THIS IS A NEW ACTIVITY.

TITLE: Strengthening the Government and Civil Societies' Response to Addressing Substance Abuse as a

Risk Factor for HIV Transmission in Zanzibar.

NEED and COMPARATIVE ADVANTAGE: As part of the United Republic of Tanzania, Zanzibar -

comprised of the islands of Unguja and Pemba - has an estimated HIV prevalence of 0.6%, and therefore

ranks Zanzibar as a low prevalence territory. Although overall HIV prevalence is low, HIV infection is rising

among most at risk populations such as commercial sex workers (CSWs), men who have sex with men

(MSMs), and injecting drug users (IDUs). A recent substance abuse study documented HIV infection among

general substance users at 13% (30% for female substance users and 12% for males) and 25% for IDUs.

The impact of other infectious diseases among this population is also notable. Twenty-six percent of

substance users had a sexually transmitted infection (STI) (11% had syphilis), and 16% were infected with

hepatitis C.

Negative social attitudes often discourage efforts to target most at risk populations, and Zanzibar is no

exception. Cultural and religious barriers restrict open dialogue on sexuality and drug use. Behaviors

associated with increased risk of HIV transmission (like multiple sex partners and injecting drug use) are

mistakenly touted as nonexistent in the country.

The goal of the substance abuse twinning partnership is to reduce the HIV/AIDS incidence and prevalence

rates amongst substance abusers in Zanzibar. This goal will be reached by strengthening the capacity of

governmental and civil society organizations to adequately incorporate quality HIV/AIDS services into their

continuum of care. Strategies for achieving this goal include establishing a peer-peer partnership between

an organization in the United States with expertise in working with substance abuse and HIV and the

Department of Substance Abuse in Zanzibar. Local civil society organizations will be brought in to

participate in a customized HIV/AIDS training, developed by the partnership for governmental and civil

society substance abuse specialists. Roll out training will include specialists from the three islands of

Zanzibar (i.e. Unguja and Pemba). Funds will cover training material production, transportation,

accommodation, food and allowance. It is anticipated that this training will lead to a cadre of master

trainers that will participate in future comprehensive outreach programs, thus enabling civil society

organizations to establish programs that focus on integrated harm reduction practices that include

counseling, promotion of condoms and VCT testing.

ACHIEVEMENTS:

In 2007, The Government of Zanzibar (GoZ) launched a five year Strategic Plan that aims to decrease the

prevalence of HIV/AIDS amongst substance abusers on Zanzibar. In an effort to support GoZ, The

American International Health Alliance (AIHA) Twinning Center partnered the Department of Substance

Abuse, Prevention (DSAPR) and Rehabilitation of the Ministry of Health and Social Welfare on Zanzibar

with the Great Lakes Addiction Technology Transfer Center (GLATTC) of Chicago, Illinois. Currently in its

first year, the partnership goal is to enhance the capacity of DSAPR to reduce HIV/AIDS prevalence by

strengthening its capacity to provide quality, comprehensive substance abuse prevention and rehabilitation

(i.e. recovery support) services to its clients . In FY 2008, the substance abuse twinning program

accomplished the following:

-Raised private funds to renovate and refurbish a drop in center (center will be used for training, resource

center, counseling and support group sessions);

-Trained DSAPR staff on recovery model (an approach to substance dependence that emphasizes and

supports an individual's potential for recovery);

-Developed DSAPR website;

-Established support groups to educate substance abusers including IDUs on HIV risk factors associated

with substance use, prevention measures and the importance of safe sex practices;

-Initiating a speakers bureau on educating the community on delivering messages on substance abuse and

consequence at youth friendly centers;

-Supporting existing health promotion initiatives at DSAPR around the issues of primary prevention of

substance abuse and HIV/AIDS in school, workplace and community;

-Training 20 recovery peer educators on recovery model;

-Establishing 12 step program at drop in centre;

-Creating the forum with Inter Faith Council (Zanzibar) on developing the 12 step program in their

institutions; and

- Rolling out Recovery Model training to Civil Society community in Zanzibar.

ACTIVITIES:

Sustainability of this program can only be ensured once DSAPR has been fully capacitated. Using scientific

best practices and lessons learned from similar programs, we seek to continue the program in FY 2009.

The same goal and objectives will be maintained, with the focus on finalizing several activities initiated with

prior years' funding. Most notably AIHA will:

-Maintain the DSAPR website and solicit contributions from partners also working with IDU;

-Institutionalize the speakers bureau on educating the community to deliver messages on substance abuse

and consequences at youth friendly centers;

-Support existing health promotion initiatives at DSAPR including those that address primary prevention of

substance abuse and HIV/AIDS in schools, workplaces and communities;

-Maintain a 12 step program at a drop in centre;

-Support the forum with Inter Faith Council (Zanzibar) on developing the 12 step program in their

institutions; and

- Continue rolling out Recovery Model training to Civil Society community in Zanzibar.

In addition, this project will strive to strengthen the institutional capacity of DSAPR in the provision of

substance abuse and HIV/AIDS services in Zanzibar by developing resource generating strategies to

sustain the project ( i.e. fundraiser, grant writing training).

Activity Narrative: LINKAGES: AIHA will coordinate and link with other parners addressing substance use in Zanzibar,

including PEPFAR partners ZACP, Columbia University and the Drug Control Commission.

SUSTAINABILITY: The national government and donor partners working in Zanzibar are very committed to

addressing the substance abuse issues on the island. A recently published HIV and substance use

prevention framework outlines the multi-sectoral response, which will be critical for the sustainability of

these efforts. These planned activities provide government institutions with the skills and capacity to enact

priorities identified in the framework.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.06:

ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP.

TITLE: Twinning Partnership for Palliative Care, Pare Diocese

NEED and COMPARATIVE ADVANTAGE: Palliative care as a component of Care and Support is a crucial

holistic approach necessary for people living with HIV/AIDS (PLWHA); however, palliative care services are

very scarce in Tanzania. The American International Health Association's (AIHA) Twinning partnership will

continue to strengthen the capacity of the Evangelical Lutheran Church of Tanzania (ELCT) to provide

quality palliative care training to healthcare and community volunteers care providers in the Pare Diocese of

the Kilimanjaro Region.

The consortium of the Southeastern Iowa Synod of the Evangelical Lutheran Church in America (SIELCA),

Iowa Health—Des Moines, and Iowa Sister States will continue to work jointly with ELCT in Pare. This

partnership will build on the already existing 18-year collaborative relationship between ELCT and SIELCA.

ACCOMPLISHMENTS: A total of 196 trainees are now providing palliative care services in hospitals,

dispensaries, and in the communities through home-based care (HBC) system. These trained health

workers are a critical component in establishing the value of HBC and serving as the referral source for the

community volunteers who make home visits to deliver palliative care. In FY 2008, Mwanga and Same

District Medical Officers approved a palliative care pilot program and offered their support. Training

curriculum for community volunteers was developed in Swahili and English. Six sites have been identified

as pilot test sites for the palliative care sustainability program. Referral arrangements made at six pilot sites

for terminally ill PLWHA to community volunteers who will provide palliative care. Sixty community palliative

care workers were trained in HBC.

ACTIVITIES: With FY 2009 funding, AIHA will:

1. Expand the pilot program to deliver community-based care and support to other villages in the Pare

diocese. It is anticipated that support can continue for the six current sites, as well as an additional six.

2. Select six Sustainability Trainers, one at each of the six sites. This person will receive training, based on

the training of trainers (TOT) model, which will allow him/her to coordinate all community volunteer palliative

care efforts. He/She will serve as a liaison with the health care facility, delegating referrals to community

volunteers, overseeing recordkeeping, and, most importantly, continuing to provide training and updates to

community volunteers who are delivering services to PLWHA.

3. Train sixty community volunteers and establish a referral arrangement with local health facilities, deliver

services to terminally ill AIDS patients, identify a Sustainability Trainer (TOT) at each site, and maintain the

mentoring program. Establish an association for these Sustainability Trainers, so they can meet with their

peers to share information and help each other address challenges.

4. Continue to develop human capacity in both medical districts of the Pare Diocese by conducting training

programs focused on Care and Support. Training programs will focus on health care workers and

community volunteers in HBC and palliative care. Test the feasibility of using electronic methods for

education, training, and communication.

5. Pilot test, in at least two of the six Year Two sites, the feasibility of low cost, high quality electronic

communication using the Internet. Promising systems and products are available at the College of Public

Health, University of Iowa. AIHA will test these and other methods late in Year Two and be ready for a full-

scale test run during FY 2009. The program will propose the training of at least one or more person(s) in

the use of the Internet and available databases in order to enhance core capacity in the Diocese. One

focus of the testing will be electronic record keeping and form completion for patients with HIV/AIDS visited

by community volunteers. Another will be use of databases and other clinical information to enhance local

understanding and capacity in dealing with HIV/AIDS at the community level. This will help to inform other

efforts in Tanzania for electronic communication to facilitate improved patient care.

6. Initiate nutrition programming. A registered dietitian will participate in an exchange and provide technical

assistance and consulting to HIV/AIDS patients and their families, physicians, other healthcare workers and

community volunteers who are serving terminally ill HIV/AIDS patients. The initiative will focus on providing

information about nutrition that is relative and feasible for people in Tanzania. In addition, information will

be developed to coordinate this training with the project growing Amaranth in the Pare Diocese. Follow-up

on programming in FY 2009 will enhance these educational/training methods for the local Tanzanian

faculty.

LINKAGES: This program works within the care and support guidelines established by the National AIDS

Control Programme (NACP). In addition, nutrition programs will link with the Tanzanian Food and Nutrition

Council and other nutrition activities underway in Tanzania.

Pare Diocese and Gonja Hospital are part of the ELCT network of 20 hospitals and 160 primary healthcare

institutions, which constitutes 15% of the healthcare services in Tanzania. The Twinning partnership

program will be closely coordinated with the activities of the ELCT Health Department and the Foundations

for Hospice in Sub-Saharan Africa, funded through the New Partner Initiative. Furthermore, the program

will establish a more formal liaison with the NACP by meeting and providing consistent correspondence

related to the program. Local government officials will continue to participate in AIHA trainings, and each

ward HIV/AIDS committee chairperson will be invited to the training program in his/her area. Village leaders

have already been involved this year by helping select the community volunteers, a process which will

continue in FY 2009. Meetings will be held in each district to coordinate activities, and will include the

participation of healthcare and social welfare leaders, District Executive Directors and District

Commissioners. Other district officials, such as District Medical Officers, District HIV/AIDS Coordinators

and Coordinators of the Community Development Department will be invited to all meetings and trainings.

Activity Narrative: Partners will also continue to collaborate and liaise with palliative care stakeholders from other USG-funded

programs, such as the Tanzanian Palliative Care Association, the African Palliative Care Association,

Mildmay International, Family Health International, and Columbia University to ensure that efforts effectively

complement the palliative care goals and objectives established by the Tanzanian Government. They will

also ensure participation in the national Care and Support Subcommittee of the National Care and

Treatment Steering Committee.

M&E: AIHA Twinning Center staff will continue to work with partners to implement a monitoring and

evaluation system for the partnership, which was developed during the first work plan year. This system will

need to be revised to include new partnership activities for the upcoming year. In collaboration with USG

stakeholders, AIHA and partners will review the current indicators and collect appropriate PEPFAR and

other relevant indicators based on activities designated in the work plan. AIHA will continue to assist

partners to develop the appropriate tools and systems necessary to collect and report data, and provide

technical assistance when necessary. AIHA will continue to report this data to USG teams quarterly, and

will further evaluate the partnership's effectiveness in meeting its goals and objectives upon completion of

the work plan period. As the national HBC monitoring system is being developed, the AIHA partners will

participate in the development and use of the national HBC system for recording, storage, retrieval, and

reporting field service data to ensure standardization at all levels.

SUSTAINAIBLITY: Through peer-to-peer exchanges, mentorship and trainings, this Twinning partnership is

building the capacity of ELCT to provide quality palliative care training to healthcare providers, family

members and volunteers. The Sustainability Trainer addition in Year Three will also contribute to the

sustainability of program. Tanzanian faculties, with technical assistance from Iowa volunteers, have been

the primary providers for training for community volunteers in Year Two. In Year Three and beyond, this

responsibility will be totally delegated to Tanzania faculty, primarily the Sustainability Trainers. If the

electronic communications and database tests in Year Two prove to be technically and financially feasible,

they will play a key role in sustainability of this palliative care program. Iowa partners will continue to

provide technical assistance, communication and support to the ongoing effort to provide a quality palliative

care program managed in Tanzania.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13432

Continued Associated Activity Information

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

System ID System ID

13432 8715.08 HHS/Health American 6495 3555.08 Twinning $250,000

Resources International

Services Health Alliance

Administration

8715 8715.07 HHS/Health American 4517 3555.07 AIHA $200,000

Resources International

Services Health Alliance

Administration

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $75,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $25,000

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.08:

ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP

TITLE: American International Health Alliance Orphans and Vulnerable Children Social Work Training

Program

NEED and COMPARATIVE ADVANTAGE: There is an acute need for trained personnel at both the national

and local levels to provide care and support for orphans and vulnerable children (OVC). Currently the

government employs social workers in only one-third of districts and a total of approximately 300 social

workers countrywide, falling far short of the need to address the needs of the estimated two million orphans

and vulnerable children (OVC) in Tanzania. The key training institution for social workers, the Tanzania

Institute of Social Work (ISW) needs strengthening and support for greater training output. Other options for

training venues need to be explored, as well. The present curriculum for both pre- and in-service training in

social work is inadequate preparation to support OVC throughout the country, and the ISW faculty and

management need strengthening. There also needs to be continued emphasis on supporting additional

short-term training for community members to handle needs of OVC until more social workers are trained

and hired.

The Twining partnership between the ISW in Tanzania and the Jane Addams College of Social Work

(JACSW) is presently strengthening ISW's capacity to train social workers and other community members

to respond to the needs of OVC. JACSW has demonstrated expertise in social work education, and is also

experienced in supporting social work training in other developing countries.

ACCOMPLISHMENTS: The Twinning partners have conducted needs assessments for trainings, developed

an OVC in-service training manual for existing social workers, and conducted training for 45 social welfare

officers. As an interim measure until more social workers can go through their full pre-service education,

the Twinning partnership has established a short-term training for people in the community who have the

potential of assisting with the needs of OVC (e.g., Community Development Officers). To implement this

program, a training manual for Paraprofessional Social Worker Trainees has been developed and pilot

training has been done. Over 50 trainers and 500 Paraprofessional Social Worker Trainees (PSWTs) have

been trained. Training materials for PSWT have been translated in Kiswahili. The ISW and JACSW

partners will work together to modify the selection process and training approach based on the pilot

experience, then hand off the responsibility for the actual roll out of training to the Capacity Project.

Currently, the Twinning partners are developing the PSW field supervisor's guidelines. Initial work was

completed in collaboration with the Capacity Project and the Tanzanian Department of Social Welfare

(DSW). Plans are underway to ensure PSWT are supervised and assessed during their six-month field

work, during which they will apply their acquired knowledge prior to certification as para-social workers

(PSWs). Capacity will work with local government councils to ensure integration and retention of the PSW

cadre. As an active member of the OVC Implementing Partners Group, the American International Health

Alliance (AIHA) has supported the coordination of activities and contributed to the development of the

National Costed Plan of Action for Most Vulnerable Children.

ACTIVITIES: With FY 2009 funding, AIHA will:

1. Continue to support capacity building of the ISW at all levels, including faculty, field supervisors, social

work students, and social workers receiving in-service training. This includes improving the institutional

capacity of ISW faculty to deliver quality pre-service social work education, particularly in the areas of

HIV/AIDS and OVC. AIHA will evaluate new OVC and HIV/AIDS-enhanced diploma and degree curricula;

support continued expansion of OVC and HIV/AIDS resources and educational materials; expand internet

connectivity at the Learning Resource Center for the use of students; establish a meaningful student

fieldwork placement and supervision program; enhance faculty skills and expertise, especially with regard to

HIV/AIDS and OVC; and engage in an ongoing exchange of resources and educational materials. The

partnership will also continue to work with DSW to identify gaps for future consideration to enhance the

capacity of community Social Welfare Officers and related staff who have a role in managing, coordinating,

monitoring, and evaluating the scaled-up response to OVC needs.

2. Increase the volume of social work students who graduate from ISW, targeting promising students and

providing 25 pre-service scholarships at ISW for social workers.

3. Expand training venues for PSWTs at the Kisangara Institute in Same (Kilimanjaro Region). The AIHA

partnership will perform a needs assessment of Kisangara Institute as a potential training venue to expand

capacity for preparing PSWTs, and provide for reasonable upgrades necessary for expanded training. This

will enhance sustainability because this Institute is funded and maintained by the Ministry of Health and

Social Welfare (MOHSW).

4. Strengthen the skills of PSWs with an additional two weeks of training normally provided to Ward Welfare

Assistants, with the goal of accreditation by the MOHSW to be fully integrated in the social welfare work

scheme. The AIHA partnership will enhance the curriculum, develop an orientation guideline, and the DSW

and Capacity will facilitate the integration of the accredited PSWs into the local government infrastructure.

The AIHA partnership will also ensure appropriate supervision of PSWT on application of national quality

standards by developing training for field supervisors. This effort will also include the development of tools

to assess the impact of the supervision on the PSWTs. This supervisor's training will occur at the ISW.

5. Re-launch and strengthen the Association of Social Workers, working with both the ISW and DSW. This

action is intended to build the professionalism of social workers and the status of the profession. Partners

will build the capacity of the Association to maintain and enforce standards of training, standards of service,

and ethics within the social work profession. Partners will plan and host the first annual social work

conference in FY 2009.

LINKAGES: As an OVC partner, this activity will continue to link with the Implementing Partner Group

Activity Narrative: network for OVC and the national OVC Data Management System (DMS). The partners work very closely

with the DSW in the MOHSW. Other linkages include PASADA, Walio Katika Mapambano ya UKIMWI

Tanzania (WAMATA), and the Regional Psychosocial Support Programme in the development of social

worker and PSW training activities. AIHA will also continue to maintain a close collaboration with the

Capacity Project for the rollout of the PSW program.

M&E: In collaboration with DSW and PSWs, the ISW will support the regular collection of data for the

training module of the OVC DMS for use in district planning. The AIHA Twinning Center has also assisted

the partners to develop a monitoring and evaluation system for the partnership achievements. AIHA will

continue to assist the partners in implementing this system and developing training-specific monitoring tools

to monitor the OVC indicators. AIHA continues to assist partners to develop the appropriate tools and

systems to collect and report relevant data and provide technical assistance when necessary. AIHA reports

these data to USG teams quarterly, and will further evaluate the partnership's effectiveness in meeting its

goals and objectives upon completion of the work plan period.

SUSTAINABILITY: The Twinning partners are helping to strengthen the existing OVC support structures

through the development of enhanced training, certificates, diplomas, and degrees that will enable

professionals to meet the needs of children affected by HIV/AIDS. To ensure the program is sustainable

beyond the involvement of JACSW, the program focuses on capacity building of ISW faculty and field

supervisors. Support from MOHSW through District Social Welfare Officers will enable ISW to continue to

provide supervision to trained PSWs.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13433

Continued Associated Activity Information

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

System ID System ID

13433 5002.08 HHS/Health American 6495 3555.08 Twinning $400,000

Resources International

Services Health Alliance

Administration

7677 5002.07 HHS/Health American 4517 3555.07 AIHA $600,000

Resources International

Services Health Alliance

Administration

5002 5002.06 HHS/Health American 3555 3555.06 $300,000

Resources International

Services Health Alliance

Administration

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $200,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.13:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In 09 AIHA will create a pool of in-country laboratory mentors by training 25 Tanzanian laboratory

personnel using a standardized training curriculum developed by MOHSW in collaboration with AIHA

international laboratory professional partners. The program in country mentors will work in the 23 regional

laboratories. AIHA will sponsor 20 students to the 18 months certificate level training, 20 students to the 3

year diploma level training, and 10 students to the 4 year Bachelor of Science degree until they complete

their courses. AIHA will arrange a twinning for the National Health Laboratory Council of Tanzania with a US

based partner

END ACTIVITY MODIFICATION

TITLE: Laboratory Mentorship Program

NEED and COMPARATIVE ADVANTAGE: There has been a marked expansion in diagnostic services to

support HIV/AIDS care and treatment. The introduction of newer automated technologies accompanied by

an increased volume of laboratory testing and the requirements for quality laboratory services has

challenged the few available skilled human resources trained in the traditional manual techniques. AIHA's

twinning partners seek to strengthen the capacity of laboratories to provide quality HIV/AIDS diagnostic

services in support of HIV/AIDS diagnosis and treatment monitoring. In FY 2008, AIHA, in collaboration with

Bolder community hospital (BCH) and a second partner, still to be named, will focus on building capacity for

regional laboratories. This activity will be complemented by other USG lab partners - Clinical and Laboratory

Standards Institute's (CLSI) implementing quality systems at the five zonal laboratories and the American

Society of Clinical Pathologists' (ASCP) working on curriculum review and development with the schools for

laboratory training. AIHA's partners, will provide ongoing mentorship in the application of HIV/AIDS

trainings and standard operational procedures developed for the country's laboratories. AIHA will also work

with laboratory assistants and build their capacity beyond the laboratory procedures hands-on training

which they undergo during their basic training to a level where they can assume technical competency and

thereby increase the pool of competent laboratory personnel.

ACCOMPLISHMENTS: The twinning partnership was formed in October 2006 between BCH and the five

zonal medical laboratory schools. In FY 2006, as part of that partnership, there was detailed planning,

needs assessments, lectures and mentorship activities. In addition, some educational materials, IT

equipment and internet connectivity were provided. In FY 2007, the partnership provided mentorship to

laboratory personnel and students on rotation in zonal and regional laboratories.

ACTIVITIES: The overall goal of the twinning partnerships with Tanzania's laboratories is to strengthen the

in-service training. The partnership between BCH and the laboratories will provide support to ensure that

laboratory personnel are confident in delivering HIV/AIDS diagnostic services via continued mentorship,

peer exchanges and exposure to best practices through a mentorship program for laboratory personnel to

ensure the application of HIV/AIDS training, use of standard operational procedures (SOPs) and

implementation of quality assurance systems. AIHA will deploy experienced and expert volunteer laboratory

mentors to the regional labs to help strengthen and expand HIV/AIDS knowledge, particularly in specialist

shortfall areas.

AIHA will provide professional development opportunities in shortfall areas through international training.

Opportunities for laboratory personnel to undertake further education are limited, unless they are able to

finance their own studies. The twinning partnership will enable laboratory personnel and tutors to upgrade

and develop specialist skills through participation in tailored short-term courses in the region and the United

States and organized study tours with other twinning laboratory partners in Africa.

AIHA will support the laboratory-related training institutions to retain current students and increase the

enrollment in training courses in Tanzania through professional development and financial support. The

lack of financial support for students is a serious obstacle to the training of sufficient laboratory personnel to

meet the country's needs. AIHA will provide sponsorship for students enrolled in diploma and advanced

diploma courses in laboratory schools, students enrolled in lab-related disciplines in universities and link

students with existing trained laboratory staff for mentorship and hands-on training to enhance coursework.

An additional US partner will be identified to train laboratory assistants to perform HIV/AIDS diagnostic

services. Laboratory assistants were identified as an important cadre of semi-skilled professionals with

potential to take on increased responsibilities if appropriately trained and supported. The partnership will

support the MOHSW's plans to support a laboratory assistant's school in Singida to expand and offer a

course to upgrade laboratory assistants to laboratory technicians. AIHA partners will review of currently

implemented laboratory assistants' pre-service curriculum to identify gaps to be addressed through training

and will design and provide training for laboratory assistants at regional laboratories.

To ensure the sustainability of AIHA efforts, twinning opportunities will be explored between the national

health laboratory council of Tanzania and a US-based partner with experience in monitoring and regulating

laboratory professionals practices, and on reinforcing professional code of conducts as health laboratory

scientists.

LINKAGES: AIHA has established excellent working relations with MOHSW's departments of Diagnostic

Services and Human Resources & Training for the development of program plans, provide regular updates

on program activities and attend MOHSW organized stakeholder meetings. In FY 2008, the twinning

partnership will also work closely with other USG partners to coordinate effective and comprehensive

support for laboratory services. Key relationships are with: ASCP, to ensure that laboratory personnel are

mentored based on the pre-service training and revised curriculum under development as well as ongoing

in-service training, CLSI, which has developed SOPs with MOHSW and is supporting the accreditation of

laboratories across the country, the Association of Public Health Laboratories (APHL), which is working on

laboratory information systems and ART partners working in the care and treatment sites.

Activity Narrative: CHECK BOXES: The areas of emphasis were chosen because the laboratory mentoring program is

building the capacity and sustainability of the regional laboratories and schools to provide up-to-date quality

HIV/AIDS diagnostic services.

M&E: In collaboration with USG stakeholders, AIHA and partners will continue to ensure that the

laboratories effectively submit laboratory data and reports to MOHSW and on PEPFAR indicators which

include the number of tests performed with USG support, number of laboratories whose capacity has been

built and the number of laboratory personnel trained AIHA will specifically assist partners to collect baseline

data on the knowledge and abilities of laboratory personnel and to develop tools to monitor improvements in

their skills, capacity, and confidence in delivering high quality laboratory services. AIHA reports these data

to USG teams quarterly and will further evaluate the partnership's effectiveness in meeting its goals and

objectives upon completion of the work plan period. This will assist the care and treatment partners in

achieving comprehensive care for HIV/ AIDS patients.

SUSTAINABILITY: The twinning partnership is building the capacity of the country's regional laboratories to

provide quality HIV/AIDS diagnostic services to patients. Through this mentorship program, laboratory

personnel and students will increase their knowledge, practical skills and confidence to provide quality up-to

-date HIV/AIDS diagnostic services. It is important to note that the twinning partnerships will fully

incorporate the revised curriculum being developed by MOHSW and ASCP into its mentorship activities and

for its in-service curriculum for laboratory assistants. This will result in a larger pool of competent laboratory

technicians to sustain the country's laboratory services.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13435

Continued Associated Activity Information

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

System ID System ID

13435 4946.08 HHS/Health American 6495 3555.08 Twinning $650,000

Resources International

Services Health Alliance

Administration

7676 4946.07 HHS/Health American 4517 3555.07 AIHA $268,521

Resources International

Services Health Alliance

Administration

4946 4946.06 HHS/Health American 3555 3555.06 $400,000

Resources International

Services Health Alliance

Administration

Table 3.3.16:

ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY2008COP

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

(OHSS), 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: Tanzania HIV/AIDS Nursing Education (THANE)

NEED and COMPARATIVE ADVANTAGE:

Tanzania is home to 1.4 million PLWHA, so building health system capacity to provide HIV care and

treatment is critical. Training for nurses must be restructured to better prepare the profession to provide

quality HIV services. AIHA's partners, Muhimbili University School of Health and Allied Sciences (MUHAS)

and the University of California San Francisco (UCSF), will help Tanzania's 62 schools of nursing to

integrate HIV/AIDS care into Tanzania's nursing curricula and to equip students with the knowledge and

skills needed to run quality HIV/AIDS services. MUHAS and UCSF are both leaders in the fields of nursing

education and HIV/AIDS.

ACCOMPLISHMENTS:

AIHA worked with MUHAS and UCSF to finalize 12 HIV/AIDS modules to be integrated into the national

nursing curriculum. In FY 2008 the AIHA nursing partnership worked closely with the Ministry of Health and

Social Welfare (MOHSW) to integrate the HIV/AIDS content from the modules into the national curriculum.

Currently, the revised curriculum is being used in ten nursing schools and is being rolled out to the other

nursing schools. Additional teaching aids, including learners guides and practical books for the tutors, will

be completed by the end of FY 2008. The AIHA partnership also completed training of master trainers on

the HIV/AIDS modules and these master trainers then subsequently trained a selected number of nurse

tutors from each pre-service nursing institution. A total of 255 nurse tutors have been trained on HIV/AIDS

content from the 12 modules. This ensured that each nursing institution would have at least one to two

nurse tutors who are well versed in HIV/AIDS.

ACTIVITIES:

1. Curriculum Development

In FY 2009 the AIHA nursing partnership will work to ensure the revised nursing curriculum, which now has

a strong HIV/AIDS component, is being utilized in all 62 nursing schools throughout Tanzania. The small

number of diploma nursing schools that fall under a separate ministry have the authority to develop their

own curriculum and are not required to adopt the MOHSW nursing curriculum. AIHA will work with these

diploma schools to ensure they adopt the already revised curriculum or undertake a separate revision

process to update their curricula to include the new HIV/AIDS content. In addition, AIHA will work with the

MOHSW to ensure the national nursing examinations reflect the new HIV/AIDS content.

2. Roll Out of Revised Curriculum

In FY 2008 the AIHA nursing partnership began support for training all the nursing tutors in Tanzania on the

newly revised nursing curriculum. The goal of this training is to ensure all tutors understand the new

curriculum and can provide high quality instruction. In FY 2009 the AIHA nursing partnership will continue to

roll out these trainings. In addition, MUHAS and UCSF mentors will provide onsite support in nursing

schools where nurse tutors are implementing the new HIV/AIDS curriculum to ensure quality.

3. Faculty Development

In collaboration with I-TECH, the AIHA nursing partnership will develop a package for in-depth faculty

development that includes training for nursing tutors on curriculum development and lesson planning. This

will increase the capacity of faculty to provide high quality instruction in pre-service settings, as well as to

revise curricula and lessons plans whenever new HIV/AIDS-related innovations and guidelines are

available.

4. Support to Nursing Schools

The AIHA nursing partnership will continue to provide support to the 62 nursing schools to address

infrastructural deficits (e.g., computers, clinician support tools, and reference materials).

5. Leadership

In FY 2009 AIHA will step up support for the Tanzania Association of Nurses and Midwives. This

organization plays a national leadership role in advocacy and quality assurance for the nursing cadre. The

association has an important part to play in ensuring nurse satisfaction and in increasing the retention rate

of nurses. Exchanges to the US and with countries in Southern Africa will be provided to nurse leaders to

empower them so they can assume more responsibility and can be better advocates for the nursing cadre.

Additional leadership and management training will be provided to nurses at pre-service nursing institutions

who demonstrate the ability to lead.

LINKAGES:

The AIHA partnership works closely with the National AIDS Control Programme (NACP) and the MOHSW's

Nursing Unit. The partnership also collaborates with a number of other USG partners, such as I-TECH,

JHPIEGO, Capacity and ASPIRE. Collaboration with the National Council for Technical Education and the

Tanzania Universities Commission is also critical and will be maintained.

M&E:

The AIHA Twinning Center provides partners with technical assistance and support to develop a structured

monitoring and evaluation system in accordance with USG/PEPFAR standards and indicators. AIHA also

helps partners to implement this system and to develop training-specific monitoring tools based on work

plan activities and objectives. AIHA works with partners to develop appropriate tools and systems

necessary to collect and report relevant data. This information is then provided to the USG quarterly.

Finally, AIHA uses this information to further evaluate the partnership's effectiveness in meeting its goals

and objectives upon completion of the work plan period.

Activity Narrative: SUSTAINABILITY:

The AIHA nursing partnership is building the capacity of the country's nursing schools to provide quality

HIV/AIDS education for its students. Schools of nursing will be better able to provide quality HIV/AIDS

education to their students as a result of advanced training, supervision, and mentoring. Tutors will increase

their knowledge, practical skills, and confidence to teach HIV/AIDS. Students will be equipped to provide

comprehensive care to PLWHAs.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16980

Continued Associated Activity Information

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

System ID System ID

16980 16980.08 HHS/Health American 6495 3555.08 Twinning $500,000

Resources International

Services Health Alliance

Administration

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $500,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.18: