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
THIS IS AN ONGOING ACTIVITY FROM FY 2008. ACTIVITIES LISTED HAVE BEEN INITIATED AND
WILL PROCEED DURING FY 2009 AS IN THE PREVIOUS YEAR. ACCOMPLISHMENTS WILL BE
REPORTED IN THE FY 2008 APR. PLEASE NOTE THAT THE ACTIVITY NARRATIVE REMAINS
UNCHANGED FROM FY 2008.
The funding for this activity has not changed
*END ACTIVITY MODIFICATION*
TITLE: Expansion of PASADA's PMTCT program in Dar es Salaam Archdiocese.
NEED and COMPARATIVE ADVANTAGE: PASADA's PMTCT program has been operating since 2002 and
currently operates in 12 facilities. The current HIV prevalence in Dar Es Salaam is 13% and current PMTCT
coverage is still low. In addition, PMTCT clients encounter numerous challenges: women not wanting to test
due to fear of violence and abandonment; not enough involvement of male partners; mobility of mothers
after delivery and lack of community awareness about PMTCT. Based on PASADA's experience and the
fact it works at community level, it will use its outreach program to sensitize the community, particularly in
the semi-urban areas where access to information is generally limited. The program is now specifically
targeting the male partners of pregnant women, as without their collaboration and acceptance, women will
not enroll in the program. PMTCT is closely linked to PASADA's other care and treatment, counseling and
HBC Palliative Care services, guaranteeing continuum of care. PASADA will strengthen the facilities it
supports to enhance quality of care and scale up coverage.
ACCOMPLISHMENTS: Sensitization activities have increased the number of men attending antenatal
clinics with their partners for HIV testing, leading to women being able to access PMTCT more freely.
Women's attitudes about HIV+ status being a "death sentence" have changed. They are therefore more
willing to test. Involvement of people living with HIV/AIDS (PLWHA) has proved extremely useful in the
sensitization of activities at the community level and has educated communities that are now taking
preventive measures in cultural practices. 4,729 pregnant women tested and received their results from July
2006 to June 2007. Over the past 12 months, 101 health workers, 80 community volunteers and 60
Traditional Birth attendants (TBAs) were trained in PMTCT issues.
ACTIVITIES: 1) Increasing coverage of PMTCT in the catchments area by: 1a) adding one new antenatal
site to the program; 1b) employing four new nurse/counselors in four antenatal sites; 1c) recruitment and
training of 100 new PMTCT community volunteers who will be actively involved in PMTCT sensitization at
community level; 1d) employment of one extra PMTCT community nurse in PASADA.
2) Increasing the demand for PMTCT services by: 2a) increasing the number of PMTCT sensitization
interventions at community level utilizing the
trained PMTCT community volunteers; 2b) through targeted drama performances transmitting appropriate
messages; 2c) through the involvement of community leaders at all levels.
3) Improving the quality of the PMTCT services provided by: 3a) provision of refresher training for all
PASADA staff and antenatal sites staff on PMTCT issues; 3b) training of all new staff on the best way to
provide PMTCT services; 3c) supervision, monitoring and evaluation of activities; 3d) employment of two
extra PMTCT nurses and maintenance of salaries for PMTCT staff.; 3e) providing opt out testing based on
the new national algorithm, women will be tested in ANC, LW and post natal, with rapid test and results
given on same day. Based on capacity, both single dose nevirapine (SDN) and more complex regimen will
be provided with a view of accessing more women to more efficacious regimen as capacity of the facility
allows. Cotrimoxazole will be provided to eligible mothers and their exposed children.
4) Promoting adherence to the PMTCT program through 4a) Targeted PMTCT sensitization and counseling
with couples; 4b) Targeted sensitization meetings with male groups at community level; 4c) Targeted
PMTCT training for pregnant women attending the antenatal clinics; 4d) Provide social support to poor HIV+
women accessing delivery services
5) Promoting maintenance of contact between the program and women enrolled in PMTCT after delivery, to
facilitate testing of all newborn at 18 months 5a) provision of social support to HIV+ mothers; 5b) Breast
feeding for six months will be promoted based on guidelines and mechanism for provision of food
supplements to mothers who have delivered within the program will be explored; 5c) provision of milk
support to children.
LINKAGES: PASADA's PMTCT program is closely linked with the national program and with other
organizations providing PMTCT services e.g. Muhimbili National Hospital, Temeke Hospital Hindu Mandal
Hospital. The Ministry of Health has provided PMTCT training for staff. The program works closely with the
current 12 antenatal sites, ten of which have maternity units. Referral systems exist for women needing
social support over and above what PASADA can offer, for example with the local offices of the Ministry of
Health and Social Welfare religious organizations of all faiths. The program also links up with community
social support groups. Linkage with VCT, C&T, TB/HIV and OVC programs supported by PASADA will be
strengthened. Linkages between facilities will also be strengthened and PASADA will continue to
collaborate with facilities funded by the Global Fund and others. Linkages with RCH activities especially
Malaria and Syphilis in Pregnancy programs, Family planning and nutritional and child survival programs in
the military facilities will be improved.
CHECK BOXES: 1) Gender: the program educates both men and women on gender issues, particularly
those around sexual behavior and relations and equality for women in accessing care and treatment. It also
focuses on violence due to blame for HIV+ status. Men in particular are targeted for behavioral change. 2)
Human capacity development: the program focuses on training of staff (PASADA, antenatal clinics,
maternity units) and of community PMTCT volunteers, so that some tasks can be shifted from nurses to
volunteers. 3) Local organization capacity building: this is achieved in the dispensaries and small
community groups. 4) Health related wrap around: infant-feeding, safe motherhood, and TB. 5) Non-health
related wrap around: economic strengthening through PASADA's Community-based Microfinance Savings
Activity Narrative: and Credit scheme for HIV+ women (in collaboration with Caritas DSM), education within the program and
some limited food security.
M&E: PASADA will work with the MOHSW and USG partners such as HARVARD in rolling out the revised
PMTCT Monitoring and Evaluation and the commodity logistic (LMIS) tools to all of the sites it supports. It
will support the facilities teams in collection and reporting of PMTCT data based on the national protocol
and will provide feedback on tool performance. PASADA will work with these institutions to strengthen and
implement PMTCT quality framework and providing regular supervision.
PASADA's PMTCT program collects and compiles all data from the antenatal clinics and feeds into the
national data collection system. PMTCT volunteers report to the PMTCT coordinator. Monitoring of activities
takes place on a regular basis, as does referrals to and from other related PASADA services, particularly
VCT, ART, TB and HBC and Palliative Care programs. Temeke Municipality and Temeke Hospital are
involved in monitoring of the program.
SUSTAINAIBLITY: 1) Antenatal clinic staff have been trained in PMTCT and infant feeding, thereby leading
to sustainability in their sites. 2) Women themselves are more empowered in seeking further information
and taking decisions about their own sexuality and pregnancies. 3) Couple counseling in PMTCT engages
the commitment also of the male partner leading to adherence to PMTCT and continued connection of the
mother to the program for testing of the newborn. 4) PMTCT contributes to the number of people testing for
HIV and therefore, accessing ART and the continuum of care. 5) PASADA will work with the Dar Es Salaam
Regional and District Councils to include PMTCT activities in their Comprehensive Council Health Plans
and increase funding from additional sources such as basket funding, GF and overtime districts own
recourses. The districts contribution to sustainability is by fully integrating PMTCT in the RCH, services,
providing the health infrastructure and staffing. 6) The project will build local ownership by working through
government and building human capacity through training, mentoring and supportive supervision.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16408
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16408 16408.08 U.S. Agency for Pastoral Activities 6549 3745.08 $164,320
International & Services for
Development People with AIDS
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $36,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
ACCOMPLISHMENTS: In FY 2008, PASADA expanded its facility-based services and enrolled at least
7,100 people on ART. Services are now offered at a total of 11 satellite sites including the PASADA
Upendano headquarters. This decentralization has brought services closer to those who need them,
reduced indirect costs for the poor target population, reduced stigma and discrimination, and created a
more supportive community environment. Strong linkages exist between the sites, community volunteers,
groups and members.PASADA also continued to provide training on patient management, renovate
outreach sites, and ensure pharmaceutical supplies.For clients not enrolled in ART, pain was assessed in
more than 70% of adults receiving care and support. Analgesics groups of first-, second- and third-ladder
World Health Organization (WHO) were available to all patients depending on the presenting pain state. In
addition, the psychological, emotional, and spiritual state was assessed and responded to by an
interdisciplinary intervention approach. Patients with severe pain who qualify for strong opiates (oral
morphine) were provided with the appropriate treatment. Other analgesics available are Paracetamol,
Diclofenac, Fastum gel, and Meloxicum (Muvera). By the end of September 2008, nearly 4,800 adult clients
will be receiving Cotrimoxazole prophylaxis.
ACTIVITIES: As in previous years, PASADA will continue to provide care and support to registered
patients at clinical sites, as well as through its home-based care (HBC) program. This narrative covers both
facility-based and home-based components of PASADA's care and support program. Patients will continue
receiving WHO staging, provision of Cotrimoxazole in accordance with national guidelines, and diagnosis
and management of opportunistic infections (OIs). PASADA will facilitate the follow-up of patients in their
homes, using PLWHA volunteers to ensure comprehensive care and linkages between the facility-based
and the HBC team for bedridden patients. Patients will receive clinical, psychological, spiritual, social, and
prevention services. Clinical care will include prevention and treatment of OIs and other complications of
HIV/AIDS. PASADA also provides counseling and psychosocial support, linkages with income-generating
activities. Also, facility counselors, who have the first contact with clients, will be provided with training and
tools adopted from the national TB program to screen for active HIV-positive patients attending care and
treatment centers.
PASADA will support clients who cannot afford specialized medical services offered by other facilities and
which are not provided by PASADA, and strengthen referrals between these facilities; e.g., Muhimbili
National Hospital and Ocean Road Cancer Institute. In addition, the program will initiate special clinics for
opportunistic cancers (such as Kaposi's sarcoma surveillance among HIV patients).
The importance of nutrition in determining clinical outcomes for people on ART is becoming increasingly
apparent. In FY 2009, PASADA will put more emphasis on addressing food and nutrition needs of clients
receiving care and support. PASADA will conduct nutritional assessments and counseling for the clinical
management of PLWHA receiving care and support. Specifically, PASADA will conduct anthropometric
measurements and determine nutrition status using body mass index calculations and other age-
appropriate measurements. PASADA will also provide dietary assessment, nutrition education, and
nutritional counseling to maintain and improve nutritional status.
In FY 2009, USG/Tanzania will be initiating a therapeutic supplemental feeding program using ready-to-use
therapeutic food products targeting eligible clients. PASADA will be a part of this program through case
identification and progress monitoring following the established entry and exiting criteria. PASADA will use
USG funds for procurement of necessary equipment required to carry out effective nutritional assessment
(adult and pediatric weighing scales, mid upper-arm circumference tapes, etc.). In addition, PASADA will
use USG funds to support the rollout of nutritional assessments; trainings will be conducted to equip health
care workers, and HBC providers with necessary tools and curricula to implement these services. Linkages
will be made to other USG entities and/or community services to provide patients with initiatives addressing
household food security and economic strengthening.In FY 2009, there will be an increased emphasis on
provision of prevention with positives (PWP) services for PLWHA. All sexually active PLWHA will be linked
with sexually transmitted infection treatment services and counseling to reduce high-risk behaviors.
Referrals will be made for family planning, if appropriate. Implementing partners will discuss with PLWHA
specific strategies for disclosing one's HIV status to sexual partners, and offer confidential HIV testing to the
partners of and children born to all PLWHA in their coverage areas. In addition, PASADA will strengthen
its basic prevention package. PLWHA will be provided with counseling, and linked to support groups or
peer-led interventions through the HBC system. There will be increased involvement of PLWHA in the
community in service provision as HBC providers. PLWHA will be provided with information about ways
they can protect their own health, prevent common illnesses, and improve access to safe water and hygiene
practices. PASADA will ensure that interventions address the comprehensive needs in an environment free
from stigma and discrimination. PASADA will support procurement and/or distribution of insecticide-treated
bed nets to PLWHA, and promotion on their correct usage. PASADA will ensure that all PLWHA are
receiving Cotrimoxazole for prevention of opportunistic infections. PLWHA will also be provided with water
treating tablets and water vessels in provision of safe drinking water. PASADA will train HBC providers on
screening for TB and linking the clients to services. HBC volunteers will also be addressing and monitoring
adherence to TB treatment.LINKAGES: To ensure a continuum of care in facility-based service delivery,
linkages with other programs will emphasize that women attending PMTCT services are also referred to the
CTC for pre-ART care; providing effective referral mechanisms between the various wards in the catchment
area. There will be close coordination between PASADA's facility-based and home-based care and support
services, as well as strong linkages to programs in the community, e.g., for Income Generating Activities.
PASADA will continue to work closely with Parish Health Committees, Small Christian Communities, local
community groups and different faith groups, including the Muslim community. M&E: For facility-based care
M&E, PASADA will use the ART monitoring system developed and updated by the MOHSW and NACP.
PASADA's main CTC and its 11 satellite facilities use the national paper-based tools to collect patient data,
which are then entered into the National CTC2 database. Data entry and management and analyses is
centrally located at PASADA where the electronic system generates national (NACP) and USG reports, as
well as feedback reports to the CTC teams and PASADA management. For HBC, PASADA will participate
in the development and implementation of the national system for monitoring HBC services.*END ACTIVITY
MODIFICATION* TITLE: Consolidation and Scale Up of Home-based Palliative Care Services in all Districts
of Dar es Salaam and Four Districts of Coast Region
NEED and COMPARATIVE ADVANTAGE: Home-based and palliative care can relieve the burden of care
currently allocated to the health system and families. Demand is rising as more people become aware of
their status. Also through HBC, stigma about HIV/AIDS is reduced and the need to access the continuum of
Activity Narrative: care increases. PASADA's home-based care (HBC) and facility-based palliative care program started in
1994 and has evolved to include the PASADA main site and 12 satellite sites at the community level. The
service operates through nurse supervisors, outreach nurses, and trained community volunteers.
PASADA's strong and sustained experience in home-based and facility-based palliative care, as well as
their extensive geographical accessibility, make them an ideal partner in addressing this need.
ACCOMPLISHMENTS: PASADA offers holistic care to both adults and children by providing spiritual and
general counseling to patients and caregivers regarding treatment, nutritional support, pain control, linkage
to community volunteers and support groups, and referral to and from antiretroviral therapy (ART) and TB
services, as well as services for orphans and vulnerable children. The participation of trained community
HBC volunteers has enabled the service to reach more people in need. In FY 2007, approximately 3,500
clients received assistance in their homes. Training of caregivers in basic nursing skills has improved the
quality of HBC and continuous contact and training with communities has reduced stigma and
discrimination. Many of PASADA's palliative care team have been trained at Hospice Uganda, which serves
as a model of palliative care for Africa. In addition, PASADA has secured permission from the Ministry of
Health and Social Welfare (MOHSW) to use oral morphine for pain control. Of note, PASADA "graduated"
from sub-partner status to direct support this past year.
ACTIVITIES: In FY 2008, PASADA will work to increase access to both HBC and facility-based palliative
care by expanding of the service to three new sites (Makoka, Kibangu, and Luhanga). They will identify and
train 30 nurses to work in government and private facilities on palliative care both home-and facility-based).
PASADA will hire additional trained nurses in overburdened outreach sites.
PASADA will also focus on improving the quality of HBC and palliative care services by training six nurses
in palliative care using a distance-learning course from Kampala, Uganda. PASADA will provide additional
training for community HBC volunteers in order to increase their knowledge and skills. Refresher courses
for all nursing staff involved in the service, including upgrading of counseling skills will be organized.
PASADA, operating under the auspices of the Archdiocese of Dar es Salaam, will ensure regular payment
of salaries to all staff in the service, in order to retain competent, qualified, and motivated personnel.
Through the provision of support (nutritional, transport costs, and motivational meetings) to trained
community HBC volunteers PASADA will maintain motivation and activities. Staff will be trained in data
collection and management in order to improve reporting skills. PASADA will maintain regular supervision
throughout the tier system and ensure the regular and constant supply of appropriate and sufficient
harmaceutical and medical consumables. PASADA will ensure adherence to treatment and improvement in
the physical condition of patients by providing nutritional support to qualified individuals using specific
criteria for eligibility, duration, and quantity. PASADA will provide basic essentials including bedding,
insecticide treated mosquito nets, and cooking utensils to the most needy. In addition, they will promote
adherence and prevention messages with HIV positive patients.Since the project's area of service is large
and patients are often located in areas with difficult access, it is vital to ensure continuity and efficiency of
HBC and palliative care service by ensuring, maintaining, and fuelling the two service vehicles; providing
travel reimbursement to nurses operating in outreach sites; ensuring communication through the provision
of telephone facilities; and maintaining and improving referral links to ART, TB, counseling, and OVC
services. LINKAGES: PASADA is a member of the Tanzania Palliative Care Association. The program has
a twoway referral system with PASADA's other services (e.g. ART, general medical, counseling and OVC)
and a referral system with Muhimbili National Hospital, Ocean Road Cancer Hospital, Temeke District
Hospital, and other facilities. The program is linked with all the satellite sites in which PMTCT is operating.
The service is linked with Selian and Muheza Hospitals for exchange visits and collaborates closely with
other organizations involved in palliative care, particularly those involved in facilitation in training. At the
community level, the program offers training to local organizations. In addition, PASADA links with
community programs that provide wraparound services, such as income generating activities, small loans,
and nutritional support. PASADA also links with the National AIDS Control Programme (NACP).CHECK
BOXES: The program covers both sexes of all ages and through its links with other PASADA services, also
the specific groups mentioned. Capacity building of local organizations and human capacity building are
achieved through training activities. The HBC palliative care program is closely linked with TB program as it
identifies and refers patients for TB diagnosis and treatment. It also operates as a two-way referral system
for ART.M&E: Community HBC volunteers submit regular reports to outreach nurses who then compile their
own reports, which are submitted to the HBC palliative care supervisors. Overall reports are sent to district
authorities to feed information into the national system. The program holds regular monitoring meetings to
review progress, challenges, and solutions. Internal annual evaluations are carried out and the results are
used for decision-making in future strategies and plans. All activities are in line with the national guidelines
on palliative care. Once the new national palliative care monitoring system is available, PASADA will use
this system for its own monitoring, as well as to inform the national program. FY 09 targets for community
based care is 1913 and facility based care is 10291 with a de duplicated target of 10965.SUSTAINAIBLITY:
One of the priorities of the palliative care program is to support family caregivers by increasing their
knowledge and skills (which also improves the quality of care in the home). Community HBC volunteers are
also supported with motivational activities and psychosocial support. Both are important for sustainability, as
the program could not reach such high numbers of patients without their collaboration. Regular meetings
are held so that they can share experiences and challenges. The program is fully integrated into a
continuum of care with general medical, ART, PMTCT, TB, and OVC services, which also enhances
sustainability. Community awareness and acceptance of HBC contributes to stigma reduction and further
sustainability.
Continuing Activity: 13562
13562 12392.08 U.S. Agency for Pastoral Activities 6549 3745.08 $378,530
12392 12392.07 U.S. Agency for Pastoral Activities 4570 3745.07 $50,000
Estimated amount of funding that is planned for Human Capacity Development $214,950
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $40,000
and Service Delivery
Table 3.3.08:
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP.
TITLE: Continued expansion of PASADA's comprehensive ART services in Dar es Salaam Archdiocese
NEED and COMPARATIVE ADVANTAGE: In FY 2008, PASADA expanded its services and enrolled at
least 7,100 people on antiretroviral therapy (ART), including pediatric cases. During FY 2008, PASADA
decentralized ART services to a total of 11 satellite sites including PASADA Upendano headquarters.
Decentralization is an important strategy in bringing services closer to those who need them, reducing
indirect costs for the poor target population, reducing stigma and discrimination and involving the
community in responding to the needs of those affected by and infected with HIV/AIDS. In addition to
decentralizing to outreach sites, PASADA has also engaged in training in ART management based on
national guidelines, while also renovating satellite facilities and ensuring pharmaceutical supplies. PASADA
is well-placed to expand the provision of quality ART services, as it offers a continuum of care from
prevention and voluntary counseling and testing (VCT) to home-based care (HBC), TB diagnosis and
treatment, prevention of mother-to-child transmission (PMTCT), and support to orphans and vulnerable
children.
ACCOMPLISHMENTS: By September 2008, 3,681 adults were on ART (902 males and 2,779 females)
and six sites were operating. All sites are operated by one Assistant Medical Officer and one Nurse
Counselor. Together with ART provision, the training of PLWHA on adherence, community mobilization and
prevention of HIV transmission and supervision of all sites have been taking place. Decentralization takes
into account the holistic nature of PASADA's services; hence, all sites have both VCT and HBC services.
The increase in CD4 count over a recent six-month period is 43%.
ACTIVITIES: With FY 2009 funding, PASADA will:
Carry out expansion of the ART program to lower-level satellite dispensaries. This is a critical element in
PASADA's ART program, as expansion to lower-level facilities leads to improved access, care and support,
and good adherence not only to ART, but also to the whole continuum of care. ART and related services
will be based on the national ART guidelines and protocol. Activities to facilitate program expansion include
training of clinical and laboratory staff in ART management; providing technical and financial/management
support to initiate ART in lower level sites so as to carry out patient management, minor renovation work,
furnishing and supply of appropriate clinical and diagnostic equipment commodities and supplies;
supervision, monitoring and evaluation of ART progress; and supporting the employment of clinical staffs in
each of the supported dispensaries. Funds will also be used to Improve the quality of treatment services
through innovative on-site continuing education program for all ART program staff; improved data collection
and management; continuous quality improvement initiatives; attention to retention of competent, qualified
and motivated staff (provide salaries of ART program staff); ensured continuous availability of
pharmaceuticals, medical consumables, laboratory reagents, test kits, equipment and supplies in PASADA;
and building capacity through training in and outside the country. PASADA will also involve people living
with HIV/AIDS (PLWHA) in promoting prevention, disclosure, behavior change through risk reduction,
adherence, gender awareness, and reduction of stigma at the community level. Linkages between the
sites, PASADA supervisors, community volunteers, groups and members will be strengthened. Follow up of
those lost to follow up will be undertaken through these volunteers. Lastly FY 2009 funds will be used to
strengthen organizational operations, including improvement of general management skills and financial
management and accountability through ensuring regular transport for activities; ensuring regular
maintenance and insurance of project vehicles, buildings etc.; maintaining security services of the
organization; and ensuring communication and general organizational support.
Laboratory services:
Provide crucial ongoing training for laboratory technicians, especially those at the dispensary level. In-
service training for all laboratory staff at PASADA will be carried out in handling the CD4 machine,
hematology, clinical chemistry and rapid tests. PASADA has its own trainer of trainees, so it can facilitate
these trainings. Collaborate in all quality assurance activities conducted by the Ministry of Health and
Social Welfare (MOHSW) and the USG lab team. Continue to support and perform HIV rapid testing for TB
patients receiving counseling at TB clinics. Sputum for smear will also be conducted in the laboratory.
Ensure that all rapid tests for HIV in the PMTCT program are done by trained nurses in the antenatal clinic
and labor ward. PASADA laboratory staff will ensure quality of testing is kept to standard. PASADA
technicians will also participate in training for syphilis testing using rapid test kits. Perform rapid testing for
HIV at lower facilities in the laboratory, with the exception of stand-alone sites. Trained nurse counselors
will conduct the test, while PASADA laboratory staff will ensure the quality of service according to the
national guidelines. Collaborate with Harvard and Muhimbili to ensure infants born to HIV-positive mothers
have access to Early Infant Diagnosis (EID) services. Train laboratory staff on sample management,
transportation, and management of results. Maintain laboratory equipment through various sources
including the USG, MOHSW and other agencies. Obtain reagents for CD4, rapid tests and other laboratory
supplies through the National AIDS Control Program (NACP) and Medical Stores Department. When there
are shortfalls, PASADA will procure them from private suppliers as required.
LINKAGES: PASADA will ensure that it continues to provide services that support a continuum of care
model by providing HIV-related services within its sites and also though linkages with public and private
faith-based organizations, and continues strong links with communities. Linkages with other programs will
be ensured by ensuring women receiving PMTCT services are also referred to the ART for pre-ART care;
providing referral forms with feedback mechanisms to ensure patients referred from TB or PMTCT program
are tracked; emphasizing screening of all TB patients for HIV, initiating eligible patients on ART; and
establishing PMTCT, TB, and ART services are available in a single location. In addition, PASADA will print
educational materials and conduct ART community mobilization and sensitization activities PASADA will
continue collaborative links with government agencies (e.g.; TACAIDS, NACP, National TB Control
Program, Global Fund) and government health facilities (e.g., Muhimibili National Hospital, Ocean Road
Cancer Hospital, and Temeke District Hospital), with some specific NGOs involved in HIV/AIDS (e.g., Pact,
Pathfinder International, Catholic Relief Services, Action Aid, and HelpAge International). At the community
level, PASADA will continue to work closely with Archdiocese of Dar es Salaam Parish Health Committees,
Activity Narrative: Small Christian Communities, local community groups, and different faith groups, including the Muslim
community. Promotion of interfaith collaboration in the fight against HIV/AIDS is one of PASADA's
priorities, particularly through the Community Education and prevention program.
M&E: PASADA will use the ART monitoring system developed and updated by the MOHSW/NACP.
PASADA's CTC and its 10 satellite facilities use the national paper-based tools to collect patient data which
are then entered into the National CTC2 database. Data entry, management and analyses is centrally
located at PASADA where the electronic system generates national (NACP) and USG reports as well as
feedback reports to the CTC teams and PASADA management for utilization in informing patient
management and program improvement. All departments involved in the ART program hold regular M&E
meetings.
SUSTAINAIBLITY:
Focus for sustainability will be on: improving the technical and management capacity of PASADA in
general; improving the technical and management capacity of lower level sites; improving the capacity of
PLWHA to be actively involved in prevention, stigma reduction, ART adherence and counseling at
community level; assisting communities to identify and strengthen their own responses to the problems of
HIV and AIDS; improving links with government and other agencies
Continuing Activity: 13564
13564 5560.08 U.S. Agency for Pastoral Activities 6549 3745.08 $1,750,000
7784 5560.07 U.S. Agency for Pastoral Activities 4570 3745.07 $750,000
5560 5560.06 U.S. Agency for Pastoral Activities 3745 3745.06 $650,000
Estimated amount of funding that is planned for Human Capacity Development $131,625
Table 3.3.09:
THIS IS A NEW ACTIVITY
TITLE: Pediatric Care and Support
NEED and COMPARATIVE ADVANTAGE: PASADA is a faith-based organization providing
comprehensive HIV services to a catchment population of 1,300,000. The need for antiretroviral therapy
(ART) services in the region is still high, evidenced by the increasing number of HIV-positive clients
registered; currently over 36,000, with 10,300 active clients. By the end of September 2008, 1,141 pediatric
cases will be receiving care and support. During FY 2008 PASADA decentralized ART services to a total of
11 satellite sites, including PASADA Upendano clinic, which is the headquarters. Decentralization is an
important strategy in bringing services closer to those who need them, reducing indirect costs for the poor
target population, reducing stigma and discrimination and involving the community in responding to the
needs of those affected by and infected with HIV/AIDS. In addition to outreach activities, PASADA has also
engaged in training on ART management, renovation of facilities, and ensuring pharmaceutical supplies are
available. PASADA is well-placed to expand the provision of quality ART services, as the program offers a
continuum of care from prevention and voluntary counseling and testing to home-based palliative care
(HBC), TB diagnosis and treatment, prevention of mother-to-child transmission (PMTCT) and support for
orphans and vulnerable children (OVC). Strong linkages between the PASADA sites and programs in the
continuum of care, community volunteers, community groups and members, help to ensure a supportive
environment for families and their children.
PASADA "graduated" from sub-grantee status to direct partnership with USG in FY 2007. By September
2008, 1,141 children were receiving care and support, and 800 of whom were receiving cotrimoxazole
prophylaxis. A significant proportion of children receiving HIV care and support are malnourished, and
currently only few receive nutritional support through very limited resources via linkages with OVC and HBC
programs. Sexual education for adolescents has been continuously provided through peer education in
collaboration with the OVC program. The establishment of pediatric clinics in PASADA (three per month)
plays a major role in stigma reduction with regard to care and support for pediatric cases. In addition, the
clinics are more conducive venues for disclosure. Availability of drugs for opportunistic infections (OIs) has
enabled treatment of OIs among pediatric patients, resulting in improvement of patients' health status and a
return to normal life.
1. Identify children who have been exposed HIV and ensure they continue to be followed in the care and
treatment clinic (CTC). Refer children as necessary for early infant diagnosis.
2. Refer mothers who are found to be HIV-positive to the CTC for evaluation and follow-up
3. Maintain the two-way referral system for children receiving OVC support and facility-based care and
support.
4. Intensify efforts in nutritional support for HIV-positive children. Specifically, PASADA will support
conduct anthropometric measurements and determine nutritional status using Body Mass Index (BMI)
calculations and other appropriate measurements such has mid-upper arm circumference (MUAC) and
weight for age. PASADA will procure the necessary equipment required to carry out effective nutritional
assessment such as weighing scales, MUAC tapes, and stadiometers. Training in the use of these tools
will be conducted, as well as in dietary assessments of patients and the provision of nutrition counseling
and education. In addition, PASADA will participate in a pilot therapeutic supplemental feeding program.
5. Continue to provide a basic package of medical support, economic support and malaria interventions
(through linkage with national Under Five Insecticide-Treated Mosquito Nets, if applicable) for all HIV-
positive children
5. Continue to support interdisciplinary teams composed of social workers, counselors and clinicians, who
work together with families on challenging cases and intervene from many different aspects to reach
solutions (Family-Centered Care)
6. Implement institutional organization strengthening, including improvement of management skills, financial
management and accountability through: ensuring regular transport for activities, ensuring regular
maintenance and insurance of project vehicles, buildings, etc., maintaining security services of the
organization, and ensuring communication and general organizational support.
faith-based organizations and continued strong linkages with communities. Linkages with other programs
will be ensured by:
- Ensuring women attending PMTCT services are also referred to the CTC for pre ART care and the follow
up of their infants
- Providing referral forms with feedback mechanisms to ensure patients referred from TB or PMTCT
program are tracked
- Emphasizing screening of all TB patients for HIV; eligible patients will be initiated on ART
- Establishing PMTCT, TB, and ART services under one roof
- Printing educational materials and promoting ART community mobilization and sensitization activities
- Access materials developed for pediatric AIDS programs by the Baylor International Pediatric AIDS
Initiative (e.g., pediatric treatment guides for patients, pediatric palliative care materials, etc.)
- Continuing collaborative links with government agencies (e.g., TACAIDS, National AIDS Control
Programme (NACP), National TB Control Program, and Global Fund) and government health facilities (e.g.,
Muhimbili National Hospital, Ocean Road Cancer Hospital and Temeke District Hospital), with some specific
NGOs involved in Pediatric HIV/AIDS and children's services (e.g., Elizabeth Glaser Pediatric AIDS
Foundation, Columbia, Baylor, Pact, Pathfinder International, Catholic Relief Services, Action Aid, and
HelpAge International).
- Continuing to work closely with Archdiocese of Dar es Salaam Parish Health Committees, Small Christian
Communities, local community groups and different faith groups, including the Muslim community.
Promotion of interfaith collaboration in the fight against HIV/AIDS is one of PASADA's priorities, particularly
through the Community Education and prevention program.
Activity Narrative: M&E: PASADA will use the ART monitoring system developed and updated by the Ministry of Health and
Social Welfare and NACP, which tracks all patients on facility-based care and treatment. PASADA's CTC
and its ten satellite facilities use the national paper-based tools to collect patient data, which is then entered
into the national CTC2 database. Data entry, management and analyses is centrally located at PASADA,
where the electronic system generates national (NACP) and USG reports as well as feedback reports to the
CTC teams and PASADA management for informing patient management and program improvement. All
departments involved in the care and support program hold regular M&E meetings to review progress,
discuss issues of concern, and chart the way forward. The CTC2 database at PASADA is currently
managing data from the PASADA CTC as well as five satellite sites The database will have data from one
CTC and five satellites by September 2008, and one CTC and ten satellites by September 2009. SI
Targets: To do above activities, PASADA will support training of 150 healthcare workers in SI and provide
technical assistance to ten satellite dispensaries.
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $1,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $2,000
Table 3.3.10:
THIS IS A NEW ACTIVITY.
Title: PASADA-PEDIATRIC TREATMENT
NEED and COMPARATIVE ADVANTAGE: PASADA is a faith-based organization providing comprehensive
HIV services to a catchment population of 1,300,000. The need for antiretroviral therapy (ART) services in
the region is still high, evidenced by the increasing number of HIV-positive clients registered (currently over
36,000). PASADA has expanded its services and enrolled at least 7,100 clients on ART, 15% (1,050) of
which are children. In 2008, 10% of ART patients were pediatric cases. During FY 2008, PASADA
decentralized ART services to a total of 11 satellite sites, including PASADA Upendano headquarters.
indirect costs for the poor target population, reducing stigma and discrimination, and involving the
decentralizing to outreach sites, PASADA has also engaged in training in ART management, facility
renovation, and ensuring pharmaceutical supplies. PASADA is well-placed to expand the provision of
quality ART services, as the program offers a continuum of care from prevention and voluntary counseling
and testing (VCT) to home-based care (HBC), TB diagnosis and treatment, prevention of mother-to-child
transmission (PMTCT) and support to orphans and vulnerable children (OVC).
As of September 2008, the number of children on ART is 385, of whom 12 are less than 1 year of age, and
56 are between the age of two and four years. Trained people living with HIV/AIDS (PLWHA) actively
promote prevention, gender awareness, and stigma reduction at the community level. They are also
proactively identifying pediatric cases of HIV at the community level. Strong linkages exist between the
sites, community volunteers, groups and members.
PASADA "graduated" from sub-grantee status to direct partnership with the USG in FY 2007. From that
time, it is operating as successful program with ongoing expansion to other sites within the Archdiocese of
Dar es Salaam. All sites are operated by assigned one Assistant Medical Officer and one Nurse Counselor.
Opening sites at community level increases the identification of children who need to access services.
Children's access to services is limited by the economic status of the family, children's status within the
family, and lack of knowledge about pediatric HIV. Community mobilization and sensitization activities
promote children's access to services.
ACTIVITIES: With FY 2009 funding, PASADA shall:
1. Carry out expansion of the ART program to five lower-level satellite dispensaries. This is a critical
element in PASADA's ART program, as expansion to lower levels of care improves access and adherence
to ART. Other activities include: training laboratory staff in ART management; providing technical and
financial/management support to initiate ART in lower level sites, in order to carry out minor renovation
work, furnishing and supply of appropriate clinical and diagnostic equipment commodities and supplies;
supervising, monitoring and evaluating ART progress; and supporting the employment of two clinical staff in
each of the five dispensaries.
2. Improve quality of treatment services through an on-site continuous quality improvement program and an
innovative continuing education program including all ART program staff; improved data collection and
management; employment and retention of competent (with additional focus on retention strategies),
qualified and motivated staff. The program will also ensure continuous availability of pharmaceuticals,
medical consumables, laboratory reagents, test kits, equipment and supplies in PASADA. Capacity will
continue to be built through training in and outside the country.
3. Train ART program staff (clinical staff, adherence counselors, HBC nurses) in PASADA and the
dispensaries on management of pediatrics ART.
4. Sensitize people at community level on importance of HIV testing for children to access care, treatment
and support throughout the catchments area.
5. Stage children according to their CD4 percentage.
6. Conduct morning health lessons for clients attending care and treatment clinics (CTCs), including
promotion to bring children to health services.
7. Intensify efforts in nutritional support for HIV-positive children. Specifically, PASADA will support
calculations for and other appropriate measurements such has mid-upper arm circumference (MUAC) and
and education. In addition, PASADA will participate in the pilot therapeutic supplemental feeding program.
8. Provide provider-initiated testing and counseling (PITC) in collaboration with counselors.
9. Carry out organizational and institutional strengthening activities including improvement of general
management skills, financial management and accountability. Ensure regular clinical and senior
management meetings. PASADA will also strengthen management of pharmaceuticals, inventories of other
commodities and reagents, and overall management of equipment maintenance and insurance of project
vehicles, buildings etc. Maintain security services of the organization; and ensure communication and
general organizational support.
LINKAGES:
PASADA will ensure that it continues to provide services that support a continuum of care model by
providing HIV-related services within its sites and also though linkages with public and private faith-based
organizations and continued strong linkages with communities. Linkages with other programs will be
ensured through:
- Ensuring women attending PMTCT services are also referred to the ART for pre-ART care
- Establishing PMTCT, TB, and ART services in one location
Activity Narrative: - Printing of educational materials and conducting ART community mobilization and sensitization activities
- Accessing materials developed for pediatric AIDS programs by the Baylor International Pediatric AIDS
NGOs organizations involved in Pediatric HIV/AIDS or children's services (e.g., Elizabeth Glaser Pediatric
AIDS Foundation, Columbia, Baylor, Pact, Pathfinder International, Catholic Relief Services, Action Aid, and
- Continuing to work closely with Parish Health Committees, Small Christian Communities, local community
groups and different faith groups, including the Muslim community. Promotion of interfaith collaboration in
the fight against HIV/AIDS is one of PASADA's priorities, particularly through the Community Education and
prevention program.
Areas of emphasis:
1. Construction and renovation: minor renovation work to dispensaries
2. Gender issues: gender is crosscutting in all activities and all ART and non-ART clients are counseled and
assisted in gender issues, including gender violence
3. Human capacity development: program activities include extensive training of PASADA and dispensary
staff, community volunteers and community members
4. Local organizational capacity building: the program assists capacity building of dispensaries
5. PASADA performs training on the management of HIV/AIDS in the workplace for private companies and
other institutions
6. PASADA is a site within the national TB control program and has an integrated community-based TB/HIV
HBC program
PASADA will use the national ART monitoring system developed and updated by the Ministry of Health and
Social Welfare and the NACP. PASADA's CTC and all its satellite facilities use the national paper-based
tools to collect patient data, which is then entered into the national CTC2 database. Data entry,
management and analyses is centrally located at PASADA, where the electronic system generates national
(NACP) and USG reports as well as feedback reports to CTC teams and PASADA management for
utilization in informing patient management and program improvement. All departments involved in the ART
program hold regular M&E meetings to review progress, discuss issues of concern, and chart the way
forward. The CTC2 database at PASADA is currently managing data from the PASADA CTC as well as ten
satellite sites. The database will have data from one CTC and ten satellites by September 2009.
Strategic Information targets: to do above activities, PASADA will support the training of 150 healthcare
workers in SI and provide technical assistance to ten satellite dispensaries.
Construction/Renovation
Estimated amount of funding that is planned for Human Capacity Development $15,600
Table 3.3.11:
TITLE: Scaling up of PASADA's integrated TB/HIV service in PASADA and in outreach sites
Pastoral Activities & Services for People with AIDS (PASADA) will continue collaborate with Program for
Appropriate Technology in Health (PATH) and National Tuberculosis and Leprosy Program (NTLP) in the
implementation of collaborative TB/HIV activities in Dar es Salaam and Coast regions. In FY09 PASADA
will increasing the number of outreach service outlets from 9 to 13 and improve TB diagnosis by upgrading
one health facility which was providing treatment for TB to (DOT centre) to diagnostic centre where sputum
smear microscopy will be examined. 4 new diagnostic centers will be established. Health care providers will
be trained on collaborative TB/HIV activities in according to Ministry of Health guidelines. In FY09
Intensified TB care finding in Care and treatment clinic will be strengthen. All HIV patients attending care
and treatment clinic will be screened using screening tool. Patients with active TB will be referred to TB
clinic for TB treatment. At TB clinic all TB patients will be offered HIV counseling and testing and those who
will be HIV positive will be referred for Care and treatment services. HIV Prevention messages will be
provide to all TB patients. TB-HIV co infected patients will be encouraged to disclose their HIV sero status
to their sexual partners. Condoms will be available at TB clinics and will be promoted and distributed to HIV
co-infected TB patients. PASADA will strengthen referral and linkages to HIV related services including STI,
VCT, ART, OVC, HBC and Palliative Care. Information exchange meeting between heath care providers
from HIV and TB clinics and interdepartmental meetings will be supported. Reporting system will be
improved to ensure that reports are submitted on time. Community awareness will be improved. PLWHA
whom are ex TB patients in community will be trained on TB/HIV activities and community DOT. The
trained PLWHA will be actively involved in providing services at the community level e.g. by carrying out
community awareness activities, screening for TB symptoms providing health education on TB, HIV and
TB/HIV, Home-Based and Palliative Care. Community leaders and community volunteers will also be
trained. Improve quality of TB/HIV services by providing regular supportive supervision and mentoring.
Cotrimoxazole will made be available for HIV co infected TB patients. Staff will continue supported using
FY09 fund. PASADA will support training of heath care providers from outreach sites providing TB/HIV
collaborative activities. The training will follow National guideline which will include modules for provider
initiated testing and counseling in TB clinical setting, HIV rapid testing, intensified TB case finding and TB
infection control.
NEED and COMPARATIVE ADVANTAGE:
This service was started in PASADA in response to the evident association between HIV/AIDS and TB. It
was also seen that while all HIV+ clients presenting typical symptoms of TB in PASADA were tested, TB
patients at the district level were not being encouraged and advised to test for HIV. The need to integrate
HIV/AIDS Home-Based Care services with TB services was also recognized. PASADA's TB service started
gradually in late 2003 and has enrolled approximately 1,400 TB patients to date. It is a diagnosis and
treatment site within the National TB Control program, and is part of the Integrated TB/HIV/AIDS Program in
collaboration with Temeke District. It is part of the continuum of care in PASADA e.g. general medical, ART,
HBC and Palliative Care, counseling and OVC services and has nine outreach sites in local dispensaries.
ACCOMPLISHMENTS:
The program has been innovative particularly with regard to the integration of Community-based TB and
HIV/AIDS Home-Based Palliative Care and its relative referral system. The program has also trained 100
PLWHA who are, or were, infected with TB, on community education skills and stigma reduction. Currently,
70 of these volunteers are active in community sensitization and community directly observed therapy
(DOT). The program also trains clinical staff in government and non-government dispensaries to encourage
TB patients to test for HIV status. To date, the program has registered approximately 2,100 patients on TB
treatment.
ACTIVITIES:
1) Increasing the number of outreach services from nine to 13 by
1a) upgrading one DOT centre to diagnostic centre;
1b) establishing four new diagnostic centers;
1c) training 300 training of HCP in the Care and Treatment Clinic on TB/HIV collaborative activities.
2) Ensuring effective referrals and links with other comprehensive PASADA services e.g. general medicine,
ART, HBC and Palliative Care, Counseling and OVC and with all outreach sites and TB clinics through
2a) regular supervision of TB outreach sites and review meetings with site administrators
2b) regular meetings with district TB clinics
2c) interdepartmental meetings in PASADA
2d) maintaining regular report submission to the National TB Control Program.
3) Strengthening community responses and referrals to TB/HIV services by
3a) carrying out community awareness activities with targeted drama performances
3b) sensitize community leaders and community volunteers on identification of TB patients, treatment
adherence, HIV and AIDS education, ART, Home-Based and Palliative Care. This community-level
education aims at raising awareness about the continuum of care available.
4) Improving the quality of TB/HIV services by
4a) regular provision of Cotrimoxazole as prophylaxis HIV/TB therapy to all TB/HIV patients
4b) continuous availability of funds to pay for X-ray examinations for all suspected TB patients with sputum
negative (PASADA does not have an X-ray machine)
4c) training TB service staff in order to increase their knowledge, skills and performance
4d) guaranteed payment of TB service staff salaries; 4e) increasing the number of supervisory visits to
outreach sites and improving the quality of supervisory tools
4f) providing transport for supervision and community activities
4g) using NTLP monitoring tools.
Activity Narrative: 5) Improve TB infection control practices in the CTC and in patient wards to prevent transmission of TB
among HIV+ as well as health providers
5a) CTC staff will be trained on TB infection control practices
5b) assess and modify CTC to ensure ventilation
2c) provide protective safety gear and support in proper use to clinic and laboratory staff.
To date PASADA's HIV/TB service has been funded by the German Leprosy and TB Relief Association
(GLRA) and Norwegian Heart and Lung Association (the latter donor funds the collaboration with Temeke
District). However, these funds are limited and do not allow expansion. The service operates within the
National TB Control Programme. It is currently linked to nine dispensaries (outreach sites) and to local
community groups for sensitization. It has a two-way referral system with all other PASADA services.
Training of counselors and Community Health Educators on TB/HIV has been carried out through the
Global Fund. Strong links exist with Temeke District, as partners in integrated TB/HIV and home-based
care and in collaboration with district TB clinics with PASADA.
CHECK BOXES:
The HIV/TB service targets the general population, male and female and all age groups. Training is carried
out at different levels: health care workers in outreach sites, PASADA staff in other services, PLWHA and
community members. Sensitization targets the general population, but in some semi-urban geographical
areas of the catchment area specifically targets army personnel and the Masai mobile population. The
service is part of the National TB Control Program.
M&E:
The activities of the HIV/TB service are reported on from outreach sites and reports are compiled for
submission to the National TB Control Program and to donors. The National Program regularly monitors the
service. Internal narrative and statistical reports on progress are also compiled and submitted to PASADA
management for decision-making. There is a need to develop appropriate monitoring tools, as specified
above in the activities section. A percentage of the budget will be dedicated to Monitoring and Evaluation
(5%). By mid 2008, PASADA will have a centralized data collection system which will guarantee access to
accurate data for decision making. For the specific collaboration with Temeke District, all relative data is
submitted to the person in charge.
SUSTAINAIBLITY
At community level, sustainability is enhanced through sensitization and training of different groups of
community members. The contribution made by PLWHA groups is particularly important. Capacity building
with regard to the management of HIV/TB services at the outreach dispensary sites also contributes to the
general sustainability of the National TB Control program. Sustainability of the referral system is guaranteed
in PASADA - through regular training and review meetings, and with the district, through similar events
Continuing Activity: 16441
16441 16441.08 U.S. Agency for Pastoral Activities 6549 3745.08 $175,000
Table 3.3.12:
In FY 2009, PASADA will continue to provide comprehensive services to orphans and vulnerable children
(OVC). Additional focus will be placed on improving the quality of services for OVC through adaptation of
the national quality standards of OVC services. Information from the recent national nutritional assessment
of OVC will inform PASADA's strategy for food and nutritional support, particularly those who are HIV-
positive and are growth stunted or malnourished.
PASADA will also apply the national identification process for OVC in all program areas to maintain
consistency with all USG-supported OVC programs. In particular, it will follow those infants born to women
participating in the Prevention of Mother-to-Child Transmission (PMTCT) program, all of whom are
considered vulnerable. In addition, PASADA will maintain standards identified by the national strategy for
community-based OVC care. This will enable wider community participation and ownership of the program.
PASADA plans to scale up children's participation in activities and community support. This includes
implementing economic strengthening initiatives for child-headed households and supporting elderly
caregivers to strengthen these vulnerable households and help to ensure sustainability. Lessons learned
will be shared among implementing partners, and other OVC stakeholders will have the opportunity to visit
and learn about ongoing activities, existing and future linkages, and ways to engage the community to
support the program.
PASADA will adapt the data collection tools that they presently use so that they begin using the national
OVC Data Management System,. PASADA will hire a data clerk to expedite data entry of the previous
year's supported OVC in the system. Family Health International, through the Department of Social Welfare
of the Ministry of Health and Social Welfare will provide technical support on software utilization and posting
of the data to the national system.
TITLE: TITLE: Expansion of PASADA's Support Services to Orphans and Vulnerable Children (OVC) in Dar
es Salaam Archdiocese
NEED and COMPARATIVE ADVANTAGE: The number of orphans and vulnerable children (OVC) is
steadily rising and their growing needs must be addressed. Children orphaned by HIV/AIDS are particularly
disadvantaged due to the trauma of losing their parents and the stigma surrounding HIV/AIDS. Although
not orphans, many children are deemed vulnerable because of the pandemic and these individuals are
often even more difficult to identify and assist. PASADA is a faith-based program operating under the
auspices of the Catholic Diocese of Dar es Salaam. It currently serves over 20,000 People Living with AIDS
(PLWHA) and nearly 4,000 OVC with many different services. Assistance to OVC started in PASADA in
1994. Services aim at building the capacity of OVC in education, psychological stability, empowerment, and
other areas of need. Services are closely linked to the care and treatment components of the PASADA
program and to communities. One of the main priorities is assisting communities to identify and strengthen
their response to the problems of OVC.
ACCOMPLISHMENTS: PASADA has developed an expanded system of support to OVC with regulated
service entry and exit points, aimed at avoiding "dependency syndrome." Extensive psychosocial support is
provided, including memory work and residential grieving groups. Educational support at all school levels,
including a vocational training program with training on small business management and a small grant on
successful completion of vocational training courses (graduates' small businesses are then monitored
regularly). PASADA also offers support services to the elderly (mainly grandmothers) caring for OVC,
including training on parenting skills. PASADA, as a comprehensive service HIV/AIDS program, is poised
to identify both OVC in the community and serve their needs.
ACTIVITIES: Key activities to address the needs of OVC with FY 2008 funding include:
1) Expansion of support to OVC for education from nursery to secondary school level through to vocational
training level with promotion of remunerated activities for teenage OVC. These include: provision of
uniforms, books, stationary, shoes, bags, and bus fares; payment of school fees; monitoring of child's
progress with teachers; increased number enrolled in VT programs; increased number trained in small
business management; increased number receiving small grants to start small enterprises; and increased
involvement of the private business section in apprenticeships for vocational training graduates.
2) Capacity building and empowerment of OVC through: "Stepping Stones Life Skills" training; training on
alcohol and drug abuse; training on the legal rights of children; memory work (together with parent/s who
are still alive and/or with guardians; residential grieving groups aimed at helping OVC overcome the
traumas they have endured; various peer group activities including sports and the arts; and consolidation
and expansion of the TAYOPAD initiative that aims at training and developing community linkages of
vulnerable youth groups, teenage OVC on the borderline of risky behavior, and the local police force. The
reformed youth groups are trained as trainers of "Stepping Stones Life Skills" and train and counsel OVC
who are about to be involved in, or are already engaged in behavior that could lead to HIV infection. Local
police are also trained on how to work with youth groups and OVC.
3) Support to caregivers, particularly elderly guardians, through: care and parenting training to elderly
guardians; care and parenting training to small community groups; provision of basic household essentials
to families who need them most; provision of health care for elderly guardians; provision of social support;
and provision of opportunities for income-generating activities for elderly caregivers.
4) Strengthening of the OVC department and ensuring quality of services through: regular payment of
salaries to staff; capacity building of staff through targeted training courses; monitoring and evaluation of
strategies and activities; and ensuring regular operation of the department.
Activity Narrative: 5) Assisting communities to identify their own responses to the problems of OVC in their midst and
provision of technical assistance in the consolidation of those responses. This will occur specifically
through collaboration with specific community groups, local political and religious leaders, small Christian
communities and others.
LINKAGES: PASADA's OVC department works closely with other departments (e.g., home-based care,
medical, and Antiretroviral Treatment, counseling, and community education) in order to ensure integrated
action and support. The department also works closely with the Ministry of Health and Social Welfare
(MOHSW) on policy issues; the Institute of Social Welfare for field work of their students in PASADA; NGOs
working to support OVC; with small local grassroots associations; and with key participants and
stakeholders within the legal system with vested interest in issues of children's rights and child abuse. The
department has established a good network with vocational training centers throughout Dar es Salaam, with
head teachers and teachers in primary and secondary schools, and with teachers in special schools for the
physically and psychologically disadvantaged.
CHECK BOXES: The target populations chosen reflect the effective target population of all PASADA OVC
services: children from 0 years to 18 years of age (male and female); vulnerable youth groups; children on
the streets; and children on the borderline of various types of risky behavior. The services also target key
stakeholders in the community who are involved in the problems and activities surrounding OVC and can
serve as role models (e.g., executives for vocational training activities, teachers, and religious leaders) as
persons in positions of authority and power with regard to community behavior and outcomes. Areas of
emphasis also reflect the services offered.
M&E: All OVC enrolled in the OVC service have personal files and monitoring and updating of these is
computerized. Regular reports are sent to the appropriate government agencies at district level, thereby
feeding into the national system. PASADA reports the implementation of the national Data Management
System and will use that system for its own M&E. Regular progress reports evaluating key indicators are
compiled monthly and submitted to donors. Community groups report to the PASADA OVC department on
their activities and refer identified OVC in need of services to the applicable agencies.
SUSTAINAIBLITY: The difficult area of sustainability is addressed at various levels: empowering OVC
themselves, psychologically and in terms of capacity to build their own future lives in terms of education,
vocational training, and initiation of small businesses ; involving the community through identifying and
consolidating their responses to OVC; empowering the guardians of OVC to carry out their parenting role
and to support the OVC in their care; awareness raising and training at community level; improving the
capacity of affected individuals to manage OVC problems. Sustainability is also considered in terms of
quality services and this can be achieved through retaining competent, qualified, and motivated staff and by
improving knowledge and skills.
MAJOR ACTIVITIES:
1. Expand support of education for OVC from nursery to secondary level and to the vocational training
level.
2. Provide capacity building and empowerment of OVC, including consolidation and expansion of the
TAYOPAD initiative.
3. Support caregivers of OVC, particularly elderly caregivers.
4. Strengthen PASADA's OVC department and ensure quality of services provided.
5. Assist communities in identifying their own responses to the problems of OVC and provide technical
assistance in consolidating those responses.
Continuing Activity: 13563
13563 8708.08 U.S. Agency for Pastoral Activities 6549 3745.08 $700,000
8708 8708.07 U.S. Agency for Pastoral Activities 4570 3745.07 $507,346
Estimated amount of funding that is planned for Human Capacity Development $166,250
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $10,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $10,000
Estimated amount of funding that is planned for Economic Strengthening $200,000
Estimated amount of funding that is planned for Education $150,000
Table 3.3.13:
ACTIVITY NARRATIVE REMAINS UNCHANGED FROM FY 2008.
TITLE: Expansion and Quality Improvement of PASADA's Counseling and Testing Outreach Sites in Dar es
Salaam Archdiocese
NEED and COMPARATIVE ADVANTAGE: Increased access to and integration of CT services (both PITC
and VCT) is essential for curbing transmission and facilitating access to care and treatment. PASADA's
VCT services operate from the PASADA HIV/AIDS Centre and from 17 satellite sites around the catchment
area. Thirteen of these sites also have PASADA HBC and palliative care services and are located in
dispensaries. The other four are stand-alone VCT sites.
Currently, PASADA carries out over 1,200 HIV tests per month and has over 20,000 registered clients.
There is a two-way referral system between the VCT service and all other PASADA services. All sites are
regularly supervised by the PASADA supervisory team for continuous quality improvement. All sites provide
ongoing supportive counseling for HIV+ clients. Many of the trained counselors are non-medical personnel
and many are PLWHAs.
ACCOMPLISHMENTS: All clients testing HIV+ are registered and access a full continuum of care,
treatment, and psychosocial support free of charge including palliative care, ART, TB, HBC, OVC and
supportive counseling. PASADA also continuously trains batches of 50 to 100 PLWHA in basic counseling
skills and prevention strategies, so that they are actively involved at the community level in mobilization,
prevention, promotion of VCT, and dissemination of information about available services and living
positively with HIV. PASADA also trains VCT counselors from other government and non-government
institutions. PASADA operates according to national guidelines and the new testing algorithm. Some of the
sites are already providing same-day results and the others are now preparing to do so.
ACTIVITIES: In FY 2008, PASADA will improve access to VCT by setting up three new VCT outreach sites
where clinical and HBC services already exist; conducting VCT training of new staff and participants from
other institutions; training of all clinical and other health workers in the dispensaries on the importance and
implementation of PITC; continuous training of PLWHA to enable them to be actively engaged in
prevention, promotion of HIV testing, and provision of services. It will also improve referral services between
CT services and other PASADA integrated services and share lessons learned through regular meetings
between PASADA service sites and other nearby service providers. PASADA will also increase supervisory
visits to all sites; continue in-service training of all counselors to ensure skills and knowledge remain current
and support appropriate services to facilitate disclosure; counsel discordant couples; and enable prevention
among both HIV positive and negative clients.
PASADA will implement anti burn-out strategies within the counseling department through twice-yearly
review counselor retreats; individual counselor mentoring counselor (professional and personal) and regular
peer counseling meetings to share experiences, difficulties, and jointly identify solutions.
All PASADA sites test children and one of PASADA's priorities in FY 2008 is to emphasize active pediatric
ART case finding through increased child testing. PASADA also promotes "Living Positively with HIV and
AIDS" through monthly "Now that you know" meetings. These are meetings held at the end of each month
and all clients who test HIV+ in that month are invited. Important service provision information is provided,
referral to services not provided by PASADA, and sharing with other veteran clients who are living positively
with the virus. These meetings also provide a venue for sharing of information, discussing problems and
solutions, forming self-support groups and receiving external speakers on specific issues identified by the
clients themselves. In FY 2008 PASADA will also expand PLWHA-run help desks at all VCT sites. These
help desks are staffed by PLWHAs who are trained in counseling and are available to answer questions and
provide support and referrals to all VCT clients.
LINKAGES: PASADA's VCT department operates according to NACP guidelines for VCT and will also
adopt NACP guidelines for PITC in outreach sites located in dispensaries. The department collaborates with
many government and non-government institutions, particularly in facilitation of training events. It also
collaborates with private companies and some embassies with general counseling and information sharing
for employees. The outreach counselors are also linked to local schools, community leaders, and groups.
M&E: All outreach sites send monthly reports to their respective districts while PASADA Upendano
compiles quarterly reports and sends them to the districts. All outreach VCT sites collaborate closely with
the dispensaries in which they are located and with the PASADA HBC and palliative care staff working in
the same location. Individual performance of counselors is monitored through regular supervisory visits to
sites and through individual mentoring. Site performance is also monitored through regular supervision
(monitoring tools are already in place) and through analysis of collected data. By mid 2008, PASADA will
have a centralized data collection system which will greatly assist management in monitoring the quality of
service provision and in decision-making for improvement. Internal evaluations are carried out at the end of
each year. Additionally, the program will ensure effective monitoring and evaluation of services by a)
training counselors on the importance of data collection and management and how to do it; b) training of
decision-makers within PASADA on effective and useful analysis of data for the improvement of services; c)
establishing an efficient monitoring system and developing monitoring tools; d) carrying out an external
evaluation of the services.
CHECK BOXES: The VCT services target the general population, male and female of all age groups.
Particular emphasis is placed on women and young girls and children as the most vulnerable groups, with
specific regard to HIV associated gender violence and to access to services. The service collaborates in
workplace programs and is heavily involved in ART and TB counseling.
Continuing Activity: 16453
16453 16453.08 U.S. Agency for Pastoral Activities 6549 3745.08 $300,000
* Reducing violence and coercion
Workplace Programs
Table 3.3.14:
