PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
ACTIVITY UNCHANGED FROM FY 2008.
TITLE: Scale-up of Home-based Care Activities for People Living with HIV/AIDS in Tanzania
NEED and COMPARATIVE ADVANTAGE: HIV/AIDS remains the biggest public health challenge in
Tanzania. Community home-based care (HBC) is a critical component of the continuum of prevention,
care, support, and treatment for People Living with HIV/AIDS (PLWHA). HBC services aim to teach clients
to live positively while providing palliative care and support, in addition to linking individuals to health and
social services. HBC creates strong two-way referral linkages between the community and medical
facilities. HBC helps clients get the treatment and support required in order to live longer, healthier lives.
Pathfinder International (PFI) has been working in HBC in Tanzania since 2001 and has built strong working
relationships at the community level. PFI and its sub-partners are providing comprehensive home-based
palliative care services that include clinical, psychological, spiritual, and social care, as well as providing
insecticide treated nets (ITNs), water vessels, purification tablets, cotrimoxizole prophylaxis, nutritional
support/education, home counseling and testing services, and referrals.
ACCOMPLISHMENTS: PFI has supported 18,000 individuals with general HIV-related palliative care,
sensitized 120,000 community members on services and need for HBC, trained over 800 individuals, and
extended services to 67 wards. Over 3,000 HBC kits and 3,000 ITNs have been distributed. PFI has
conducted needs assessments for five implementing partners and is a member of the care and support
subcommittee of the National Advisory Committee on HIV/AIDS. PFI assisted the National AIDS Control
Programme (NACP) in coordinating and pre-testing supervision tools and in proposing a strategic
framework for HBC planning.
ACTIVITIES: With FY 2008 funding, PFI will:
1. Scale up coverage and strengthen provision of integrated, high-quality care and support for PLWHA in
five existing and two new regions. PFI will support and encourage community leaders to mobilize local
resources and enlist community involvement and ownership. Mapping of facilities will be done to identify
how partners will establish collaboration between facility-based and community HBC, entry-to-care points,
and other key services actors. The program will strengthen and formalize systems between local health
facilities, community-based organizations (CBOs), Council Multisectoral AIDS Committees (CMACs), and
community groups to support referrals, supervision, reporting, and follow-up for continuity and efficacy of
services.
2. Build the capacity of local government and civil society for sustainable delivery of services for PLWHA.
PFI will also provide input to NACP to strengthen programs and coordinate community HBC activities,
institutionalize technical monitoring, supervision systems, and tools. PFI will provide intensive institutional
capacity building (ICB) support for district health management teams (DHMT) and CBOs to expand
activities. Possible tailored support includes strengthening of financial, human resource, operational
management systems, as well as governance and strategic planning. An efficient, rapid, and flexible sub-
grant mechanism will work in tandem with capacity-building support for scaled-up service delivery in order
to develop intermediary organizations as key stakeholders in the national HIV/AIDS response.
3. Expand access and integrated service networks of PLWHA to the continuum of care and comprehensive
HIV/AIDS services, as well as preventive care and interventions and prevention with positives. PFI will
encourage local and national groups and committees (including PLWHA groups), to share their work and
raise implementation challenges with high-level stakeholders, institutionalizing mechanisms to
collaboratively address PLWHA and HIV-related issues. PFI will advocate for increased attention to
palliative care at all levels with policymakers and government representatives. PFI will provide clients with
comprehensive home-based palliative care services that include clinical, psychological, spiritual, social
care, and preventative services (ITN, water vessels, cotrimoxizole, nutritional support/education, counseling
and testing services, and referrals). By establishing linkages with antiretroviral therapy (ART) partners and
municipal facilities will aid in strengthened referrals. A critical aspect that will receive renewed attention is to
identify children in the household who may have been exposed to HIV and ensure they are tested and
referred as appropriate for care/treatment. PFI will also take advantage of home visits to ensure that
prevention messages are provided for those who are positive to reduce behavior that risks transmission,
offer condoms and family planning (as appropriate), and monitor adherence.
4. Train and equip service providers for quality service provision. PFI will conduct training of trainer (TOT)
courses for new areas and refresher courses for existing TOTs in new technical areas. PFI will train new
community home-based care providers (CHBCPs). Existing providers will have refresher training which will
include provision of home-based care for HIV-positive children. PFI will facilitate coordination between
health training centers and lead agencies to promulgate palliative care training. It will be important to
expand successful purchase of supplies allowing management of supplies with district medical stores
officers who are provided with community HBC kit stock management training. All providers will be given
HBC kits after trainings.
5. Work with NACP and key HBC partners to develop, print, and disseminate behavior change
communication/information, education, communication (BCC/IEC) material and best practices. They will
also develop different communication materials to increase utilization of services, inform, and educate the
public on community HBC and other HIV/AIDS issues. Success stories and project experiences will be
documented, published, distributed in country, and presented at appropriate international learning
conferences.
6. Pilot the use of solar-powered handheld electronic devices to connect community and facility levels for
palliative care referrals, linkages, and back-up support. In remote areas, this will allow more effective
transmission of data.
LINKAGES: As one of the large HBC implementing partners, PFI will provide input and feedback to the
Tanzanian Commission for AIDS (TACAIDS) and NACP on policy, standards, M&E, and coordination
Activity Narrative: related to HIV/AIDS prevention, care, treatment, and impact mitigation. They will also participate in HBC
technical and coordination groups. To ensure access to and use of quality of services, the project will
develop strategic partnerships and build linkages with existing governmental and non-governmental
organizations at all levels. They will collaborate with existing structures to build local capacity and access
wraparound programs including food security, education and vocational training, safe water, ITNs linked
with the President's Malaria Initiative, and income-generating activities (IGA). The project will work closely
with USG and non-USG funded HIV/AIDS and health projects to expand breadth and depth of service
coverage especially for counseling and testing, PMTCT, ARVs, opportunistic infection prevention and
treatment, and wraparound services. Under the regionalization process, Pathfinder will specifically
coordinate the activities of other implementing partners to avoid duplication of effort and to ensure good
communication to the CMACS and local government.
CHECK BOXES: The project will be implemented in seven regions and will target PLWHA and the general
population. Both urban and rural areas will be targeted for service provision although areas with referral
facilities will be given preference to allow for linkages and wraparound services. Through ICB activities,
DHMTs and implementing partner's managerial capacities will be strengthened to improve program quality.
The project will strive to ensure that every individual in the operational area in need of HBC service is
accessing services through trained providers.
SUSTAINAIBLITY: PFI will promote sustainable activities by building capacity of existing DHMTs, CBOs,
coordination bodies, and CHBCPs and have formal agreements stipulating each party's roles,
responsibilities, and expectations in order to support incorporation of HBC activities in comprehensive
district plans. Sub-grantees will be strengthened in internal governance, financial sustainability, and
management information systems. Programmatic sustainability will be strengthened by upgrading skills
through step-down training by intermediate organizations.
MAJOR ACTIVITIES:
1. Scale up coverage and strengthen provision of integrated, high quality care and support for PLWHA at
the community level in seven regions: five existing and two new.
2. Expand access and integrated service networks of PLWHA to the continuum of care and comprehensive
HIV/AIDS services as well as preventive care and interventions and prevention with positives to avert new
infections through partnerships and referrals linkages.
3. Train and equip service providers for quality service provision.
4. Contribute to regional process of HBC partners, linking with appropriate treatment partners and
coordinating with other palliative care partners.
5. Develop, print, and disseminate BCC/IEC material and best practices.
6. Build the capacity of government and civil society for sustainable delivery of services for PLWHA.
7. Pilot solar electronic devices to connect community and facility providers.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13565
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13565 3468.08 HHS/Centers for Pathfinder 6550 1415.08 $3,600,000
Disease Control & International
Prevention
7785 3468.07 HHS/Centers for Pathfinder 4571 1415.07 $2,375,000
3468 3468.06 HHS/Centers for Pathfinder 2871 1415.06 $1,300,000
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $1,199,620
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 $250,000
Economic Strengthening
Education
Water
Table 3.3.08:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
In addition to those activities undertaken in FY 2008, in FY 2009, PFI will focus on improving quality of
services for OVC through adaptation of the standardized national quality standard of OVC services. This
will be initiated with the provision of direct support to OVC in the Shinyanga region. PFI will select one
district with high HIV/AIDS prevalence to set an example as a "program learning district." This district will
serve as a model to demonstrate linkages between referral systems, prevention programs, and treatment
programs stemming from a collaborative effort from implementing partners. Specifically, PFI will work in
collaboration with the OVC food and nutrition implementing partner to pilot the community nutrition support
program in its learning district. PFI is in the best position to pilot the program as it currently implements
both home-based care and OVC services. PFI works collaboratively with the treatment partner in their
regions (the Elizabeth Glaser Pediatric AIDS Foundation--EGPAF), to ensure that services are coordinated,
and neither duplicated nor insufficient. EGPAF also implements prevention of mother-to-child transmission
services in these communities, and monitors adolescent HIV/AIDS prevalence growth rates. EGPAF then
links OVC with the Maternal and Child Health (MCH) community outreach activities or care and treatment
clinics for HIV care and support, based on need. HIV-positive OVC are linked to existing programs that will
provide facility-based food by prescription, or whatever available services they may require.
PFI will enhance its work with MVCCs to ensure that OVC are formally identified and linked with community
services that provide food and nutrition assessment and education, as well as referral for MCH services.
Through MVCC linkages, services can be particularly focused on OVC under five years of age, children who
are primarily responsible for the household, and to elderly caregivers of OVC.
To ensure sustainability, PFI will strengthen poor households through trainings on food security, increased
income generating activities, and development of entrepreneurship skills. In addition, PFI will build capacity
at all levels to ensure community participation and ownership of the program. PFI will work with the district
councils to ensure integration of the OVC programs in the districts plans and budgets.
Best practices and lessons learned will be shared across the OVC implementing partners. Other OVC
stakeholders will have opportunities to visit and learn about the ongoing activities and linkages as well as to
gain knowledge of how to solicit the community to take ownership of the program and for OVC in their
catchment areas.
*END ACTIVITY MODIFICATION*
TITLE: Tutunzane Integrating Community Program for Orphans and Vulnerable Children (OVC).
NEED and COMPARATIVE ADVANTAGE: Tanzania has approximately 2.5 million orphans and vulnerable
children (OVC). Previously, orphanhood did not pose a problem to existing coping mechanisms. However,
the increasing numbers of OVC have overburdened traditional coping mechanisms. In response, Tanzania
has developed different strategies to improve and scale up services to assist OVC and families affected by
HIV/AIDS. Pathfinder International (PFI) has worked in Tanzania since 2001, building strong working
relationships at the community level and providing home-based care to people living with HIV/AIDS
(PLWHA). This provides an opportunity to do case finding for HIV-exposed OVC and provide services to
them. The home-based care program, called Tutunzane (which translates to "let us take care of each
other"), will be expanded to include support for OVC, leveraging its relationships with communities and
expertise in home-based care.
ACCOMPLISHMENTS: Tutunzane already serves 18,000 PLWHA. Its key sub-partner, the Axios
Partnership in Tanzania (APT) also has considerable expertise working with OVC and communities. With
Abbott funding, APT served 4,698 OVC in paralegal cases; 15,000 in medical and psychosocial support;
11,000 with nutritional support; 1,148 with birth certificate registration; 165 with income generation activities
(IGA); and trained 811 volunteers. APT also built capacity for vocational training, worked with school health
programs and district OVC management teams, developed a business coalition model, produced guidelines
for institutional care, and developed an exit strategy for mature OVC to transition from institutions into the
community.
ACTIVITIES: With FY 2008 funds, Tutunzane will collaborate with APT as a sub-partner to scale up the
OVC National Plan of Action (NPA) by applying the national OVC identification process and provision of
comprehensive, effective, and high quality services. Tutunzane will build on existing local initiatives and
programs to establish interventions that are culturally appropriate in care giving and suitable to the
communities. Emphasis will be placed on ensuring that OVC receive better care within communities than in
institutions. This project is proposed to be implemented in the regions where Tutunzane is already active, in
addition to expanding to seven districts of Shinyanga Region. It will operate both in urban and rural areas,
with preference for areas with referral facilities for wraparound services. The program is expected to reach
9,800 OVC.
By the end of year one, PFI and APT will have completed a baseline survey, including an identification of
the OVC, and a market analysis of micro enterprise opportunities; trained project staff in psychosocial
outreach to OVC; and solidified project partnerships for rollout. PFI will provide educational support to OVC
identified by the community during the baseline assessment. Methods of operation will also be established,
laying out procedures to identify children who have been exposed to HIV so that they are referred for testing
and care/treatment, if necessary. OVC served during this period will include those children and adolescents
already identified by communities through other community-based organizations (CBOs) and local Most
Vulnerable Children's Committees (MVCCs). Established indigenous and other organizations will receive
necessary training in order to carry out project activities, and MVCC will be supported in building capacity to
provide oversight. Lessons learned and insight gained from this process will be used to inform, encourage,
and facilitate replication to other communities. In subsequent years of the project, PFI will work with
established partners to rapidly take to scale, model interventions, and mentor newly identified CSOs to
replicate the project and share relevant experiences. The programmatic responses will be complemented
Activity Narrative: and supported by implementing activities that strengthen the policy and program environment to adequately
address the needs and interests of OVC.
The Tutunzane Program will train community home-based care providers (CHBCPs) on the provision of
psychosocial support (PSS) to quickly catalyze and coordinate community PSS for OVC. Cultural,
recreational, and life-skills activities will be accessible to all children and adolescents in the community, with
a particular emphasis on the inclusion of OVC. Educational opportunities for OVC will be facilitated in
partnership with local CBOs through activities such as awareness raising by CHBCPs; provision of
scholastic materials to OVC; and teacher training on PSS. Vocational and life skills training for adolescents
will be developed following the program baseline survey and market surveys. Tutunzane will link with
community programs for food provision, coordinated by sub-grantees, to reduce food insecurity felt by
households caring for OVC. CHBCPs will provide nutritional education both inside and outside the home.
Tutunzane will collaborate with other OVC programs to ensure that child protection, social welfare, and
succession programs will be in place to bridge the gap between law and traditional practices, strengthen
child protection capacity at district and community level (to protect children from abuse and exploitation),
and provide a focal point to link all OVC related interventions.
Throughout the project intervention, particular attention will be given to child protection and minimizing girls'
vulnerability to exploitation and abuse. CHBCPs will ensure that those girls identified as being particularly
vulnerable to sexual exploitation are actively recruited for vocational training.
LINKAGES:
This activity will link with all USG-funded OVC activities, especially through the OVC Implementing Partner
Group network. It will also be closely aligned with the PFI home-based care activity. Basic mapping will be
accomplished in program regions to identify other programs for potential wraparound activities. Replication
of the national OVC IPG activities at district and regional levels will be encouraged in order to enhance
linkages, reduce duplication, and support the districts' social welfare capacity to coordinate OVC activities.
PFI will also link with Peace Corps to strengthen nutritional and economic needs of OVC households.
CHECK BOXES: The project will be implemented in five regions and the target populations are OVC. Both
urban and rural areas will be targeted for service provision with preference for areas with referral facilities
for wraparound services. Tutunzane will also assist to the MVCCs and CBOs to strengthen managerial
capacities in order to improve program quality and ensure compliance with the national programs. The
project will strive to ensure that every individual in the operational area in need of OVC service has access
to the services, with particular attention given to child protection and minimizing girls' vulnerability to
exploitation and abuse.
M&E: Tutunzane will adopt the national Data Management System, and will use that system for monitoring
and evaluation. They will ensure that sub-grantees are responsible and accountable for inputting
information about identified OVC. Tutunzane will also ensure that the data from the local level feeds not
only into the national system, but is also available to MVCCs at the local level for planning, decision making,
and monitoring. Tutunzane will also work with FHI to build capacity of the district social welfare and M&E
officers and purchase them computers to ensure data quality and integrity. In addition, PFI will conduct
quarterly field visits to assess the quality of services provided, collect data, and provide onsite refresher
training as needed. Lastly, PFI will support CBOs that are implementers at the district level to ensure
correct monitoring of the Emergency Plan program. Monthly data will be compiled, reviewed, and
aggregated from all districts/regions on a quarterly basis, to be shared with stakeholders and the USG.
SUSTAINAIBLITY: Tutunzane will support capacity development of the MVCCs, district social welfare
officers, and local CSO sub-grantees to ensure sustainability. Tutunzane will have memoranda of
understandings with council health management teams and implementing partners stipulating each party's
roles, responsibilities, and expectations, including the stipulation that OVC activities be included in
comprehensive district plans. At village levels, households will be strengthened through training and
income generating activities and entrepreneurship skills. With the support of district leaders, MVCC and
community leader's strategies will be developed to leverage local food production to create community
reserves for the child and elderly headed households. Tutunzane-supported CSO will be offered training in
project proposal development to open other grant opportunities.
1. Identify and provide high quality care and support services to 9800 OVC.
2. Train Most Vulnerable Children Committees and strengthen provision of integrated services for OVC at
the community level.
3. Support district and regional coordination of the OVC implementing partners.
4. Perform basic mapping of the region and build partnerships and referrals to achieve integrated service
networks and wraparound programs.
5. Expand access of OVC to the continuum of care and comprehensive HIV/AIDS services as well as
preventive care and interventions.
6. Build the capacity of government and civil society for sustainable delivery of OVC services.
7. Purchase computers for the district social welfare officers, as well as two for APT, to ensure quality data
and feedback report to the community
Continuing Activity: 16423
16423 16423.08 HHS/Centers for Pathfinder 6550 1415.08 $1,200,000
Health-related Wraparound Programs
* Child Survival Activities
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $15,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $50,000
Estimated amount of funding that is planned for Education $250,000
Table 3.3.13:
TITLE: Scaling up HBCT within Tutunzane Program in Five Regions
NEED and COMPARATIVE ADVANTAGE: A limited number of Tanzanians know their HIV serostatus,
which hinders individual access to appropriate care and support. HIV counseling and testing services
provided in the home, in conjunction with CHBC programs, will serve as an efficient way to scale-up
counseling and testing in targeted communities. Home-based CT will also strengthen referrals and linkages
to care, treatment and support services.
ACCOMPLISHMENTS: PFI held several meetings with key implementing partners in Arumeru and Temeke.
Finally, project site selection was completed in collaboration with District authorities. Eight wards are
currently implementing Home Counseling and Testing in Temeke and Arumeru and a total of approximately
1500 individual have accessed Counseling and testing services for the last four months through 30 trained
providers.
ACTIVITIES:
PFI plans eight key strategies to scale up HBCT.
1. Increase coverage and strengthen provision of CT at the community level in selected regions from two
existing districts in two regions to 18 districts in seven regions.
1a) Community sensitization and mobilization meetings will be conducted with leaders and stakeholders at
all levels to build community acceptance and garner support for community and home based CT.
1b) CT outreach services will be conducted for hard to reach populations (e.g., mining and plantation
workers) in partnership with CBOs and FBOs implementing counseling and testing services.
2. Expand access and integrated service networks through partnerships, referrals and linkages.
2a) Orientation meetings will be conducted at regional and district levels with administrative and health
facility staff to engage leaders in support of the activity and to plan specific activities that they can carry out
to build community acceptance.
2b) Additional orientation/sensitization workshops will be conducted for regional and council health
management teams in the selected districts.
2c) Conduct mapping exercise to identify care and support services within Tutunzane operation areas and
advise the program on how best to establish functional referral systems.
2d) Identify laboratory facilities for quality assurance of test results.
3. Implement prevention with positives activities to avert new infections.
3a) Strengthen risk reduction counseling, including counseling on correct and consistent condom use, in
order to avoid HIV transmission to uninfected partners and avert new HIV infections.
3b) Strengthen screening for gender based violence through HIV pre and post-test counseling and make
appropriate referrals to safe shelters for women, support groups in the community, and referrals to legal
3c) Counsel individuals in order to increase disclosure of HIV status to partners when there is no
foreseeable harm to the client. Staff will also provide counseling on several key prevention issues, including
sexual risk reduction, adherence and reduction of alcohol consumption.
3e) Establish a referral system to care and treatment, PMTCT, STI and RCHS/family planning clinics.
3f) Develop IEC materials with prevention messages for HIV positive persons (e.g., proper use of condoms,
family planning, STI prevention).
4. Train and equip service providers for quality HBCT service provision.
4a) PFI will train 72 laboratory staff from 36 health facilities in 18 districts. Training will include the new
national rapid test algorithm and quality assurance and control issues. It is anticipated that every tenth
positive and fiftieth negative test result will be sent to the nearest designated laboratory for confirmatory
testing.
4b) PFI will train lay health counselors to provide pre and post-test counseling and training on the provision
of rapid testing to individuals to determine differences in quality of testing provided by laboratory staff versus
lay health counselors.
4c) PFI will train 350 lay counselors and 150 new supervisors (health personnel) in expanded areas.
The trained personnel will be responsible for the actual testing and the lay counselors will be involved in the
provision of counseling services.
4d) Finally, PFI will conduct refresher training as needed.
5. Procure commodities and supplies to support the HBCT program, including 4400 Bioline, 165 Determine
and 28 Unigold test kits and supplies. PFI is unable to receive testing supplies through the government
store because it is a private organization.
6. Develop, print and disseminate BCC/IEC materials that respond to identified needs for different
audiences.
7. Maintain equipment and vehicles. A portion of funds will be used for fuel for vehicles and motorcycles,
maintenance and other running costs.
8. Maintain project staff to support planned activities. New staff will include supervisors (270) and lab
personnel (80) to assist in supervision and quality assurance issues.
Activity Narrative: NEED and COMPARATIVE ADVANTAGE: A limited number of Tanzanians know their HIV serostatus,
which hinders individual access to appropriate care and support and limits the proven preventive effect of
testing for HIV-negative individuals. VCT is a cost-effective method for increasing the number of Tanzanians
who know their HIV serostatus and reducing high-risk sexual behavior and preventing HIV transmission. It
has been estimated that VCT offered to 10,000 Tanzanians would avert 895 HIV infections at a cost of $346
per infection averted and $17.78 per disability-adjusted life year (DALY) saved. One strategy for scaling up
VCT services is the integration with community home-based care (CHBC). Home counseling and testing in
conjunction with CHBC programs will serve as an efficient way to scale-up counseling and testing in
targeted communities by utilizing existing volunteer CHBC providers with established networks for referral
and care and support.
ACCOMPLISHMENTS: PathFinder International (PFI ) began piloting home-based counseling and testing
(HBCT) in FY 2007 after a team from NACP, CDC, USAID, FHI and PFI learned how HBCT is being
implemented during a study tour in Uganda. PFI held several consultative meetings with key implementing
partners, including NACP and DMOs in Arumeru and Temeke. Finally, project site selection was completed
in collaboration with District authorities. PFI is scaling up the number of trained health care providers
needed to be able to reach large numbers of Tanzanians who are unaware of their status.
1. Increase coverage and strengthen provision of counseling and testing at the community level in selected
regions from two existing districts in two regions to 18 districts in seven regions.
all levels. Meetings will focus on all aspects of project implementation will serve to build community
acceptance and garner support for community and home based counseling and testing (CT).
facility staff. Meetings will cover all aspects of community and home based CT implementation to engage
leaders in support of the activity and to plan specific activities that they can carry out to build community
acceptance.
management teams in the selected districts - to link the services to the health facilities.
2c) Conduct mapping exercise with NACP/MOHSW to identify care and support services within Tutunzane
operation areas and advise the program on how best to establish functional referral systems.
3a) Counsel individuals in order to increase disclosure of HIV status to partners when there is no
3b) Establish a referral system to care and treatment, PMTCT, STI and RCHS/family planning clinics.
3c) Develop IEC materials with prevention messages for HIV positive persons (e.g., proper use of condoms,
4a) PFI will train 72 laboratory staff from 36 health facilities in 18 districts in collaboration with the MOHSW
Diagnostic Unit. Training will include the new national rapid test algorithm and quality assurance and
control issues. It is anticipated that every tenth positive and fiftieth negative test result will be sent to the
nearest designated laboratory for confirmatory testing.
4b) PFI also will train 350 lay counselors and 150 new supervisors (health personnel) in expanded areas.
4c) Finally, PFI will conduct refresher training for lay counselors and supervisors, as needed.
5. Procure commodities and supplies to support the HBCT program. PFI will procure and distribute 4400
Bioline, 165 Determine and 28 Unigold test kits (the new algorithm) and supplies (e.g., gloves, safety boxes)
through MSD.
6. Develop, print and disseminate BCC/IEC material and best practices.
6a) PFI will develop a variety of print communication materials to facilitate community awareness about
HBCT, the testing process and benefits.
6b) Working in collaboration with HBCT partners, PFI will adapt job aides and pocket guides. These will be
used to provide clear step by step instructions on community/home based counseling and testing for HCT
providers. The aides will be durable and portable to allow providers to carry them during visits.
8. Hire new project staff to support planned activities. New staff will include supervisors (72) and lab
personnel (36) to assist in supervision and quality assurance issues.
LINKAGES: PFI is committed to ensuring continuum of care through networking with other organizations
implementing HIV programs. Effective linkages have been created throughout Tutunzane operation areas
and include collaborations with health facilities, care and treatment clinics for ARV and PMTCT Programs
like Tunajali and CCBRT among others. Other linkages are to family planning programs, TB clinics, and
Activity Narrative: coordination with male circumcision as appropriate. In addition the Tutunzane program in which HBCT is
incorporated will serve as a platform for supporting HIV positive identified individuals with services like
supportive counseling and nutrition counseling. Furthermore, HIV positive individuals will be linked to other
care and support services provided by FBOs and CBOs in
their community. Tutunzane will also foster collaboration with legal associations like WLAC and TAWLA for
legal aid in case of gender violence related to disclosure of HIV status.
M&E: The M&E system developed in the pilot phase builds on existing tools and local capacities, allowing
for necessary adaptations. It reports achievements against the project's results, and monitors qualitative
and quantitative indicators. The approach is participatory and interactive, encouraging joint accountability
and specific outcomes and responsive to needs and capacities of local partners; and provides ongoing
feedback. To extract and analyze data, Tutunzane employs a number of methods, including, but not limited
to service delivery statistics, monitoring visits and program meetings. Monthly data will be compiled,
reviewed, and aggregated from all districts/regions and shared with DHMT, NACP, other stakeholders and
CDC on a quarterly basis. PFI will work in collaboration with NACP and other actors to develop relevant
tools for monitoring the program.
SUSTAINAIBLITY: PFI through its Tutunzane program will promote sustainable activities by building the
capacity of existing DHMTs, CBOs, coordination bodies and CHBCPs. PFI also will have MOUs with them
that stipulate each party's roles, responsibilities and expectations and support incorporation of HBC
activities in comprehensive District plans. Sub-grantees will be strengthened in internal governance,
financial sustainability, and management information systems. Programmatic sustainability will be
strengthened by upgrading skills through step-down training by intermediate organizations.
Continuing Activity: 13566
13566 9085.08 HHS/Centers for Pathfinder 6550 1415.08 $1,000,000
9085 9085.07 HHS/Centers for Pathfinder 4571 1415.07 $620,000
Table 3.3.14:
This activity began in FY 2007 and did not receive funding in FY 2008 because there were sufficient funds
remaining to undertake activities in FY 2008. In FY 2008 Pathfinder conducted training and orientation
sessions for both Bugando Medical Centre (BMC) and the Zanzibar AIDS Control Programme (ZACP) staff,
aimed at equipping the staff with skills to improve their performance in project planning and management.
Pathfinder also completed a thorough management information system (MIS) and financial system review
for both organizations to identify areas that need to be strengthened. Following the installation of new
accounting software and modules for both MIS and the financial system, staff was trained on: (i) the
management information system; (ii) using data for decision-making; and (iii) financial reporting and
administration. With FY 2009 funding Pathfinder International will complete their institutional capacity
building (ICB) activities with ZACP and BMC. They will undertake the following three activities.
1.) Development of a human resource plan for ZACP. Pathfinder International is supporting ZACP to
improve its working systems and to improve the skills of project staff. Pathfinder will undertake an extensive
job analysis to identify the nature and distribution of work. The current available human capacities will be
assessed and existing gaps identified. Pathfinder will provide technical assistance to ZACP to help develop
a plan for better distribution of workload and to strengthen the skills of existing staff to undertake their
assigned tasks.
2.) Provide training on resource mobilization to BMC and ZACP. Both BMC and ZACP depend on funds
raised from donors. In order to enhance sustainability, these organizations need to be equipped with the
necessary skills for mobilization of resources, including proposal writing so that they can diversify their
funding sources and effectively write funding proposals. Pathfinder will provide five days of training for
project staff involved in fund raising and financial management.
3.) Provide training on management and leadership to BMC and ZACP. The project management teams at
both BMC and ZACP are technical people with medical backgrounds. They have not been officially trained
in management and leadership, yet these are the skills most needed to effectively manage their programs.
Pathfinder will provide training in management and leadership skills with a five day training aimed at senior
staff from both organizations.
TITLE: Institutional Capacity Building Support to Public Institutions in Tanzania responding to HIV/AIDS
NEED and COMPARATIVE ADVANTAGE:
Pathfinder International, a non-profit organization, was originally incorporated as The Pathfinder Fund in
1957. Pathfinder has been active in Tanzania since 1984. The achievements in Tanzania include pioneering
community-based distribution of family planning methods, establishing a youth center program, supporting
an adolescent fertility survey, education counseling project for young mothers and the institutional capacity
of local partners and has unique public-private linkages, including private practitioners to improve
reproductive health services in their facilities.
ACCOMPLISHMENTS: This is a new activity for FY 2009.
MAJOR ACTIVITIES: Public sector institutions in Tanzania, such as the National AIDS Control Programme,
referral hospitals, National Institute for Medical Research, city, district and ward councils, and district health
management teams, have increasingly become an integral part in HIV/AIDS programming, either by
provision of direct prevention, care, and treatment services or by formulating policies and providing
technical direction. However, the effectiveness of these organizations is often compromised because of the
variability of their institutional capacity, which in turn affects the quality and outreach of their programs and
services. Because Tanzania's success in the fight against HIV/AIDS depends heavily on these institutions,
Pathfinder is committed to strengthening their capacity to mount the strongest possible response to the
epidemic.
In FY07, Pathfinder will strengthen the institutional capacities of CDC's public sector grantees, including
NACP, ZACP, NIMR, Bugando and Mnazi mmoja Hospitals. Pathfinder's ICB approach begins with a
thorough participatory needs assessment using a tailored version of Pact's organizational capacity
assessment tool (OCAT) modified to fit the needs and realities of public sector institutions. This assessment
will focus on 7 major components of organizational effectiveness: governance; management practices;
human resources; financial resources; services delivery; external relations; and sustainability. Pathfinder
will assess management & systems capabilities, current services, practitioner skills and competence,
information management and data systems, the potential for existing systems to handle scaling up of
existing activities. Throughout the initial assessment process, Pathfinder will cultivate a close working
partnership with the senior management of these public institutions to facilitate a favorable environment for
organizational change.
Based on assessment findings and recommendations, Pathfinder will work with the partners to develop
organization-specific technical assistance plans. The TA plans will include training, on-site support,
supportive follow-up visits and interim assessments. Anticipated training services include: results-oriented
project management; financial management; operational planning; resource mobilization and proposal
development; and development of management information systems. With regards to financial
management, a strong government financial management system already exists, but implementers often
lack the sustained training, governance systems, and accountability structures to ensure that such systems
are used appropriately. The training will be complemented with intense one-on-one coaching and
mentoring to ensure that the learning is institutionalized.
Expected outcomes of the activity include substantially higher managerial and institutional performance and
accountability of USG public sector partners with regards to PEPFAR and in general, and greater likelihood
Activity Narrative: of program ownership and sustainability. It is also envisaged that as these USG-funded public institutions
grow stronger in institutional capacity, they will be in a position to provide mentoring to emerging
organizations.
LINKAGES: This program assess the existing systems, in order to provide technical assistance at the
institutions so as to address financial management and internal control issues and creating consistent and
accurate financial systems and effective internal controls. This helps to strengthen internal linkages. This
technical assistance will also increase Tanzanian partner's capacity to effectively and efficiently manage
programs which will further strengthen linkages within and outside these institutions. Also well written
records and documentation and good flow of process will increase staff efficiency and improve service
provision.
M&E: Continuous quarterly Monitoring and follow up visits to both BMC and ZACP to assess progress on
the implementation of proposed activities and produce periodic reports.
SUSTAINABILITY: The initiative's goal is to improve institutions capacity to coordinate, implement, and
manage HIV/AIDS programs effectively and efficiently, thus helping to ensure sustainability and local
ownership of PEPFAR programs. This project will assist BMC and ZACP in strengthening their financial and
control mechanisms in order to safeguard against loss and achieve goals also strengthen institutional
capacity to scale up HIV/AIDS initiatives across all program areas including improvement of working
environment and data collection tools.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $75,000
Table 3.3.18:
