ACTIVITY UNCHANGED FROM FY 2008.

TITLE: Technical Assistance to the National AIDS Control Programme for Strengthening Palliative Care and

Developing/Implementing a National Palliative Care Monitoring/Evaluation System for HIV/AIDS

NEED and COMPARATIVE ADVANTAGE: The National AIDS Control Programme (NACP) has been

successful in rolling out the care and treatment program. However, in order to reach the majority of those

who need care and treatment effectively, there must be stronger coordination and integration of available

services, and strengthening of planning and monitoring for program scale up and quality enhancement. The

Counseling and Social Services Unit (CSSU) of NACP, charged with the responsibility for palliative care, is

severely understaffed. This has contributed to inadequate guidance, coordination, and monitoring. Service

providers' noncompliance to set operating procedures continues to be a problem, resulting in poor quality of

services. FHI has played a systems strengthening role with NACP for several years, and is well positioned

to be a catalyst to strengthen the vulnerabilities in this program, and help orchestrate the scale up of

services throughout the country. FHI has considerable expertise in the Tanzanian health system, which has

been shown to build trust, technical reliability, and respect with the NACP, regional, and district-level

authorities, and with other USG partners. This also positions FHI to help "raise the bar" on expectations at

the NACP.

ACCOMPLISHMENTS: FHI successfully assisted the Ministry of Health and Social Welfare (MOHSW) to:

develop home-based palliative care guidelines and training materials for NACP and Zanzibar AIDS Control

Programme (ZACP), and standard operating procedures (SOP) for care and treatment; and effectively

regionalize services and decentralize supportive supervision. FHI provided extensive technical assistance to

the Health Sector Strategy for HIV/AIDS (2008-2012) development focusing on care, treatment, and

support. FHI was instrumental in updating national guidance with regard to d4T toxicities, and will be

leading the community pilot for prevention for positives interventions. In addition, FHI has developed the

monitoring system for OVC, with many lessons learned for the development/implementation of a palliative

care monitoring system.

ACTIVITIES: The program will focus on strengthening quality of services and the CSSU at NACP in four key

ways:

1. FHI will work closely with other USG-funded programs that will contribute to the quality of palliative care

services, such as the African and Tanzanian Palliative Care Associations and Ocean Road Cancer Institute.

In addition, there is a New Partner Initiative program with the Foundations for Hospice in Sub-Saharan

Africa (working with the Evangelical Lutheran Church—ELCT), and a twinning partnership with the Iowa

Synod of the ELCT. These programs all pledge to bring additional expertise to the table for the

review/update of the national guidelines for palliative care, including the strengthening of pain management

and end-of-life care. These guidelines will feed into the soon-to-be-initiated accreditation process for service

providers.

2. FHI will assist the CSSU in developing a coordinating mechanism, since palliative care has been an area

without strong direction and leadership from NACP in the past. FHI will contract a qualified health-planning

expert to the care and treatment unit (CTU) to plan the expansion of care and treatment activities. The

planner will help the CSSU plan and operationalize the rollout of the HIV/AIDS care component of the

Health Sector Strategy for HIV/AIDS (2008-2012). FHI will facilitate the regionalization of home-based care

(HBC) providers, and help to strengthen the linkages with Care and Treatment Clinics (CTC), PMTCT, and

TB/HIV activities.

3. There will be a component of the program to enhance the package of services available for patients,

including the basic preventive package initiated in FY 2007. In addition, FHI aims to promote integration of

prevention messaging and interventions, adherence counseling, and home counseling and testing. The

home counseling and testing by lay providers will require advocacy for policy change. Because FHI will

assist in adapting the CDC/WHO operational guidelines to implement care and treatment at health

centre/dispensary level, they will help to integrate the local health center into the palliative care services

provided to PLWHA.

4. FHI will convene all stakeholders to develop and plan the implementation of a palliative care monitoring

system to include standardized reporting tools and data management system. This system is regarded as a

tool on at the national level, as well as at the local level for planning, budgeting, management, and decision

making. A key component will be to pilot the system and its application, and to organize a phased

implementation plan to involve all palliative care partners to catalyze the process. FHI will develop training

materials and conduct training of trainers in anticipation of the rollout. A data manager will be contracted to

the CSSU to manage the database and rollout of HBC monitoring. FHI will also organize a team of systems

implementation specialists for an effective and smooth rollout.

Because the accomplishments in this activity will be to strengthen the system and provide appropriate tools,

standards, and systems for palliative care, there are no targets associated with the work. There should be

over 100 individuals trained in and five organizations provided with institutional capacity building in the

system strengthening area at time of reporting.

LINKAGES: FHI works closely with NACP, specifically with the CTU, the CSSU, and the technical

subcommittees. It is a member of the national advisory committee and the following subcommittees: clinical

care; training and human resource; and care and support services. Through membership in these

committees, FHI is able to collaborate with key partners and decision-makers in the MOHSW and national

health institutions. It also works with treatment partners directly to ensure synergy in activities; national level

work is informed by on-the-ground experience; and compliance to national guidelines. In updating the

guidelines/curricula, FHI will work with the African and Tanzanian Palliative Care Associations, Mildmay, the

Foundations for Hospice in Sub-Saharan Africa, the AIHA Iowa Synod partnership, Columbia

University/Ocean Road Cancer Institute, and all palliative care implementing partners. Similarly, the

conceptualization and development of a monitoring system will arise from collaborative efforts for

Activity Narrative: improvement in palliative care. In addition, FHI will collaborate with the I-TECH, and Capacity Project

programs, as well as medical officers, assistant medical officers, clinical officers, and nursing training

schools to enhance pre-service training. FHI partners with regional and district health authorities,

department of training in the MOHSW, Muhimbili University College of Health Sciences School of Public

Health, Department of Social Welfare, and the private medical sector to advance the concept of

comprehensive care across a continuum.

CHECK BOXES: Project activities focus on strengthening capacity with NACP, especially the CSSU, and

pre-service training institutions. NACP staff will be trained in continuous quality improvement, planning,

coordination, and monitoring of standards for care and treatment. Pre-service practical training at care and

treatment clinics will be implemented nationwide. FHI will also emphasize piloting and rollout of innovative

task-shifting and retention strategies. The project targets the NACP staff members, particularly the CTU and

CSSU staff, and pre-service training institutions. Support also extends to implementing organizations.

M&E: A key need is to develop a national monitoring system that can provide more data about palliative

care services, the quality of those services, and the impact of those services. The system will ensure that

quality and completeness of data can be assessed through regular data audits and feedback from staff.

FHI will also develop standardized monitoring tools to capture data and report routinely on progress and

quality of proposed national level activities. In order to facilitate effective program monitoring, and develop

M&E capacity for full scale up, a variety of methods will be used to build NACP M&E capacity, including

training and on-the-job mentoring.

SUSTAINAIBLITY: FHI's technical support to NACP is designed to build human and institutional capacity

leading to the sustainability of national level coordination, monitoring, and standards development. FHI will

work as a partner with NACP to provide training, mentoring, and building capacity for systemic planning.

The focus is on innovative mechanisms to increase and retain qualified staff at all levels. Emphasizing

decentralization and sourcing out of activity areas will free time for NACP to focus on normative functions.

In addition, FHI will enhance local capacity and encourage sustainable, quality services by ensuring that

implementing partners work within existing public and private systems, and use national guidelines,

standards, and monitoring system instead of creating a parallel system.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16304

Continued Associated Activity Information

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

System ID System ID

16304 16304.08 U.S. Agency for Family Health 6516 1219.08 $400,000

International International

Development

Table 3.3.08:

THIS IS A NEW ACTIVITY

TITLE: Home-based Care Coordinator Strengthening

The government response to the HIV/AIDS crisis in Tanzania is shared by the health sector response,

represented by the Ministry of Health and Social Welfare through The National AIDS Control Programme

(NACP), and a multi-sectoral response, represented by the Tanzania Commission for AIDS. In addition, the

Prime Minister's Office for Regional and Local Government (PMORALG) is also involved, since it is the

Tanzanian government body responsible for the oversight of programs and the district level. Although great

strides have been made to ensure comprehensiveness of services and effective coordination at all levels,

collaboration between these bodies remains a challenge.

Successful implementation of national AIDS response plans is dependant on strong planning, coordination,

implementation, monitoring, and supportive supervision at all levels, as well as a strong policy environment.

The decentralization of government functions in Tanzania has placed increased demand on the local

government structure, particularly the district councils. Implementation and coordination of HIV/AIDS

programs at the district level is suffering from gaps in coordination, human resource capacity, and lack of

streamlined processes of governance. In addition, the roles and responsibilities of staff are loosely defined,

resulting in confusion, missed opportunities, and ineffectiveness. The focus on effective, quality home-

based care (HBC) services for people living with HIV/AIDS (PLWHA) mandates a collaborative intervention

to strengthen HBC Coordinators employed by the districts, in order to streamline communications,

reprioritize roles, and strengthen linkages and referrals. HBC Coordinators work under the Program

Coordinators for the districts, who oversee other health programs coordinators such as TB, leprosy, and

maternal and child health. Program Coordinators are also members of the District/Council Management

Teams for health.

HBC Coordinators are responsible for all HBC activities within their district, working together with

governmental bodies and non-governmental organizations to serve PLWHA in their communities. The role,

responsibilities, and professional requirements vary throughout the country, and the confusion that

surrounds the position hampers the ability of the HBC Coordinators to link effectively to service providers

and identify gaps in the programs. The District HBC Coordinator is an existing position within district

councils, funded through the district council budget through the health department. HBC Coordinators get

technical support through NACP, and are expected to be a critical link in ensuring the coordination of

programs and the flow of information to the national level.

With FY 2009 funds, TBD will initiate an assessment of the current situation in at least four districts in two

regions, to assess the function of HBC Coordinators and recommend more appropriate roles and

responsibilities for HBC Coordinators, District AIDS Coordinators, and Council HIV/AIDS Coordinators

(representative of the multi-sectoral response). TBD will help the district councils and NACP to clearly

define and understand these roles, and develop an efficient framework for data flow and reporting. TBD will

promote HBC Coordinators strengthening through the foundation of a standard model of responsibilities and

professional trainings. The program will streamline communications through all levels of management, and

identify and strengthen appropriate links between these positions and service providers. During the

assessment, TBD will also be able to evaluate the local AIDS response in order to identify additional

challenges or best practices being implemented. Results from the assessment will be developed into a

portable framework to share with other districts and implementing partners for possible scale-up.

Additionally, lessons learned will be shared with the national systems strengthening initiative, as well as

policy partners addressing issues that may need intervention.

TBD will consider initiating recommendations of the assessment in districts that are intended to be "model

learning districts" that will help to inform scale-up of effective practices. TBD will also consult with

PMORALG at the outset, during the assessment phase, and at the time future plans for the role of the HBC

Coordinators to ensure the plans fit with the local scheme.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.08:

ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP

TITLE: Strengthening National Systems for OVC Services in Mainland and Zanzibar

NEED and COMPARATIVE ADVANTAGES: Tanzania has an estimated two million orphans and vulnerable

children (OVC). To date, only about half of the 134 district councils have established Most Vulnerable

Children's Committees (MVCCs) to identify vulnerable children and address their needs, and only about

20% of these vulnerable children have been formally identified. Despite the considerable progress in OVC

identification and provision of services, systems for decentralized programs for OVC are weak. A

considerable challenge is those districts that have been unreached to date because funds are not presently

available to support services. Social welfare services (including OVC programs) are supposed to have

been decentralized by devolution under government reform; however, the transfer of responsibility in this

sector has not occurred with clarity. Strategic leadership is particularly necessary at this time from both the

Department of Social Welfare (DSW) in the Ministry of Health and Social Welfare (MOHSW) and the

Department of Local Governments (DLG) in the Prime Minister's Office for Regional Administration and

Local Governments (PMORALG). These bodies are responsible for coordinating, implementing, and

monitoring the rollout of the National Costed Plan of Action (NCPA) for Most Vulnerable Children, as well as

the related national Data Management System (DMS), which tracks OVC and OVC service providers. Yet

the DSW remains weak and has not coordinated their rollout plans clearly to PMORALG to date. Although

implementing partners, with technical assistance from Family Health International (FHI), have made

substantial progress in OVC identification and service provision, they also require continued assistance to

catalyze implementation of the NCPA and DMS successfully at the district level. There is also considerable

need to standardize the quality of OVC services. A national Quality Standards (QS) Framework of care for

OVC was recently developed and is now ready for implementation at the service delivery point. As the lead

organization in the QS Framework development, the NCPA, and the DMS, FHI is well-positioned to

strengthen the planned rollout of these new national systems. FHI has a strong working relationship with

the MOHSW; a formal partnership with PMORALG (which implements and monitors NCPA activities at the

district and community level); and successful collaborations with other implementing partners.

ACCOMPLISHMENTS: In mainland Tanzania, the following key milestones have been accomplished with

FHI's technical support and leadership: 1) the NCPA was finalized and launched at an event presided over

by First Ladies Salma Kikwete and Laura Bush; 2) the national DMS was introduced in 43 district councils;

3) 180 social welfare, community development, and M&E officers were trained on the DMS; 4) full

application of the DMS (with data feeding up to the national system, being analyzed, and reported back to

districts) was completed in six districts; and 5) 30 national facilitators received training in caretaking skills.

FHI has provided ongoing support and systems strengthening advice to the DSW for the rollout of the

NCPA and the DMS. A DMS manager has been seconded to the DSW to develop and support national

coordination of the data system. FHI has signed a memorandum of understanding with PMORALG to ignite

local government involvement and increase communication and partnership with all district councils in the

rollout of programs to serve OVC. A joint implementation plan has been developed to build upon

accomplishments of the past year and expand the rollout of the NCPA and the DMS to an increasing

number of districts. Likewise, FHI supported implementing partners to strengthen their capacity to ensure

quality of data and to use data for decision making at national and local levels.

FHI and the DSW Zanzibar have advanced OVC efforts in Zanzibar significantly. Within the past year, an

OVC situation analysis was completed, information technology equipment was supplied and installed, an

FHI-funded Data Management Specialist was recruited, and work on the development of the DMS for

Zanzibar has commenced with FHI support.

ACTIVITIES: In FY 2009, FHI will continue to provide support for the DSW and the DLG to intensify efforts

for effective implementation and quality assurance of national OVC policies, strategies, guidelines, and

operational plans. This support aims to strengthen the capacity of both the DSW and DLG staff to scale up

quality and sustainable services for OVC. In previous years, FHI has focused on supporting the DSW, but

now that the NCPA is in the rollout stage and needs strong local government involvement, support has been

extended to the PMORALG. To expand the phased implementation of the NCPA to an increasing number

of districts, FHI will support the efforts of the PMORALG OVC focal person in the DLG. FHI will provide

information technology support to the DLG to facilitate coordination and monitoring of NCPA

implementation. FHI will also facilitate ongoing and clear communication from PMORALG to the district

councils and MVCCs about the NCPA, sharing effective implementation tools and the successes of several

model districts. FHI will continue to work with the DLG and implementing partners to ensure the effective

functioning of district councils to develop district-specific NCPA plans, integrate OVC care and support in

their day-to-day work, and strengthen and empower Council Multi-sectoral AIDS Committees and MVCCs to

provide and coordinate OVC care and support. FHI will provide ongoing technical support to PMORALG to

advocate for increased funding allocation for OVC support in central and local government budgets to

ensure appropriate resources for the success of the NCPA. FHI will help to reinforce local government's

roles and responsibilities for OVC under a decentralized structure, and facilitate collaboration between

implementing partners and local government through the DLG. FHI will also work with PMORALG to set the

stage for the overall devolution of social workers into the local government system and the integration of

paraprofessional social workers to support local needs.

FHI will continue to strengthen the DSW by focusing on the strategic national role they should play in terms

of policy, standards, manpower development, and monitoring. FHI will help the DSW ensure that the

leadership and effective coordination needed for a successful rollout of OVC programs through the NCPA is

in place, and that that national OVC guidelines and policies are up-to-date. FHI will also help to ensure a

smooth transition in leadership resulting from the retirement in FY 2009 of the two major government

leaders responsible for the OVC programs. An important component of the transition is to strengthen the

delegation of authority and responsibility within the DSW. Also, staff will be strengthened with ongoing

leadership and management support, plus funds will be made available for renovation of an OVC resource

facility within the office of the DSW.

Activity Narrative: To foster national leadership, FHI will also work with the DSW to ensure that the National Steering

Committee for OVC (comprised of high level officials from several ministries and key national stakeholders)

meets on a regular basis. This Steering Committee provides the backbone for the national OVC

Implementing Partners Group (IPG), whose membership makes up the national Technical Coordinating

Committee. FHI will provide crucial technical assistance to the effective functioning of these important

groups, which are led by the government of Tanzania (GOT).

FHI will continue to provide technical expertise and advice to other OVC implementing partners and to local

implementation. Useful avenues to achieve this include providing technical leadership and facilitating

Quality Improvement Taskforce meetings. FHI will continue to co-chair the Quality Improvement Taskforce

formed by the OVC IPG, leading the pilot of the newly-developed national QS framework for OVC care and

support. FHI will also develop mechanisms to ensure inputs from implementing partners, local

communities, MVCCs and children's clubs to inform policy and planning. In addition, to ensure that critical

technical issues are discussed and practices are evaluated for scale-up, FHI will sponsor periodic inter-

regional learning sessions to share and disseminate promising practices for OVC care and support, and

identify those practices to be considered for adoption into the national guidelines for OVC services.

Technical tools and materials will be developed by FHI to strengthen the provision of services. For

example, to address the psychosocial needs of OVC, FHI will finalize the national guidance for establishing

and managing children's clubs and will conduct training for trainers. FHI will engage HelpAge International

to develop a resource manual for service providers to support elderly caregivers. Also, materials may be

developed for individuals who will use DMS data as a case management tool. FHI will also work with

FANTA to include appropriate nutritional support into the OVC guidelines.

A strategic piece of an effective OVC program is the routine monitoring of OVC services by the GOT, which

depends on a highly functional DMS system and competent staff to manage it. In addition the presently-

supported DMS Manager, FHI will second a new M&E officer to the DSW. This officer will monitor, analyze,

and report on OVC data from the DMS, as well as evaluate the progress toward goals outlined for the

implementation of the NCPA and DMS. In addition, in FY 2009, FHI will work with the DMS staff at the

DSW to identify lessons learned from the initial 43 rollout districts to improve the system. In FY 2009, FHI

will also engage and oversee a team of information technology experts that will rove the districts working

with the DMS staff to ensure that partners and local government are collecting data appropriately, and that

the local MVCCs and local government authorities are equipped to use the data for planning, budgeting,

and decision making. These technical experts will also continue to roll out the DMS to all 134 districts,

perform local "troubleshooting," build local capacity to ensure data quality, and ensure that data recording,

reporting, and use for OVC programs are operational at all levels. In addition, FHI will provide guidance to

help national government officials understand how to use data for multiple aspects of their job, including

overseeing programs, policy development and planning, and decision-making. FHI will also work with the

DSW to train staff on data quality review systems. Lastly, FHI will support DSW to connect the server for

the national DMS in their new office space, and to procure necessary computers for key staff members.

FHI will work with the DSW and the Intrahealth Capacity Project to address the severe nationwide shortage

of social workers. A critical element of this initiative is to have, at a minimum, the short-term needs

addressed so that at least minimal infrastructure is in place for the rollout of the NCPA. Specifically, FHI will

work with the IPG to involve trained paraprofessional social workers in community-based OVC support

activities. In addition, FHI will work with the Intrahealth Capacity Project, PMORALG, and the President's

Office for Public Services Management to advocate for the full integration of the paraprofessional social

workers into district systems. FHI will also work with the DSW and the Institute of Social Work to organize

student internship opportunities.

Finally, FHI will continue to support Zanzibar's DSW to further increase its capacity to oversee and

coordinate OVC services in Zanzibar and operationalize its DMS. Based on lessons learned from the

mainland, FHI will support the piloting of the DMS in five districts. In addition, FHI will support training of

trainers in community identification of and planning for care and support of OVC, particularly psychosocial

support and caretaking skills.

LINKAGES: This activity will link with the OVC IPG network, which includes all USG OVC implementing

partners, as well as UNICEF, the Tanzanian AIDS Commission (TACAIDS), and other key OVC

stakeholders. FHI will support these linkages through technical assistance, sharing strategic information at

IPG meetings, and harmonizing methods and approaches. Where appropriate, FHI will formalize linkages

through memoranda of understanding (MOU) in joint projects, such as the MOU with Pact and Africare. FHI

will collaborate with the DSW and GOT Ministries on issues of local government, education, vocational

training, food security, nutrition, and legal support. FHI will work with the National Bureau of Statistics to

integrate the DMS into their system and TACAIDS to coordinate OVC HIV/AIDS multi-sectoral framework.

FHI will also work closely with the PMORALG and the Intrahealth Capacity Project to facilitate the

devolution of social workers and integration of OVC support.

M&E: The program will continue to support the national DMS for tracking OVC and service providers, and

will support its rollout by providing staff, technical support, and training on data quality and use. FHI will

continue to assist all OVC USG-funded implementing partners to adopt the system. The program will also

assist the DSW national M&E data analysis and dissemination to provide feedback to frontline data

collectors and inform policy makers on progress.

SUSTAINAIBLITY: FHI will continue to foster sustainability by mentoring DSW and DLG staff, and fostering

leadership through existing government structures such as the DSW and DLG. All activities are designed to

build the capacity of DSW, DLG, local GOT structures and other partners for sustainability. Through the

proposed decentralization strategy of OVC identification, DMS, NCPA and supportive supervision, local

government authorities can gradually embrace their important role in providing for the care of OVC,

especially by including OVC issues into their annual plans and budgets to ensure sustainable quality care.

Also, through capacity building, systems strengthening, and policy environment improvements, the DLG and

Activity Narrative: DSW will be in a stronger position to scale up and monitor quality OVC services in the country.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13477

Continued Associated Activity Information

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

System ID System ID

13477 8703.08 U.S. Agency for Family Health 6516 1219.08 $1,000,000

International International

Development

8703 8703.07 U.S. Agency for Family Health 4537 1219.07 $400,000

International International

Development

Table 3.3.13:

ACTIVITY NARRATIVE REMAINS UNCHANGED FROM FY 2008.

The funding for this activity has changed from clinical services (HTXS) to Health Systems Strengthening

(OHSS), and as a result the targets have also changed to reflect their contribution to OHSS targets. In FY

2008, this activity did not contribute to HTXS targets.

TITLE: Technical Assistance to the NACP Care and Treatment Unit to Build Strategic Planning and

Management Capacity

NEED and COMPARATIVE ADVANTAGE:

The National AIDS Control Programme (NACP) has made some successes in rolling out the National Care

and Treatment Program; however it is critical to strengthen its capacity to plan, orchestrate implementation,

and monitor national, regional, and district-level activities in order to reach the majority of those who need

care and treatment most effectively. Family Health International (FHI) is well-positioned to provide national

level

support because of its health systems and HIV care and treatment expertise. It has successfully

collaborated with the NACP in Tanzania for several years. Its approach of working "through" government

has allowed FHI to gain the trust and respect of the NACP, which has resulted in FHI being often called

upon to provide feedback and technical guidance to the NACP.

ACCOMPLISHMENTS:

FHI's work with NACP has led to the development of national Standard Operating Procedures (SOPs) for

care and treatment. It was instrumental in conceiving the regionalization of treatment activities, the

decentralization of supportive supervision, and the development of supportive supervision tools. FHI

provided technical assistance and to the Ministry of Health and Social Welfare in the development of the

Health Sector Strategy for HIV/AIDS-2008-2012, leading a team of experts in the components focused on

care

and treatment. FHI has conducted an analysis of NACP management capacity, followed by a teambuilding

retreat to strengthen effective management and communication. FHI facilitates convening of important

technical meetings, including the national care and treatment subcommittee. This includes fostering good

policy and practices by facilitating discussions and providing technical state of the art inputs. For example,

this has led to the updating of national guidance with regard to d4T toxicities and phasing out stocks of d4T

40.

ACTIVITIES:

NACP is severely understaffed, which leads to an inability to effectively orchestrate the rollout of care and

treatment services, and provide adequate monitoring and supervision of established standards and

operating procedures. Its highly bureaucratic procedures delay implementation. To address this, FHI will

identify and proceed with appropriate ways to build coordination, planning, and management capacity of the

NACP Care and Treatment Unit (CTU). FHI will continue skills building in planning, implementation

(translating plans into phased action) through secondment of a senior-level health planner, who will assist

the head of the CTU. The seconded staff will facilitate the development, implementation, and monitoring of

the unit's work plans and budgets according to MOH and donor priorities. This includes required assistance

in mobilizing other donor funds, e.g., Global Fund. FHI will draw on expert consultancies as necessary to

ensure that NACP rolls out their work plan in a timely and coordinated fashion, as well as NACP's

implementation of the 2008-2012 HIV/AIDS health sector strategy with regard to care and treatment. As

follow-on to the management retreat conducted last year, FHI will support biannual retreats and workshops

for NACP staff to further improve management and coordination skills focusing on areas identified during

the previous retreat. FHI will ensure regular meetings are conducted for the national technical

subcommittee on care and treatment. FHI will guide the CTU in translating recommendations into policies

and guidelines through: contributing to setting the agenda for the subcommittee meetings; ensuring state of

the art information feed into discussions; facilitating development of clear action points; and ensuring action

points are carried out. FHI will provide technical and financial support in development/updating and printing

of national policy and strategic guidelines, such as the development of guidelines for:

(1) implementing the continuum of care approach

(2) integrating HIV services into general health service delivery

(3) implementing "prevention for positives" package.

It will also support the printing of the recently revised national treatment guidelines.

FHI will assist the NACP in planning linkages between treatment the regionalization of other HIV-related

services, in particular palliative care (HBC), PMTCT and TB/HIV activities as agreed with USG and other

partners. FHI will ensure technical consistency between the hospital level SOPs and the health

centre/dispensary level operational guidelines, which is currently being developed through the support of

CDC/WHO. FHI will drive the agenda to ensure that state of the art information and lessons learned inform

decision makers and those developing training materials. In the area of human resources, FHI will

document its success with the "retired but not tired" health worker recruitment, and work with NACP and the

MOHSW to bring that intervention to scale. It will also look for other best practices in maximizing health

manpower (e.g. task shifting), and work with the Government of Tanzania and the Capacity Project to bring

those interventions to scale.

Though there are no direct targets for treatment, there will be individuals trained and capacity built with local

organizations, which will be reported in the semi-annual and annual reports.

LINKAGES:

FHI works closely with the NACP, specifically with the CTU, and the National HIV Care Advisory Committee

and national technical care and treatment subcommittee. FHI also works closely with the other USG

treatment partners directly to ensure national-level work is informed by on-the-ground experience,

complementarity of activities, and compliance to national guidelines. It partners with regional and district

health and medical authorities, Muhimbili University College of Health Science, and various clinical training

institutions for nurses and clinicians and as well the private medical sector to advance the concept of

comprehensive care across a continuum with sound clinical and referral components.

Activity Narrative: CHECK BOXES:

Project activities focus on technical and managerial capacity building for better strategic planning and

technical skills NACP staff will be trained in planning, coordination, management, and monitoring of

standards for better rollout of a decentralized implementation of care and treatment following national

standards. This activity area targets the NACP staff members, particularly the CTU and affiliates in other

units, the ministry and partners.

M&E:

To assess progress systematically and provide timely information for making mid-course adjustments, FHI

will use standardized monitoring tools to routinely capture data and report on progress and quality of

proposed national level activities. The quality of data will be ensured by regular data audits and feedback

from staff. FHI will use approximately 7% of its budget for M&E activities.

SUSTAINAIBLITY:

FHI technical support to NACP is designed to build human and institutional capacity leading to the

sustainability of national level coordination, planning, monitoring, and standards development. FHI will work

"through" more than "with" NACP through training, mentoring, and building capacity for systemic planning.

Its focus on innovative mechanisms to increase and retain qualified staff at all levels. Emphasizing

decentralization and outsourcing of activity areas will free time for NACP to focus on normative functions. In

addition, facilitating and ensuring implementing partners work within existing public and private systems,

and use national guidelines, standards, and monitoring system, instead of creating a parallel system, will

ensure enhanced local capacity. Lastly, FHI will work with the private sector to provide technical inputs in

the training on care and treatment to private providers in major urban centers, in collaboration with the

Muhimbili University of Health and Allied Sciences Public Health department and the Private Physicians

Association. Though there are no direct targets related to treatment in this activity, FHI will provide capacity

building to one organization and a minimum of five individuals with this funding.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16473

Continued Associated Activity Information

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

System ID System ID

16473 16473.08 U.S. Agency for Family Health 6516 1219.08 $400,000

International International

Development

Emphasis Areas

Human Capacity Development

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

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.18: