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: SELIAN LUTHERAN HOSPITAL AIDS CONTROL PROGRAM - PMTCT PROJECT
NEED and COMPARATIVE ADVANTAGE: Selian and its clinics provide Antenatal Care (ANC) to over 3000
women annually. The current HIV prevalence in Arusha is 5.3% (as per the HIV indicator survey 2004)
THIS) and the current coverage does not avail access to all women in need of PMTCT services. Selian
aims to avail most women attending ANC to receive comprehensive PMTCT services. Selian plans to
provide PMTCT services to 1,105 women in FY 2008 and 2,200 in FY 2009
In addition, most Selian ANC clinics sites are need of repairs to improve the quality of reproductive health
(RH) services that is being provided, Health care workers needs retraining and closer supervision. The
program has additional needs to make follow up of exposed infants and provide services to pediatric clients.
ACCOMPLISHMENTS: As of July 2007, through Selian five sites: Selian Hospital, Kisongo, Bangata
dispensaries, the Arusha Town Clinic, and Kirurumo health centre at Mto wa mbu reached 1124 women
with PMTCT services including counseling, testing and receiving results. Of these, 50 pregnant women
were referred to CTC for ART treatment and their Infants provided with Nevirapine and cotrimoxazole
prophylaxis. Trainings for counselors to be done in August. Infant follow up and home visiting was carried
out to 80 infants and children.
ACTIVITIES: Testing will be opt out based on the new national algorithm, women will be tested in ANC,
labor ward (LW) and post natal, with rapid test and results given on same day. Based on capacity of the
facility, both SD Nevirapine and more complex regimen will be provided with a view of accessing more
women to more efficacious regimen as capacity of the facility allows.
Selian will increase access to PMTCT services so that more pregnant women at all Selian Sites in Arusha
and Simanjiro Regions can benefit from a full range of PMTCT services. New PMTCT services will be set
per NACP standard guidelines and regimens, renovations will be carried out, and improvements made to
ANC clinic environment, labor and delivery ward. Selian will ensure appropriate PMTCT commodities Test
kits, PMTCT drugs and other commodities.
Selian will ensure that clinical staging of HIV positive women is carried out and that appropriate referral for
all clients in need of ART to CTC for provision of HAART treatment and prophylaxis for their infants is
carried out. Cotrimoxazole and other necessary additional services will be provided.
Selian will ensure that appropriate feeding is carried out and supplementary feeding after BF for six months
is carried out after assessment and evaluation.
Selian will carry out capacity building in several fronts: Training service providers in PMTCT, infant nutrition
and infant feeding; Carrying out retaining session and seminars and attending conferences so that service
providers can be up to date with most recent information:; carrying out community mobilization to raise
awareness develop better involvement of the community; and work with the MOHSW and other USG
partners to use the information education and communication (IEC) materials developed at the national
level and ensure they are adopted/used in Selian sites.
This activity will carry out and link Infant diagnosis and follow-up including home visits and Follow Ups. It will
also ensuring that the PMTCT services are linked and integrated with other HIV related services such as,
Home based care, Care and Treatment, Family planning, Orphans and vulnerable Children etc.
LINKAGES: Linkage will be strengthened with, VCT, C&T, TB/HIV, Infant Diagnosis and OVC programs
supported by Selian and other USG programs. Linkage will also be improved with Reproductive and Child
Health (RCH) activities especially Malaria and Syphilis in Pregnancy program, Family planning and
nutritional and child survival program. Further more, linkages between facilities will be strengthened to
collaborate with facilities supported by the Global fund and other supporters.
To ensure continuum of care through relationships with Non - HIV programs , effective linkages have been
created with a number of organizations US government (USG), Ministry of health social welfare (MoHSW),
Ministry of Education (ME), Ministry of Community development (MCD), human resource development
(HR), Tanzania AIDS commission (TACAIDS) and local government (LG); also linkages with programs such
as Sexual transmitted infections (STI), Family planning (FP), orphans and vulnerable children (OVC), and
safe motherhood initiative (SMI).
AREAS OF EMPHASIS:
As a PMTCT component, this activity focuses almost entirely on Pregnant women. Increasingly, couples
are being counseled together but this activity mainly directed to the ANC which women primarily attend.
M&E: Selian will work with the MOHSW and USG partner such as EGPAF 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 collect and report PMTCT data based on the national protocol and provide
feedback on tool performance. Selian will work with these institutions to strengthen and implement PMTCT
quality framework and providing regular supervision. All sites of Selian monitoring & evaluation system are
done in an ongoing monthly, quarterly, semiannual and of year fashion in preparation of reports to all MOH,
NACP, USG and Selian ACP.
Selian will work with the Arumeru, Monduli, and Simanjiro District Councils to include PMTCT activities in
Activity Narrative: their Comprehensive Council Health Plans and increase funding from additional sources such as basket
funding, global fund (GF) and overtime districts own resources. The districts contribution to sustainability is
by fully integrating PMTCT in the reproductive child health (RCH), services, providing the health
infrastructure and staffing.
The project will build local ownership by working through government and building human capacity through
training, mentoring and supportive supervision.
Focus for sustainability is ensuring both technical and management capacity of Selian Hospital staff and
region and local authorities. The program will systematically review all programs to identify elements that
are not led by Selian staffs. At the sites level, criteria for transition to autonomy in services provided will be
finalized with MOH and USG.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13587
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13587 8220.08 U.S. Agency for Selian Lutheran 6559 4082.08 $91,968
International Hospital - Mto wa
Development Mbu Hospital
8220 8220.07 U.S. Agency for Selian Lutheran 4580 4082.07 $60,000
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 $23,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Estimated amount of funding that is planned for Education $15,135
Water
Table 3.3.01:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
This narrative covers the facility-based and home-based care and support for the approximately 4,500 HIV
positive individuals registered at Selian Hospital, Selian's Arusha Town Clinic, and a satellite facility
(Kirurumo Health Centre at Mto wa Mbu).
ACCOMPLISHMENTS: Facility-based care: As of September 30 2008, Selian has enrolled approximately
4,500 patients in its three care and treatment clinics (CTCs). About 93% of those enrolled are adults. All
care and support patients have been provided with treatment of opportunistic infections (OIs).
Approximately 2,600 patients were receiving Cotrimoxazole prophylaxis, and 217 adults were provided with
food support from the World Food Programme (WFP).
ACTIVITIES: As in previous years, Selian will continue to provide care and support at its three program
clinical sites to registered patients, as well as through its home-based care (HBC) program. Patients will
continue receiving WHO staging, provision of Cotrimoxazole and Isonazid prophylaxis in accordance with
national guidelines. Selian 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. Selian also provides
counseling and psychosocial support, linkages with income-generating activities. Clients will be screened
for TB, cryptococcal infection, and opportunistic cancers. They will also receive pain assessments and
management, as well as adherence counseling to ensure patients return to the CTC regularly for
monitoring. Selian will ensure continuous availability of pharmaceuticals and medical consumables for
treatment of OIs. To support the clients most in need, Selian will ensure referrals to Ocean Road Cancer
Institute for expert cancer management, and provide five patients with support for transport costs and
meals.
The importance of nutrition in determining clinical outcomes for people on ART is becoming increasingly
apparent. In FY 2009, USG/Tanzania care and support programs will put more emphasis on addressing
food and nutrition needs of clients. Selian will conduct nutritional assessments and counseling in order to
better inform the clinical management of PLWHA receiving care and support. Selian will use USG funding
for procurement of necessary equipment required to carry out effective nutritional assessment (adult and
pediatric weighing scales, stadiometers, MUAC tapes, etc.), logistics, and inventory control costs. Selian will
cover all costs associated with training, supervision, M&E, and reporting. Linkages will be made with USG
entities and/or community services to provide patients with other community initiatives addressing
household food security and economic strengthening.
In FY 2009, there will be increased emphasis on provision of prevention with positives (PWP) services for
PLWHA. Sexually active PLWHA will be provided with condoms (depending on the religious
appropriateness), and linked with sexually transmitted infection treatment services and counseling to reduce
high-risk behaviors. Referrals will be made for family planning, if appropriate. Selian staff 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, Selian 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 communities 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. Selian will ensure that interventions address the
comprehensive needs in an environment free from stigma and discrimination. Selian will support
procurement and/or distribution of insecticide-treated bed nets to PLWHA, and promotion on their correct
usage. Selian 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.
LINKAGES: Selian will ensure that it continues to provide services that support a continuum of care model
by providing several reproductive health and HIV-related services within its sites and through its internal
referral system between facility-based care and support and HBC, TB, and prevention of mother-to-child
transmission services, as well as referrals for orphans and vulnerable children.
M&E: Selian uses the national ART monitoring system. In FY 2009, the three CTCs will continue to use
paper and electronic systems to collect, manage, and analyze HIV care and treatment data. In addition,
Selian will participate in the planning for and implementation of the national system for tracking HBC
services. Technical assistance for M&E will be provided for the three Selian organizations, using about 5%
of the budget for M&E.
TITLE: Selian Hospital Home-based Care/Palliative Care
NEED and COMPARATIVE ADVANTAGE: The number of chronically ill patients with HIV/AIDS in Tanzania
is increasing. The available health facilities cannot provide comprehensive care to patients; hence the need
for continuum of care at their homes. Home-based care (HBC) and palliative care can relieve the burden
currently allocated to the health system and families. The service operates through nurse supervisors,
outreach nurses, and trained community volunteers. However, as more people become aware of HBC and
stigma about HIV/AIDS is reduced, the demand for access to HBC has increased. In an effort to improve
the health and well-being of all Tanzanians with HIV/AIDS, Selian hospital has been providing HBC to
patients in its catchment area (Arusha municipal, Monduli, Arumeru and Simanjiro districts). The care
provided addresses the needs of the patient as a whole and includes physical, spiritual, emotional, and
psychological support. Selian hospital has a demonstrated record of providing patients with high-quality
Activity Narrative: HBC.
ACCOMPLISHMENTS: Selian offers holistic care to people with HIV/AIDS and their families: spiritual and
general counseling to patients and caregivers, treatment, nutritional support, pain control, linkage to
community volunteers and support groups, and referral to and from antiretroviral therapy (ART), TB, and
OVC services. Selian holds monthly meetings with its 196 volunteers(4 volunteers died) to offer support
and supervision. Volunteers have conducted home visits to 1500 patients and provided them with
medication and nursing care. Selian has provided 36 respite day-care gatherings with average attendance
of 40 clients and family members per day care event. Selian has identified 1500 clients with poor nutritional
status and distributed nutritional supplements to approximately 700 patients. Fifty new volunteers were
trained as of July 2007; these volunteers were provided with bicycles and HBC kits which included safe
water supplies, insecticide treated nets and brings the total volunteers to 200 . Selian recruited staff for
HBC/PC. Community mobilization has been conducted to raise awareness and reduce stigma. One staff
member attended clinical pastoral education training at Kilimanjaro Christian Medical Center. One nurse
and one clinical officer attended palliative care training in Uganda.
ACTIVITIES: Using the National AIDS Control Programme (NACP) guidelines on HBC, Selian's activities
will focus on improving HBC services to clients in their target region; building the capacity of staff and
volunteers to better care for people living with HIV/AIDS (PLWHA); community sensitization to decrease
stigma and increase demand for HBC; and improving mechanisms for staff to share and learn from others.
Selian will scale up continuum of care services through additional HBC visits and facility-based services.
Through its network of trained providers and volunteers, Selian will provide patients with a basic care
package of services. This will address the physical, spiritual, emotional, and psychological well-being of
clients. They will also ensure the regular and constant supply of appropriate and sufficient pharmaceutical
and medical consumables. Selian 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. Selian will conduct interventions to improve prevention for positives which
will include provision of insecticide treated nets (ITNs) for malaria control, condoms, water purification
tablets and vessels for water safety, and cotrimoxazole for prophylaxis. Selian will provide respite day care
to approximately 50 families caring for PLWHA. Effective referral networks will be developed to link patients
to care and treatment services including ART, TB, counseling, and OVC services. Selian will also integrate
prevention with positives messages into HBC visits. Since the project's catchment area 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 maintaining administrative functions (office supplies, computer, and furniture) as
well as fuelling vehicles.
Selian will work to increase the capacity of providers and volunteers through sending two staff for training
on palliative care at Nairobi Hospice in Nairobi, Kenya and a refresher course for approximately 200
volunteers to update skills and knowledge including counseling. Selian will ensure regular payment of
salaries and benefits to all staff in the service in order to retain competent, qualified, and motivated
personnel. Through the provision of support (bicycles for transport, monthly honorarium, meetings, etc) to
trained community HBC volunteers Selian will maintain motivation and activities. Staff will be trained in data
collection and management in order to improve reporting skills. Selian will maintain regular supervision
throughout the tier system.
Selian will work with communities to sensitize them to the need for and benefits of HBC in order in increase
demand and reduce stigma for PLWHA. Stigma reduction interventions will be conducted in communities to
enhance voluntary counseling and testing (VCT). Finally Selian will participate in meetings, seminars,
conferences, and other forums, as applicable, to share experiences and learn from other similar projects.
Selian will participate in a palliative care/ hospice team retreat to build organizational capacity and
efficiency.
LINKAGES: The program has been linking and collaborating with the District AIDS Control Coordinator
(DACC) for technical assistance and Council HIV/AIDS Coordinator (CHAC) for community mobilization and
sensitization as well as ward, village, and religious leaders in the four districts of operation. Other linkages
include community, faith, and non-governmental organizations working on HIV/AIDS and HBC, Ministry of
Health and Social Welfare, Tanzania AIDS Commission (TACAIDS), USAID, World Food Program and local
and international church ministries. The project links HBC with facility-based palliative care, and will also
strengthen linkages with providers of prevention of mother-to-child transmission (PMTCT), TB, VCT and
family planning services.
CHECK BOXES: The program covers both sexes of all ages and through its links with other Selian services,
also the specific groups mentioned. Capacity building of local organizations and human capacity building
are achieved through all the training activities. The HBC and facility-based palliative care program is closely
linked with TB program. Both programs identify and refer patients for TB diagnosis and treatment. Services
are particularly linked with ART services.
M&E: Five percent of Selian's budget will be dedicated to M&E. Monitoring and evaluation of HBC activities
will be completed using HBC national forms and other forms as applicable. Volunteers will be the primary
data collectors; they will send data to the supervisors for compilation. Selian will ensure that both volunteers
and supervisors are well trained in data collection. Data review will be undertaken by the Selian HBC
hospital team to analyze and finalize reports to be submitted to USAID, CHAC, DACC, and the social
welfare office. Data will also be accessible for official use in and outside Selian hospital (e.g. in forums,
meetings). The program will hold regular monitoring meetings to review progress, challenges, and solutions
with volunteers/ supervisors, CHAC, DAC, and others as applicable. All M&E activities will follow the
national guidelines on palliative care. For FY 09 Selian's community based targets for individuals served is
1275 and for facility based palliative care 3600. The de duplicated target is 3983.
SUSTAINAIBLITY: One of the priorities of the palliative care program is to support family care-givers by
Activity Narrative: 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: 13588
13588 6515.08 U.S. Agency for Selian Lutheran 6559 4082.08 $325,000
7803 6515.07 U.S. Agency for Selian Lutheran 4580 4082.07 $220,000
6515 6515.06 U.S. Agency for Selian Lutheran 4082 4082.06 $300,000
Estimated amount of funding that is planned for Human Capacity Development $5,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $50,000
and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Commodities $24,336
Estimated amount of funding that is planned for Economic Strengthening $6,400
Table 3.3.08:
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY2008COP
TITLE: Selian - ARV Services
NEED and COMPARATIVE ADVANTAGE: The Arusha region in northern Tanzania has more than 25,000
HIV-positive people in need of comprehensive treatment services, but only about 8,500 have been initiated
on antiretroviral therapy (ART). Since 2003, Selian AIDS Control Program Care and Treatment Services
has been providing care and treatment to patients suffering from HIV/AIDS. Selian is a faith-based initiative
with a comprehensive and integrated spectrum of HIV/AIDS related services, including counseling and
testing, prevention of mother-to-child transmission (PMTCT), facility- and home-based palliative care, and
services for orphans and vulnerable children (OVC). Selian provides ART through a network of three
facilities; Selian Hospital, Arusha Town Clinic, and Kirurumo Health Centre at Mto wa Mbu.
ACCOMPLISHMENTS: As of September 30 2008, Selian has enrolled approximately 4,500 patients in its
three care and treatment clinic (CTCs). Nearly 2,400 cumulative patients have ever started on ART, 91.5%
of whom were adults. There are about 2,000 patients currently on ART, 91.6% of whom are adults.
According to research done at the Selian town clinic in 2007, the adherence rate of approximately 94% at
Selian CTCs is good.
ACTIVITIES: With FY 2009 funding, Selian will:
Continue to improve the quality and comprehensiveness of ART services for adults at the current CTCs
following the National Guidelines for ART. The program will further increase the number on ART through
recruitment of eligible clients from in-patient and outpatient settings by stepping up provider-initiated testing
and counseling (PITC), particularly in maternal and child health (MCH), PMTCT, and also strengthening
linkages with voluntary counseling and testing (VCT) settings. Efforts to follow up on ART patients lost to
follow up will be strengthened through home-based care programs. Selian will improve quality of treatment
services through continuous quality improvement activities and innovative on-site continuing education
programs for all ART program staff, training staffs on ART care and treatment. The program will also carry
out refresher training on PITC to clinicians. Selian will also conduct networking seminar for sharing
experiences with other health facilities providing ART around Selian CTCs. Also, to ensure quality of care,
Selian will ensure continuous availability of pharmaceuticals, and medical consumables. Other activities in
FY 2009 will be to expand community outreach for raising awareness concerning the successful treatments
available with ART and PITC and promote the use of expert clients. This effort includes conducting
seminars for community leaders around CTCs to reduce stigma and promote ART, providing support for
ART football clubs and other ART clubs; and increasing the number of voluntary Adherence Counselors to.
Expand lab capacity in all current CTCs to be in-line with provision of quality services, by maintaining and/or
procuring modern equipment and supplies and test kits. Train staff and promote quality assurance to attract
more clients. Funds will also be used to identify opportunities to strengthen the financial and programmatic
management of the Selian ART program.
referral system with palliative care, TB, OVC, PMTCT, PITC and Selian Hospital to ART treatment. Selian
will also strengthen relationships with other organizations, especially other implementing partners with
whom Selian can share experiences, lessons learned, tools, and materials. The program will also maintain
effective relationships that have been established with several organizations, including the World Food
Program for food supplementation to ART patients, the Evangelical Lutheran Church in Tanzania for
provision of palliative care and Hospice, and other providers.
CHECK BOXES: Selian is actively engaged in providing in-service training for its staff. Selian provides food
from the WFP to clients enrolled in ART. As an ART component of the National AIDS Control Program
(NACP), the target population is people living with HIV/AIDS and pregnant woman. As a faith-based
organization, Selian has religious leaders as a target population.
M&E: Selian uses the national ART monitoring system. All three sites use the national paper-based tools
(CTC2 card and pre-ART and ART registers) to collect patient data. These are then entered into the NACP
CTC2 database, which in turn generates the required NACP and USG reports. Selian will continue to
incorporate government monitoring systems into hospital computerized Health Information Management
System. For data quality assurance, an external M&E consultant reviews the data from all three sites on a
quarterly basis and provides feedback to CTC staff. In FY 2009, the three CTCs will continue to use paper
and electronic systems to collect, manage and analyze HIV care and treatment data. Technical assistance
and training on M&E will be provided to staff in all CTCs. 5% of the budget is used for M&E purposes.
SUSTAINAIBLITY: Selian is a Tanzanian faith-based organization providing ART services. The capacity
built through this project will remain within the organization. As an integrated component of national health
services, the services are sustainable as long as there is direct support through the government of
Tanzania.
Continuing Activity: 13591
13591 6518.08 U.S. Agency for Selian Lutheran 6559 4082.08 $774,000
7805 6518.07 U.S. Agency for Selian Lutheran 4580 4082.07 $500,000
6518 6518.06 U.S. Agency for Selian Lutheran 4082 4082.06 $400,000
Table 3.3.09:
THIS IS A NEW ACTIVITY
TITLE: Pediatric Care and Support
NEED and COMPARATIVE ADVANTAGE: There are an estimated 25,000 HIV-positive people in the
Arusha area of northern Tanzania. Among them, over 11,000 have been enrolled into care and support,
and approximately 8,500 have been initiated on antiretroviral therapy (ART). Selian AIDS Control Program
Care and Treatment Services provides care and treatment to patients suffering from HIV/AIDS, while
prioritizing the needs of children. Regardless, there is room to improve on pediatric case-finding to increase
the number of children receiving care and support.
Selian is a faith-based initiative with a comprehensive and integrated spectrum of HIV/AIDS-related
services, including support for orphans and vulnerable children (OVC), counseling and testing, prevention of
mother-to-child transmission (PMTCT), and facility- and home-based care and support. Selian provides
ART for children through a network of three facilities; Selian Hospital, Arusha Town Clinic, and Kirurumo
Health Centre at Mto wa Mbu.
ACCOMPLISHMENTS: By September 2008, Selian has enrolled approximately 310 children in three care
and treatment clinics (CTCs), which constitute 7% of all patients. All children were provided with care and
support, including treatment for opportunistic infections. Nearly 100 children were receiving cotrimoxazole
prophylaxis. In addition, 235 were provided with care and support through the OVC program, and 23 others
were directly provided with food support from the World Food Programme (WFP). Other children were
indirectly supported through their parents on ART who were WFP food beneficiaries.
ACTIVITIES: In FY 2009, Selian shall:
1. Continue to provide care and support for all enrolled children at three CTCs. The program will increase
enrollment of children from 310 to 470 into the care and support program through recruitment in PMTCT
and provider-initiated testing and counseling, particularly in pediatrics in- and outpatient departments.
Selian will provide treatment for opportunistic infections and cancers to children, as well as provision of
Cotrimoxazole prophylaxis, and will ensure continuous availability of the required pharmaceuticals and
medical consumables. HIV-positive patients will also receive pain assessments and management. Selian
will provide orientation on child counseling to ART nurses, counselors and Voluntary Adherence Counselors
for psychological support, and refer children to the home-based care (HBC) program for spiritual counseling
and social support.
2. Intensify efforts in nutritional support for HIV-positive children. Specifically, Selian will support and
conduct anthropometric measurements and determine nutritional status using Body Mass Index calculations
and other appropriate measurements such has mid-upper arm circumference (MUAC) and weight for age.
Selian 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.
3. Initiate early infant diagnosis for babies under 18 months old born to HIV-positive mothers, working with
Columbia and EGPAF to strengthen the program.
4. Intensify case-finding among those in households receiving HBC and OVC services. Refer children with
specific needs to related programs (e.g., to the OVC program for nutrition, as well as school uniforms and
materials for those attending school).
5. 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.
for children by providing HIV-related services within its sites and internal referral system with HBC, TB,
OVC, PMTCT and the HIV pediatric clinic started at Selian hospital. Selian will strengthen relationships with
other child survival programs such as immunization, malarial initiatives, and nutritional support. In addition,
Selian will strengthen organizations and health facilities to provide an easy referral system for children in
need. Selian will also continue to cooperate closely with other providers in the area, especially the CTC at
St. Elizabeth's Hospital in Arusha and the Mt. Meru Regional Hospital. Selian will also link with other
pediatric AIDS programs in Tanzania, especially Elizabeth Glaser Pediatric AIDS Foundation, Columbia
ICAP Program for Early Infant Diagnosis, and the Baylor International Pediatric AIDS Initiative for the
purpose of sharing experiences, best practices, tools, and materials.
built through this project will remain within the organization. As an integrated component of health services,
the services are sustainable as long as there is direct support through the Government of Tanzania.
M&E: Selian uses the national ART monitoring system. In FY 2009, the three CTCs will continue to utilize
paper and electronic systems to collect, manage and analyze pediatric HIV care and support data.
Technical assistance for M&E will be provided for three organizations (CTCs). Staff will be trained on M&E.
Five percent of the budget is attributed to M&E.
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $500
Table 3.3.10:
THIS IS A NEW ACTIVITY.
Title: SELIAN LUTHERAN HOSPITAL: PEDIATRICS TREATMENT PROGRAM
NEED AND COMPARATIVE ADVANTAGE: There are an estimated 25,000 HIV-positive people in the
Arusha area of northern Tanzania. Among them, over 11,000 have been enrolled into treatment, care and
support. While approximately 8,500 have been initiated on antiretroviral therapy (ART), very few are
children. Selian AIDS Control Program Care and Treatment Services provides care and treatment to
patients suffering from HIV/ AIDS, while prioritizing the needs of children. Selian is a faith-based initiative
with a comprehensive and integrated spectrum of HIV/AIDS-related services, including support for orphans
and vulnerable children (OVC), counseling and testing, prevention of mother-to-child transmission
(PMTCT), and facility- and home-based care and support. Selian provides ART for children through a
network of three facilities; Selian Hospital, Arusha Town Clinic, and Kirurumo Health Centre at Mto wa Mbu.
ACCOMPLISHMENTS: As of September 2008, Selian has enrolled over 300 children in its three care and
treatment clinics (CTCs), which accounts for 7 % of all enrolled patients. Total children on ART totaled 191,
with 161 actively receiving treatment. By Sept 2008,164 children will have ever started ART. The total
number of children enrolled in ART below the age of two years is 15. Selian also has started an intensive
pediatric clinic for HIV-positive children.
Continue to provide and expand pediatric ART services at three CTCs following the national guidelines for
ART. Through more intensive case finding and early infant diagnosis, more HIV-positive children will be
enrolled. The program will also increase the number of children on treatment by end of FY 2009 through
recruitment in PMTCT and provider-initiated testing and counseling (PITC), especially in pediatrics
outpatient department clinics, including maternal and child health clinics. The project will ensure continuous
availability of pharmaceuticals and medical consumables appropriate for children. In addition, Selian will
continue to improve quality pediatric ART treatment services through innovative on-site continuing
education for all program staff. Provide orientation on child counseling to ART nurses, voluntary adherence
counselors, and promote the use of expert clients. Funds will also be used to Perform nutritional
assessments on pediatric patients on treatment and monitor nutritional status using Body Mass Index (BMI)
calculations, growth monitoring, and other appropriate measurements such as mid-upper arm
circumference (MUAC). Selian 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, Selian will link HIV-positive children who are severely malnourished
to the World Food Program nutritional support. Lastly FY 2009 funds will be used to expand lab capacity in
all three CTCs to be in-line with provision of quality pediatrics services, by maintaining and procuring
modern equipment and supplies and test kits. Train staff and promote quality assurance to attract more
clients.
for pediatrics by providing several reproductive health and HIV-related services within its sites, and through
its referral system with palliative care, TB, OVC, PMTCT and Selian Hospital for ART treatment. Selian will
strengthen relationships and linkages with other organizations. Selian will also continue to cooperate
closely with other providers in the area, especially the CTC at St. Elizabeth's Hospital in Arusha and the Mt.
Meru Regional Hospital. Selian will also link with other pediatric AIDS programs in Tanzania, especially
Elizabeth Glaser Pediatric AIDS Foundation, Columbia ICAP Program for Early Infant Diagnosis, and the
Baylor International Pediatric AIDS Initiative for the purpose of sharing experiences, best practices, tools,
and materials.
CHECK BOXES: Selian is actively engaged in providing in-service training for its staff. The training will
include special emphasis on quality ART treatment for pediatrics. Selian will also put a special priority on
food support from the World Food Program for children on ART.
paper and electronic systems to collect, manage and analyze HIV care and treatment data. Technical
assistance for M&E will be provided for three organizations. 5% of the budget will be used for M&E.
being built through this project will remain within the organization. As an integrated component of national
health services, the program is sustainable as long as there is direct support through the government of
Estimated amount of funding that is planned for Human Capacity Development $6,800
Table 3.3.11:
In FY 2009, Selian will continue providing direct support to OVC in their catchment area, focusing on
improving quality of OVC services through the adaptation of the national quality standard for OVC services.
To ensure comprehensive support, a meaningful referral system will be strengthened in all districts. Selian
will select one district with high HIV/AIDS prevalence to constitute a "program learning district," to serve as
a model for others. Information collected from this district will demonstrate linkages, referral systems to
prevention and treatment (when appropriate), and successful wraparound programs. Collaboration among
the partners, different stakeholders, and council members will be paramount, to ensure transparent
integration of the plan throughout each governing and participating unit. Promising practices and lessons
learned will be shared among implementing partners. In addition, other OVC stakeholders will have an
opportunity to visit and learn about the ongoing activities and linkages, as well as ways to engage the
community to take responsibility for the program and OVC in their catchment area.
School attendance and performance of many OVC will be improved by integrating different forms of
psychosocial support, including emotional support, into all aspects of OVC services. Selian will also
strengthen the capacity of OVC care by training 40 caregivers and 100 home-based care volunteers in four
working districts. In addition, Selian will provide 400 OVC with school uniforms and material, medical
treatment support to 60 OVC, and bedding to 50 OVC.
Selian will make important referrals to their Reproductive and Child Health Clinics for OVC requiring basic
health services through child survival programs. In addition, those qualifying for the under-5 insecticide-
treated net campaign will receive free nets, and Selian will provide them for older OVC.
Selian will put greater emphasis in FY 2009 on nutritional status of OVC, monitoring growth with mid upper
arm measurements to identify growth faltering and malnutrition. Presently, the goal is to provide food and
nutritional support to 800 OVC, with strong linkages with the World Food Programme initiative at Selian.
The results of the USG nutritional assessment for OVC services will help to inform Selian's ongoing nutrition
support program. Children with stunted growth will be referred for HIV testing and services, if necessary.
To ensure sustainability, Selian will also work on economic strengthening for 40 OVC households. This will
ensure household economic empowerment and strengthen the ability of the family to care for OVC, which
will reduce dependency on the project. With the assistance of trained volunteers, communities will be
challenged to prioritize the needs of OVC and complement program support in their development plans to
ensure continuity of the program.
FY 2008 NARRATIVE
TITLE: Selian Orphans and Vulnerable Children (OVC) program
NEED ANDCOMPARATIVE ADVANTAGE: As a faith-based organization (FBO), Selian has been working
in the Arusha region for several years supporting orphans and vulnerable children (OVC) through its
network of partners, which range from grass-roots church congregations to regional systems. The Selian
approach for OVC care is family-based support, focusing on empowering the extended families to be able to
care and support the OVC. Selian ensures a continuum of care through facilitating meaningful referral and
linkages to provide comprehensive support for OVC. Arusha is an area of particular need due to the
relatively high HIV/AIDS prevalence (5.3%).
ACCOMPLISHMENTS: As of June 2007, Selian provided direct support to 1,973 of the 5,054 identified and
registered OVC. The service area covered Arusha municipality, Monduli, and Arumeru districts in Arusha
region and Simanjiro district in Manyara region. Support provided included nutritional assistance to 750
OVC, school uniforms and school material to 296 children, medical treatment to 21 OVC, psychosocial
support (PSS) through three children, social clubs to 1,202 OVC, and economic strengthening for 20
households, which were provided with capital to start income-generating activities (IGA
ACTIVITIES:
1. Use community involvement in identifying OVC, assessing their needs, prioritizing provision of service
support, and providing direct services. This will include activities such as: offering nutritional support to
3000 OVC; providing school uniforms, and school materials to 400 OVC; providing medical treatment to 60
OVC; provision of bedding to 50 OVC; provision of psychosocial support to 2,500 OVC through six social
clubs, three of which are existing, and three of which are slated to begin building; conducting follow-up and
monthly home visits per congregational recommendations.
2. Create three additional OVC social clubs for PSS and: provide children playing kits/materials; hold
quarterly ward level meetings; support OVC tours-travels to the nearby wildlife parks once a year as a
learning and entertainment trip.
3. Build capacity of the community and caregivers to care and support OVC in four districts by identifying
and training 1000 caregivers on caring and support of OVC; conducting seminars for 150 community
volunteers on OVC support, care, and protection; conducting community sensitization meetings in four
districts on care and support of OVC. The sensitization meeting will be rolled out to all villages with help of
trained volunteers. In addition: train 40 caregivers on how to run small income generating
businesses/projects; strengthen households through providing funds to 40 families to start IGAs; and
provide funds for overhead costs for running the project.
4. Build and support government capacity in the four district councils, which includes encouraging
complementary planning by the councils to support OVC; facilitating community sensitization for village
council and wards; and provide computers for entering OVC data into the national Data Management
Activity Narrative: System (DMS).
5.Provide food supplements through centrally purchased commodities, and the insecticide treated mosquito
nets (ITNs) available through the national voucher system.
CHECK BOXES: OVC programs serve children under 18 years, as well as provide wraparound assistance
in terms of nutrition, health care, and education.
LINKAGES: The program is linked to the National OVC Plan of
Action (NPA), the national Implementing Partner Group (IPG) network for OVC, and all USG-funded OVC
programs.
At the local level, Selian will link with area organizations working on HIV/AIDS prevention, treatment, and
care, such as UHAI Centre of the Arusha RC church, along with several other church congregations
providing OVC support. Local government, along with agencies providing PMTCT, home-based care, and
CTC will also participate in collaboration. The program will also be linked to the national voucher system
for the provision of ITNS.
M&E: Selian will monitor OVC care services using the national Data Management storage and reporting
System (DMS). Volunteers will work with MVCC to register OVC at the community level. CSOs will use
service providers' registry and referral forms to track services provided to OVC and they will enter the data
in their database and export it to the district. CSOs will analyze and report data to the regional office
according to services provided, age, and gender. All reports will be shared with relevant authorities for
decision making and planning. Monthly and quarterly reports will be prepared by both the OVC volunteers
and evangelists at the congregations and sent to the national DMS focal person in each district for
compilation. The data from the DMS will provide management reports that will assist in planning which
services are provided (including healthcare, nutritional support, financial support, emotional and
psychological support, school related assistance, and number of community based committees who
mobilized services for households with OVC). The allocated funding for M&E is 5%.
SUSTAINABILITY: Selian's OVC program aims to strengthen families and ensure involvement of the
community in supporting OVC. Church parishes are a primary and ongoing community entity where OVC
are cared for and supported irrespective of their denominations in the villages. Working through these
vested parish structures will enhance sustainability. This project will broaden parish activities and involve
the communities through awareness, care giving trainings, and identification of OVC. OVC caring programs
will be initiated in every church. This innovative approach will make church congregations centers for
prevention, care, and support for PLWHA and OVC. Selian will promote sustainability by supporting the
four district councils and encouraging complementary planning by the councils to support OVC. Selian will
also sensitize and work with community leaders and CBOs to mobilize resources to support OVC. Selian
will continue to solicit funds from different development partners for continuation of the program.
MAJOR ACTIVITIES:
1. Use community involvement in identifying OVC for direct service provision support.
2. Create OVC PSS clubs in local church parishes and provide play kits.
3. Build capacity of the community and caregivers to protect and care for OVC through educational training
on OVC care, small business management, and provision of business capital.
4. Build capacity of the four district councils by providing computers to the districts for OVC data entry and
support of collaboration between the councils.
Continuing Activity: 13589
13589 6517.08 U.S. Agency for Selian Lutheran 6559 4082.08 $150,000
7804 6517.07 U.S. Agency for Selian Lutheran 4580 4082.07 $100,000
6517 6517.06 U.S. Agency for Selian Lutheran 4082 4082.06 $200,000
Estimated amount of funding that is planned for Human Capacity Development $37,500
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $5,000
Estimated amount of funding that is planned for Economic Strengthening $5,000
Estimated amount of funding that is planned for Education $25,000
Table 3.3.13:
THE ACTIVITY NARRATIVE REMAINS UNCHANGED FROM FY 2008.
TITLE: Selian voluntary counselling and testing
NEED and COMPARATIVE ADVANTAGE: Voluntary Counseling and Testing (VCT) is integral to HIV
prevention, management, treatment, and support for HIV infected people., yet only 15% of Tanzanians have
been tested. Rural communities are even much more deprived of this service. The proposed activities
should scale -p numbers reached with VCT services from 11,000 to 25,000 annually by increasing PLWHA
involvement, mobile VCT services, and sites while improving their capacity. Selian has lengthy VCT
experience, wide coverage with a continuum of care where clients are referred for care, treatment, and
services like: post test clubs, HBC/palliative care, PMTCT, CTCs, and OVC support.
ACCOMPLISHMENTS: Selian provides VCT services in five fixed sites in Arumeru, Simanjiro, Monduli
Districts and Arusha Municipality. One site (Mererani) is not USAID funded. In 2006, 11,270 people were
reached with VCT services. Selian collaborates with AMREF at one center.
1) Continue with CT services, improve quality and scale-up within national guidelines and new testing
algorithm to reach 20,000 clients by September, 2008. (a) Discuss with USAID and AMREF running Angaza
services alone without AMREF support from January 2008 at Uzima VCT. (b) Include Mererani youth center
VCT services under USAID funding from January 2008.(c) Provide office equipment (d) Provide
administrative contribution for the AIDS Control Programme. (d) Discuss using Angaza logo on contractual
basis with AMREF or national logo, if available (e) Referral to CTC and PMTCT centers for HIV positive
2) Build capacity of six sites and increase access to VCT; improve environment so there are fewer clients
sent back without services. (a) Renovate, extend, and furnish two more counseling rooms at Uzima VCT
centre in Arusha to double clients. (b) Hire/train more counselors and staff (c) Renovate Uzima VCT centre
to create more opportunities to test. (d) Introduce provider initiated C and T in three sites within the health
provision centers according to the national guidelines on PICT. (e) Provide sufficient lab supplies, reagents
and test kits.
3) Promote accessibility of VCT services in rural areas to increase access to ART through mobile VCT (a)
Recruit/ train one staff specifically for that purpose (b) Purchase vehicle for reliable mobile VCT transport
and M&E (c) Provide public address system.
(4) Build capacity of staff for better provision of services (a) Retrain 22 counselors for quality service
provision (b) Provide counselor supervision.
(5) Demand creation to attract clients including children with parents/guardians to access VCT services. (a)
Access relevant IEC from NACP or other partners (b) Engage drama groups to sensitize public. (c).Increase
involvement of PLWHAs for psychological support and stigma reduction.(d) Support post test clubs and use
PLWHAs and voluntary adherence counselors to educate others.
LINKAGES: Selian has an integrated, comprehensive AIDS program emphasizing continuum of care. VCT
services are linked to PMTCT, ART, STI prevention, TB screening, RCH, FP, OVC care, nutrition, HBC and
palliative care, voluntary adherence counseling, World Food Program, faith-based organizations and NGOs
and other CTCs like St. Elizabeth, Mount Meru hospital and West Meru district hospital. Youth activities for
adolescent sexual and reproductive health are implemented in partnership with DSW, linking with UMATI
and WAMATA. Linkages with groups of people living positively will be strengthened to educate about
prevention for further infections.
M&E: Selian VCT sites shall comply with the national CT monitoring and evaluation system, asses
operations, and improve practices and procedures in CT service delivery. Every CT site shall collect
information on CT activities using monitoring tools stipulated in the national guidelines including data
management, storage and completeness of forms. All CT centers will be monitored and evaluated by
counselor supervisors via district supervision. Staff training will be done using the national training
materials. Five percent of the budget will be used for monitoring and evaluation.
SUSTAINABILITY: Selian AIDS Control Program falls under the Evangelical Lutheran Church in the Arusha
Region. The program has grown in size and services rendered to the community. We anticipate leveraging
funds from different sources for VCT services. Selian is building the capacity of church congregations to
become centers for prevention, care, and support for PLWHs through a project called EVERY CHURCH IS
A CARING CHURCH. Since VCT is an entry point for care and treatment, the government is expected to
provide free universal VCT services to make them accessible to every citizen.
Continuing Activity: 13590
13590 8662.08 U.S. Agency for Selian Lutheran 6559 4082.08 $272,600
8662 8662.07 U.S. Agency for Selian Lutheran 4580 4082.07 $60,000
Table 3.3.14:
