HIV activities including those

for ICF, Isoniazid Preventive Therapy and TB Infection Control. TB Infection Control will be implemented to

all care and treatment clinics to prevent TB infection to PLWHA and health care providers.

NEED AND COMPARATIVE ADVANTAGE: The goal of TUNAJALI in FY 2008 is to strengthen the

continuum of quality HIV care and treatment. However, co-infection with TB presents unique challenges

whether a patient presents with active symptoms or with Immune Reconstitution Syndrome (IRS) weeks

later. Timely identification and treatment of each disease mutually improves the outcome of the other, hence

need for close collaboration and coordination between the programs. Experience gained by Deloitte and

Touche (D&T) and Family Health International (FHI) in involving TB staff, with USG partners, provides an

advantage to scaling-up and integrating services. With training, mutual referral, supportive supervision and

mentoring, TUNAJALI's strategy aims to capture patients suspected of TB-HIV co-infection, ensuring

prompt diagnosis and supervised treatment.

ACCOMPLISHMENTS: As of March 31, 2007, with QuickStart and Plus-up funds, D&T/ FHI expanded the

comprehensive care approach to 33 sites in Dodoma, Morogoro, and Iringa. D&T/FHI has made significant

progress, establishing a foundation that will enable the program to increasingly expand quality care and

treatment over the coming years The program established referral services between all the CTCs and 35

TB programs in 35 district hospitals; strengthened referral procedures, including follow-up care through

HBC; providing 20,324 patients with comprehensive care, including 9,294 on ART and 3, 597 receiving

treatment for TB disease.

ACTIVITIES: In FY 2008, Tunajali plans to strengthen the TUNAJALI care and treatment program in 38

sites in 4 regions: Dodoma, Morogoro, Iringa and Singida, to ensure that all patients have access to the

comprehensive continuum of care, including timely and appropriate management of TB-HIV co-infection.

1) Tunajali will strengthen the capacity at CTCs to address co-infection, and screening HIV patients for TB

through: a) Training CTC staff in new and established sites on integrated management of TB-HIV

coinfection,

using Ministry of Health and Social Welfare (MoHSW) guidelines. b) Providing ongoing technical

assistance (TA) on managing co-infected patients, paying attention to the management of opportunistic

infection. c) Referring patients suspected of TB for sputum smears and x-ray before being placed on

supervised TB treatment. Special emphasis will be placed for the correct diagnosis and treatment of

pediatric patients. e) Providing HIV test kits to TB clinics. e) Providing co-trimoxazole to TB clinics for

prophylaxis.

2) Assessing and improving TB infection control at care and treatment clinics, inpatient and transient waiting

wards. a) Performing minor renovations to improve ventilation and ensuring other infection control

measures are in place.

3) Strengthening referral and collaboration between care and treatment and TB clinics. a) Orienting all

Regional Health Management Teams (RHMT) on the new integrated approach in the management of

combined TB-HIV patients. b) Collaborating with RHMT and Council Health Management Teams (CHMT),

in the provision of supportive supervision and mentorship to CTC teams, to ensure quality service. c)

Monitoring service provision, data keeping, analysis, utilization, reporting back to the sites and report

writing. d) Ensuring data collection tools are continuously available. e) Recording best practices, lessons

learnt and disseminating them.

LINKAGES:TUNAJALI is committed to working in close collaboration with NTLP and USG, especially to

increase staff, training, and in planning, monitoring and supervision of activities. Involving the District

Medical Office should improve service and quality, and help ensure sustainability. TUNAJALI will ensure

collaboration with the NTLP and create linkages to and from local TB clinics to VCT, PMTCT service, HBC

and OVC programs to facilitate prompt and appropriate referrals to CTCs. Sub-grantees from TUNAJALI

will link with partners working in the region, including the sister TUNAJALI HBC program, to help strengthen

provision of comprehensive care in urban and rural settings. The program also will support linkage to

national and community-based programs, involving PLHA and volunteers to reduce stigma, promote

provider initiated testing and counseling (PITC) and improve patient adherence. Partners will be

encouraged to leverage lab, test-kits, reagents and x-ray diagnostic resources and drugs, referring patients

to access services, where available through support from the NTLP or other sources, such as the NACP,

MOHSW and Global Fund.

CHECK BOXES: Activities include training of health workers, renovation of infrastructure, supply of

commodities, strengthening district and regional health systems, strengthening linkages and referral to other

programs in and around the region. Efforts to increase the number of women and children enrolled, by

linking with PMTCT and Mother/Child Health (MCH) activities, and to increase male enrollment by using a

family centered approach to care that will justify gender-related activities. Our treatment and care activities

will focus on PLHA identified through VCT and PICT initiatives from out and in-patient wards, as well as

Activity Narrative: pediatric and TB departments.

M&E: Establishing records has been a challenge as sites had only kept log books or patient registers. By

supporting a qualified data clerk at each site, TUNAJALI will ensure consistent use of tools (paper-based or

electronic) to capture longitudinal data and provide evidence of improved patient management. Data

analysis will show trends and highlight programmatic strengths and weaknesses allowing for feedback to

the site for improvement on patient management, and factors that effect outcomes. Quality Assurance

protocols will be used to ensure accuracy. Supportive supervision by a regional data manager in the RHMT

office, in collaboration with local TB programs and the NLTP, will ensure quality data collection. Regular

meetings with CHMTs and RHMTs will help local health authorities monitor progress. The program will use

the TB/HIV monitoring and evaluation system and will contribute towards its improvement.

SUSTAINABILITY: TUNAJALI plans to focus on strengthening the technical and management capacity of

local staff involved in the care and treatment of HIV and TB, by training, mentoring and providing supportive

supervision to ensure quality of care believed to be the cornerstone for sustainability. These efforts will be

complemented by other sustainable efforts, including educating patients and communities, and linking them

to support programs within their own communities, including the TUNAJALI HBC program to provide

support needed for reassurance. In addition, TUNAJALI will work within the existing health network,

collaborating with NLTP and local authorities to create a sense of ownership.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13464

Continued Associated Activity Information

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

System ID System ID

13464 12463.08 U.S. Agency for Deloitte Consulting 6510 1197.08 Fac Based/RFE $300,000

International Limited

Development

12463 12463.07 U.S. Agency for Deloitte Touche 4532 1197.07 $300,000

International Tohmatsu

Development

Emphasis Areas

Health-related Wraparound Programs

* TB

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12:

ACTIVITY REMAINS UNCHANGED FROM FY 2008 COP.

TITLE: The Rapid Funding Envelope for HIV/AIDS (RFE) in Tanzania

NEED AND COMPARATIVE ADVANTAGE: To increase participation of civil society, ten donors and the

Tanzanian Commission for AIDS (TACAIDS) cooperated in creating a "Rapid Funding Envelope (RFE) for

HIV/AIDS" to assist with the HIV/AIDS response in mainland Tanzania and Zanzibar. The RFE is a

competitive mechanism to support not-for-profit civil society institutions, academic institutions, and

partnerships on projects up to a maximum of 12 months. The RFE allows Civil Society Organizations

(CSOs) to implement projects, build capacity, and improve project coordination and management skills,

while gaining experience and lessons learned on HIV/AIDS interventions. Projects funded by the RFE are

required to comply with national policy and the strategic framework for HIV/AIDS as set by TACAIDS and

the Zanzibar AIDS Commission (ZAC), with goals of contributing to longer-term objectives of the national

response and encouraging projects that promote institutional partnerships and have potential for scale up.

ACCOMPLISHMENTS: To date, the RFE has conducted seven rounds of grant making and approved $11.2

million for 78 projects. In FY 2007, the RFE successfully held a 4th round, providing awards worth $3.5

million to 23 CSOs (seven of which were activities addressing the needs of OVC); monitored and managed

existing sub-grantees; created a reliable base for donors to reference without duplicating efforts; continued

to strengthen CSOs, financially and technically, thus laying a solid foundation for further funding; and

facilitated increased resources for CSOs via disbursement of significant funding in a short timeframe.

Generally, funding leveraged from other donors cover the cost of the grants, and the USG funds are used

for management of the funds. The amount of funding requested for FY 2008 includes an amount for the

USG to fund at least one specific OVC activity, in addition to approximately $250,000 in funding for the

management costs for the entire RFE.

ACTIVITIES: Ongoing activities for FY 2008 will include:

1. Grants and financial management of existing sub-grantees including disbursements of grants, liquidation

reviews of sub-grantee financial reports, and M&E of projects.

2. Technical monitoring and management of existing sub-grantees, including a review of project work plans

and progress reports, review of project deliverables, and M&E of projects.

3. Completion of the fifth open round of funding including conducting pre-award assessments and sub

contracting to about 40 CSOs,

4. Financial administration of the RFE fund (USG and multi-donor accounts) including management of

donor receipts, preparation of financial reports, and engaging project audits.

5. Grants and project administration including external RFE communications/correspondence, convening of

donor meetings, and preparation of (ad-hoc) reports.

This component of the funding for the RFE will support OVC activities. The RFE will coordinate a special

OVC round that will involve solicitation and reviewing of short-listed proposals, conducting pre-award

assessments to determine organizational, financial, and technical capacity of CSOs to identify and mitigate

weaknesses. One to two successful CSOs will be contracted. The balance of OVC funds will support

management costs paid by the USG, maintained in a non-pooled account, which will leverage an

approximately additional $2 million of funding through multi-donor support of similar OVC projects.

LINKAGES: In keeping with previous arrangements, Deloitte Consulting Limited is the prime partner and the

lead for grants and finance management. They will link with Management Sciences for Health (MSH) as the

lead technical partner for supporting the RFE, and Emerging Markets Group (EMG) for initiating capacity-

building initiatives to CSOs. The RFE will work closely with the TACAIDS and ZAC in all aspects of work;

ensuring that they champion decisions made, including the path that each RFE round makes. RFE will also

develop formal linkages with large funding mechanisms including Foundation for Civil Society and Regional

Facilitating Agencies (World Bank T-MAP funding agents) to develop information networks and a common

database of funded CSOs to avoid duplication of efforts. In efforts to encourage organizational

development, RFE will share funding experiences with each donor to ensure that the right level of funding

and capacity support is provided to the CSO. With a special round under the proposed PPP initiative,

linkages will be formed with private organizations and workplaces to create partnerships in support of

workplace facilities providing HIV-related services to local communities.

CHECK BOXES: The RFE will fund organizations that support OVC within the national guidelines,

specifically targeting young girls, to provide them access to income-generating opportunities. The RFE will

support capacity building through various steps including the pre-award assessment that highlights key

areas of weakness to be strengthened in the capacity plan, technical assistance/training on programmatic

(HIV) issues and finances, and ongoing coaching from the grant manager and technical advisor.

M&E: The RFE will develop annual work plans, which will include built-in M&E for which the relevant RFE

staff member takes responsibility. RFE management will continue to conduct the following M&E activities:

regular update of project through participation in activities; quarterly reviews of technical reports for

performance against work plan; monitoring through field visits; collection of data; preparation of site visit

reports; and progress reports. The progress reports will be shared with concerned CSOs and donors, to

enable improvement and development of these organizations. Best lessons learned will be captured and

shared, publicized on the RFE website, and processed in a database according to the plans of TACAIDS

and ZAC. They will also be shared through the OVC Implementing Partners Group.

SUSTAINABILITY: RFE will encourage CSOs to foster local community networks that will assist in

continued operations of the project once RFE funding has ended. RFE requires projects to consider the

Activity Narrative: issues of sustainability during the proposal development and ensures that a realistic plan has been

developed to integrate the project into existing programs. RFE supported CSOs will also be provided

institutional capacity-building support enabling them to graduate to direct funding and/or increase the level

of funding from other donors post RFE funding. A new management structure will be proposed to the

donors to better manage the function of the RFE, whose mandate has changed from its original form due to

the number and size of projects funded.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13465

Continued Associated Activity Information

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

System ID System ID

13465 3442.08 U.S. Agency for Deloitte Consulting 6510 1197.08 Fac Based/RFE $450,000

International Limited

Development

7700 3442.07 U.S. Agency for Deloitte Touche 4532 1197.07 $300,000

International Tohmatsu

Development

3442 3442.06 U.S. Agency for Deloitte Touche 2857 1197.06 $200,000

International Tohmatsu

Development

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $30,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.13:

ACTIVITY NARRATIVE HAS BEEN REVISED SIGNIFCANTLY FROM FY 2008 COP

TITLE: Scaling Up Quality Care and Support of Orphans and Vulnerable Children (OVC) in Six Regions and

Zanzibar

NEED and COMPARATIVE ADVANTAGE: In Tanzania, 6% of children are estimated to be orphaned by

HIV/AIDS, with far greater concentrations of OVC in high prevalence areas. Community responses are

already overstretched and resources have been strained. As more people in productive ages die of

complications from AIDS, the burden of caring for OVC is growing dramatically. The responsibility has

particularly shifted to the elderly, especially the grandparents. The Tunajali (Kiswahili for "we care") team is

well-positioned to respond to OVC needs and their elderly caregivers through its established partnerships

with government structures and systems in the regions. Program staff is located in all Tunajali

implementation regions (Coast, Dodoma, Iringa, Morogoro, Mwanza, and Singida, as well as Zanzibar) to

provide timely technical assistance and supportive supervision. In addition, 27 sub-grantees and 27 district

authorities are currently supported to plan, implement, and monitor quality OVC care and support

interventions. Employees of Tunajali possess numerous strengths, including a thorough understanding of

local OVC care environment and a sound and practical technical approach.

ACCOMPLISHMENTS: As of the end of FY 2008, Tunajali, through a network of over 3,000 community

volunteers, had supported over 70,000 OVC in various areas such as education, health, psychology, and

income generation activities (IGAs). Over 30,000 OVC received primary direct support while about 40,000

were reached with supplemental direct support. The program coverage expanded to nearly 500 wards.

In FY 2008, Tunajali established and nurtured working relationships with the government. Twenty new

District Continuum of Care Coordinating Committees (DCoCCCs) were established with the aim of

strengthening ownership and increasing sustainability of the program activities. Quarterly DCoCCC

meetings were conducted in 20 districts, where challenges that partners face while addressing the needs of

the ever-increasing number of OVC were shared and strategies were set to address those challenges. To

ensure quality and compliance to the national guidelines and standards, joint supportive supervision with

the District Social Welfare Officers were conducted in 20 districts. Annual work plans and progress reports

were shared with government authorities in 27 districts. Over 300 Most Vulnerable Children Committees

(MVCCs) established and several already existing MVCCs were strengthened to ensure community

participation and ownership in OVC identification, care, and support. In recognition of Tunajali efforts in

supporting the government to implement activities of care and support to OVC, the regional and district

authorities invited Tunajali to participate in Regional Management Team, Regional Consultative Committee

and Council Multisectoral AIDS Committee meetings in Coast, Iringa, Morogoro, and Mwanza regions. In

Zanzibar, Tunajali was selected to be a member of the OVC Technical Working Group.

Through a strong partnership and collaboration with the local government councils, Tunajali has

encouraged financial commitments from the local councils' budget to complement the planned activities.

While the contributions to date have been modest, the budget allocation is an important step to strengthen

the potential for sustainability.

ACTIVITIES: In FY 2009, Tunajali shall:

1. Train 200 new volunteers and retrain 2,200 existing volunteers in OVC care and support, in collaboration

with national facilitators from the MOHSW, and establish a total of 800 MVCCs in 15 districts. A total of 250

MVCCs will be strengthened through training, in order to provide consistent information pertaining to

specific roles and responsibilities.

2. Provide services to 73,000 OVC in 27 districts, expanding the quality and comprehensiveness of

services. All OVC under both primary and supplemental support will receive psychosocial support through

activities, such as development of memory books and education of caregivers to learn positive parenting

skills. Tunajali will train paralegals in each Tunajali district to address OVC rights and social protection.

The paralegals will further support the caretakers in succession planning and will writing. Upon completion

of a needs assessment that will prioritize interventions, issues will be addressed regarding support for

education, nutrition, basic health management, and access/referral to health services, shelter, and

economic strengthening. Tunajali will continue strengthening referral networks in 27 districts for referring

OVC to services not already provided. The program will provide incentives (e.g., the provision of bicycles)

to 3,039 volunteers to ensure retention and quality service. Tunajali will continue to collaborate with the

Regional Psychosocial Service Initiative (REPSSI) in promoting children's participation and scale-up

memory book and the hero book approach in all its operational areas. Also, using the "Journey of Life"

manual by REPSSI, Tunajali will conduct "community workshops" aimed at mobilizing the community in

addressing the psychological needs of children.

3. Provide support to elderly OVC caregivers. More than 50% of OVC caregivers are elderly, with an

average of three OVC per household. During FY 2009, Tunajali will support over 10,000 elderly caregivers.

About half of these individuals will benefit from support groups or some other possible method of

strengthening their efforts and support networks. In collaboration with HelpAge International, Tunajali will

raise public awareness on the vulnerability of elderly caregivers and the need to focus on the importance of

these individuals as a conduit of services to orphans. Tunajali will facilitate the formation of elderly

caregiver support groups. These will provide opportunities for caregivers to experience understanding and

empathy, receiving some respite services, and share their challenges in caring for OVC. The program will

also provide primary caregivers with knowledge and skills to effectively care for sick OVC, as well as

training in identification of HIV-related illnesses for proper care and referral to facilities for HIV testing of the

child.

4. Strengthen referrals for vulnerable children, starting with Prevention of Mother-to-Child Transmission

Programs, so that HIV-positive infants can be identified, followed, and referred for assistance. In addition,

Tunajali will link closely with Care and Treatment Clinics to identify those vulnerable children who should be

Activity Narrative: receiving services in the community.

5. Build the capacity of 27 local community service organizations (CSOs) and district public units to network

effectively and coordinate the provision of comprehensive quality care and support to OVC. Tunajali will

regularly monitor and review referral systems at community and district levels. It will conduct regular

mapping and updates of organizations providing essential services and wraparound programs to enhance

comprehensive care in areas of medical care, spiritual support, psychosocial support, food and nutrition,

income-generating activities (IGA), and legal and human rights. Tunajali will support DCoCCC to meet,

plan, and monitor the provision of comprehensive services across a continuum of care at community and

district levels. Overall, Tunajali will increase the technical and organizational capacity of CSOs to deliver

comprehensive care and support to OVC. Tunajali will also increase the capacity of CSOs to roll out the

NCPA by strengthening links with the MVCC to address OVC needs: implementing the national OVC

quality standards, addressing legal rights and protection, increasing children participation, addressing youth

unemployment, mobilizing community to address OVC food crises by creating food storages during

harvesting, and utilization of the national data management system (DMS).

6. Build wraparound programs as often as possible. OVC needs include: education, shelter, health care,

spiritual, psychosocial support, legal rights, and economic resources. To address these needs, Tunajali will

assist sub-grantees and districts to identify institutions that can support OVC priority needs that are not

directly covered by the program such as food, nutrition, and IGA. Tunajali will strengthen local food

reserves through contributions by community members to support child- and elder-headed OVC

households. Tunajali will continue to link with Peace Corps Tanzania to scale-up Permaculture Gardening

initiatives. A team of CSO staff and ward agricultural extension workers will be trained by the Peace Corps

program and these will in turn train volunteers to ensure sustainability. Community volunteers will be

required to demonstrate proficiency in building vegetable gardens that can be replicated in OVC

households. These can also be emulated by older OVC as IGAs. Tunajali will link CSOs with HelpAge

International for sensitization of communities on supporting elderly caregivers, and REPSSI in training

community Trainer of Trainers on psychosocial support so that they may train volunteers who will provide

the same to OVC and their caregivers. In Zanzibar, the program will collaborate with UNICEF and Save the

Children in addressing the needs of OVC, especially concerning psychosocial support.

6. Build capacity of Non-Governmental Organizations (NGOs). Through Deloitte, NGOs will be assessed

and receive technical assistance to ensure that financial controls and systems are in place to ensure fiscal

accountability.

7.Develop "learning districts," which will serve as models for others. In Tunajali learning districts

(Kilombero, Magu, Njombe, Kibaha, Mufindi, West, and Chake), comprehensive care and support will be

provided in conjunction with capacity building measures for CSOs and Local Government Authorities.

LINKAGES: This activity will contribute to the implementation of the NCPA. It is linked to the President's

Malaria Initiative and/or direct USG procurement of bulk insecticide-treated nets for OVC, with a priority for

accessing nets for those less than five years of age. The program will also link closely with Maternal/Child

Health services to ensure that children receive basic health services, especially those funded with USG

child survival initiatives. Tunajali is also closely aligned with the technical assistance provided by Family

Health International to the Department of Social Welfare with USG funding. In addition, Tunajali will link

with other OVC partners through the monthly meeting of the Implementing Partners Group. The program

will attempt to maximize linkages for wraparound programs, as indicated above.

M&E: In FY 2009, Tunajali will train district officers and sub-grantee staff in 13 districts on the DMS.

Support will be provided to the 25 districts with data-related infrastructures such as computers and

accessories. The program will monitor OVC care services using the national DMS for tracking OVC and

OVC services, as well as the storage and reporting system, and will monitor the use of data for decision

making. Volunteers will work with MVCC to register OVC at the community level. CSOs will use service

providers' register and referral forms to track services provided to OVC and they will enter the data in their

database and export it to the district. CSOs will analyze and report data to the regional office according to

services provided, age, and gender. The regional office will report to the head office on a quarterly basis.

Tunajali will build the capacity of sub-grantees on data collection, use, and reporting. Duplication in

counting OVC will be avoided to the extent possible. All reports will be shared with relevant authorities for

decision making and planning. 6% of the budget will be used for M&E.

SUSTAINAIBLITY: In FY 2009, Tunajali will intensify efforts to nurture and enhance the following measures

of sustainability: play a facilitative role to ensure the incorporation of CSO work plans, budgets, and reports

in the overall Government of Tanzania district response plans; at the household level, mentor family

members to adopt caring roles; with the support of district leaders, MVCC, and community leaders, develop

strategies to leverage local food production to create community reserves for the child and elderly headed

households; train Tunajali-supported CSOs in project proposal development in order to allow for other grant

opportunities.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13466

Continued Associated Activity Information

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

System ID System ID

13466 8866.08 U.S. Agency for Deloitte Consulting 8030 8030.08 Community $4,980,000

International Limited Services

Development

8866 8866.07 U.S. Agency for Deloitte Touche 4532 1197.07 $3,100,000

International Tohmatsu

Development

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $1,225,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $95,000

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Estimated amount of funding that is planned for Economic Strengthening $12,000

Education

Estimated amount of funding that is planned for Education $726,000

Water

Table 3.3.13:

ACTIVITY REMAINS UNCHANGED FROM FY 2008.

TITLE: The Rapid Funding Envelope for HIV/AIDS (RFE) Public-Private Partnership Initiative in Tanzania

NEED and COMPARATIVE ADVANTAGE: To increase participation of civil society, 10 donors and

TACAIDS co-operated in creating a "Rapid Funding Envelope for HIV/AIDS" on Mainland Tanzania and

Zanzibar. RFE is a competitive mechanism for projects on HIV/AIDS in Tanzania. RFE supports not-for-

profit civil society institutions, academic institutions in compliance with national policy and strategic

framework with the goal of contributing to longer-term objectives of the national response and encouraging

projects that promote institutional partnerships. To date, although the private sector is involved in the fight

against HIV/AIDS, services tend to be limited to their employees, and often lack the continuum of care and

sustainability due to lack of commitment at higher level. This program seeks to use the RFE mechanism to

inform the private sector of the need to expand workplace programs, and establish partnerships with private

organization to strengthen these interventions, leveraging resources from existing medical structures within

these private institutions to make care and treatment available to employees and their communities who

would otherwise not have access to these services.

ACCOMPLISHMENTS: To date, RFE has conducted seven rounds of grant making and approved $11.2

million from pooled funds, for 78 projects. In FY 2007, RFE successfully held a 4th round, providing awards

worth $3.5 million to 23 Civil Society Organizations (CSOs) (seven had OVC activities); monitored and

managed existing sub grantees; created a reliable base from which donors can utilize without duplicating

efforts; continued to strengthen CSOs, financially and technically, thus laying a solid foundation for further

funding; and facilitated increased resources for CSOs via disbursement of significant funding in a short

timeframe.

ACTIVITIES: Ongoing activities will include management of the RFE Public Private Partnership (PPP)

initiatives to be established with FY 2007 Plus-Up funds focusing on strengthening collaboration with private

organizations; selecting and providing grants to workplace organizations for treatment and care activities in

support of the continuum of care efforts in the workplace and neighboring communities. In particular this will

involve oversight of projects worth $200,000 in grants to approximately 20 organizations. The 20 companies

will be awarded matching contribution grants for creating or extending their workplace programs.

The companies will be paired with our in-place partners to ensure that their programs adhere to best

practices and national standards. The focus of the activities will support companies in Tanzania in arranging

for local, on-site VCT ‘worker and community' test days, and to ensure that all workers are aware of - and

take advantage of - HIV counseling and testing in the workplace.

These funds will be used to expand prevention services in the companies while leveraging corporate

resources to expand HIV/AIDS treatment and care services beyond the workplace, and using the family

centered approach, include family and community members who may otherwise not have been able to

access services in these private facilities. Specific activities will include; 1) Grants and financial

management of sub grantees; including disbursements of grants; liquidation reviews of sub grantee

financial reports and monitoring & evaluation of projects; 2) Technical monitoring and management of sub

grantees; including review of project work plans and progress reports; review of project deliverables and

monitoring & evaluation of projects; 3) Financial administration of the RFE-PPP fund; including preparation

of financial reports and engaging project audits; 5) Grants/Project administration including external RFEPPP

communications/correspondence; convening of meetings with the donor/partner; preparation of (adhoc)

reports.

The program will strengthen collaboration with private organizations to find unique alternatives to which

private-for-profit companies can contribute towards alleviating the burden caused by HIV/AIDS. a) RFE-PPP

program will solicit and review short-listed private-for-profit organizations, conducting pre-award

assessments to determine organizational, financial & technical management competency of the existing

medical programs and identify potential weakness that may be mitigated towards improving the continuum

of care. b) At least five successful organizations will be contracted and funded directly with USG funds. c)

Supportive supervision will be provided to the projects, including monitoring & evaluation, guidance &

oversight of the projects through regular site visits. 2) Capacity building towards graduation towards direct

funding from donors will be provided through training and coaching/mentoring. 3) Additional support will be

sought from multi-donors to fund similar workplace programs. If successful, non pooled USAID funds will

support management of these grants.

LINKAGES: In keeping with previous arrangements, Deloitte Consulting Limited as the Prime, also the lead

for grants and finance management will link with a partner (TBD) as the lead technical partner for supporting

the RFE-PPP, and will work closely with donor, keeping within the mandates of the AIDS Business Council

of Tanzania (ABCT). RFE-PPP will also develop formal linkages with large funding mechanisms; including

Regional Facilitating Agencies (TMAP) to feed into the development information networks system, a

common database of organizations funded to avoid duplication of efforts. In effort to encourage

organizational development, RFE-PPP will share funding experience with potential donors/organizations to

create awareness and encourage buy-in.

CHECK BOXES: RFE-PPP will seek to fund organizations with existing medical programs, building capacity

as needed to afford the continuum of care to their employees, as well families and surrounding

communities. The RFE will support capacity building through various steps including the pre-award

assessment that highlights key areas of weakness to be strengthened in the capacity building plan;

technical assistance/training on programmatic (HIV) issues and finances; and ongoing mentoring and

technical assistance.

M&E: Annual work plans will be developed and will include built-in M&E processes for which the relevant

staff member takes responsibility. Management of the RFE-PPP will include conducting the following

monitoring & evaluation activities; Regular update of project through participation in activities; Review

quarterly technical reports for performance against work plan; Monitoring through field visits; Collection of

data; Preparation of site visit reports and progress reports; these reports will be shared with private

Activity Narrative: organizations concerned, and donors, to enable improvement and development of the program, Best

lessons learned will be captured and shared.

SUSTAINAIBLITY: The private organizations involved will be encouraged to foster local community

networks, and continue leveraging own resources that will assist in continued operations of the project once

RFE-PPP funding has ended. RFE-PPP requires projects to consider sustainability during proposal

development; and ensure that a realistic plan has been developed to integrate the project into existing

programs. RFE-PPP supported organizations will also be provided with institutional capacity building

support enabling them to grow/ graduate towards receiving accreditation as Care and Treatment Centers,

and allow them to receive direct funding and/or increase the level of funding from other donors, post

RFEPPP funding. The new management structure at Deloitte has been designed to better manage the

function of the RFE, to include capacity for managing the RFE-PPP, since the original mandate of the RFE

has changed from its original form and size of projects funded.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16439

Continued Associated Activity Information

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

System ID System ID

16439 16439.08 U.S. Agency for Deloitte Consulting 6510 1197.08 Fac Based/RFE $200,000

International Limited

Development

Table 3.3.14:

ACTIVITY REMAINS UNCHANGED FROM FY 2008.

TITLE: Scaling-Up Home Based Counseling and Testing Services In Seventeen Districts

NEED and COMPARATIVE ADVANTAGE: Only 15% of people in Tanzania know their HIV status. In order

to reach the estimated 400,000 PLHIV with ART services, enormous efforts must be done to scale-up

testing and counseling services. The Tunajali ("we care" in Kiswahili) program has initiated home-based

counseling and testing services in index households where PLHIV are receiving palliative care in selected

wards of two districts. Index household members have a high probability of being HIV+ and we think they

should be a target group. The Tunajali team is best positioned to undertake this activity because it has the

lessons learned that will support a quick scale-up. Tunajali has qualified staff to plan, implement, and

monitor field activities and has built strong partnerships with local institutions and district councils in the

Tunajali regions.

ACCOMPLISHMENTS: Five HBC focal persons have been trained and qualified as counselors and 25

community volunteers from two districts of Kilolo (Iringa) and Mvomero (Morogoro) have also undergone

training in home-based counseling and testing skills using a pilot curriculum. Communities and districts

have been sensitized in readiness to expand services to three additional districts in which 10 HBC

counselors and 221 volunteers will be trained. We estimate to counsel and test about 10,000 household

members within the FY 2007 plans. The GOT has approved this activity and has issued a waiver to enable

the program to use lay counselors to expand service availability.

ACTIVITIES:

1. Scale-up home counseling and testing services in seventeen districts of Dodoma Urban, Mkuranga,

Bagamoyo, Morogoro Rural, Morogoro Urban, Mvomero, Iringa Rural, Iringa Urban, Kilolo, Njombe,

Mufindi, Makete, Geita, Magu, Ilemela, Nyamagana, and Misungwi. The focus will be in high prevalence

and high transmission areas for better yields. 1a) Train 50 HBC focal persons and health facility staff on

VCT. 1b) Train approximately 2,080 community volunteers on home-based counseling and testing (HBCT).

1c) Train approximately 30 district level health staff to monitor and support HBCT services.

2) Conduct home-based counseling and testing to index patient households. 2a) Liaise with the district

medical office (DMO) for accessibility and availability of test kits, with the aim of receiving reagents and

supplies from the National AIDS Control Program (NACP) to supplement those bought directly by Tunajali.

2b) Provide the HBC focal person with transport and means of communication. 2c) Provide community

volunteers with means of communication with the HBC focal persons. Volunteers will be responsible for

initial counseling of individuals in the households and informing the HBC focal persons who will do

additional counseling before actual testing because existing national guidelines do not allow the non-health

workers to test. 2d) Establish registers for clients tested. 2e) Procure equipment and supplies necessary for

home-based counseling and testing. 2f) Refer all diagnosed HIV+ individuals to CTC services and other

support services; where indicated provide transport.

3. Conduct community sensitization campaigns to increase demand and uptake of testing. This activity will

allow the scale-up of our counseling and testing services to the wider community beyond the index

households. 3a) Sensitize local and influential leaders on HIV transmission, the harmful impact of stigma,

the importance of testing, and the availability of services. 3b) Hold sensitization meetings with community

members. 3c) Prepare and distribute information, education, communication (IEC) materials including

posters, leaflets, billboards, local drama groups performance, and TV and radio broadcasting.

4. Link with NETWO and MUCHS for promotion of stigma reduction and disclosure, as this will promote HIV

testing to community members.

5. Conduct supportive supervision in collaboration with the council health management team (CHMT) to

ensure quality HBCT is provided to clients. 5a) Develop a checklist for supportive supervision for HBC focal

persons. 5b) Link with the district HIV counseling and testing supervisor to conduct supervisory visits in

partnership.

LINKAGES: Tunajali works closely with the NACP, particularly the care and social support unit which is

responsible for counseling and testing services, the DMO's office and health facilities. This will ensure

availability of test kits as well as joint supportive supervision and good coordination of the services. Local

community service organizations (CSOs) which Tunajali works with have strong links to care and treatment

clinics (CTCs) and this will facilitate effective referrals of people diagnosed as HIV+ to CTC services for

further assessments and management. The program will collaborate with Pathfinder and if appropriate will

adopt this USG partner's QA system for home-based care.

CHECK BOXES: Human capacity development and training; our community volunteers will undergo training

on home counseling and testing. HBC focal persons and government health staff will undergo training on

voluntary counseling and testing. If HIV affected children are identified through the community-based

activity the volunteers will discuss testing with the parents and will link these individuals with appropriate

service sites.

M&E: Tunajali will adapt counseling and testing national data collection and monitoring tools. Community

volunteers will be trained on how to use tools to collect and report the data. Referral forms will be used to

refer patients diagnosed with the virus to CTC and other support services in the community. During

supportive supervision visits HBC focal persons will use checklist to address the quality of the collected

data. The data will be disaggregated by sex, age group and serostatus. Data will be aggregated and

reported monthly by CSOs to the regional office and quarterly to the head office by the regional office.

Regional M&E will routinely support CSOs to address data quality issues. The quarterly reports will be

shared with GoT authorities for future planning. M&E will use 6% of the total budget.

SUSTAINABILITY: Training of community volunteers, HBC focal persons at the community level, and health

staff will ensure continuity of the services. Collaboration of the program with the local authority and

community leaders is also a step towards sustainability of the service as the program/service will be part

and parcel of the districts plans.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16440

Continued Associated Activity Information

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

System ID System ID

16440 16440.08 U.S. Agency for Deloitte Consulting 8030 8030.08 Community $735,000

International Limited Services

Development

Table 3.3.14: