ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP

RENAMED UNIVERSITY OF WASHINGTON INTERNATIONAL TRAINING AND EDUCATION CENTER

ON HIV (I-TECH) WITH FXB

TITLE: Create linkages and coordinate PMTCT and pediatric HIV service delivery

NEED AND COMPARATIVE ADVANTAGE: USG-Tanzania has indicated a need for technical assistance

(TA) 1) to enhance the structure and effectiveness of national efforts for scale-up of PMTCT services by

regionalization; 2) to create effective linkages between the PMTCT and pediatric HIV programs in order to

support follow-up, care, diagnosis and treatment of HIV-exposed infants; 3) to integrate comprehensive

PMTCT service and mother-infant follow up within Reproductive and Child Health services. Joint workplans,

a model for infant-follow-up, and plans for program integration will be instrumental in building sustainable

program activities. TA to the PMTCT Unit in their work with regional MOHSW representatives, donor

organizations, and other ministries, will support timely accomplishment of program objectives. The FXB

Center has a successful history of collaboration with USG-Tanzania and the MOHSW in facilitating

sustainable programs and enhancing quality standardization of PMTCT services. As a registered

organization in Tanzania with in-country management, the Center is well positioned to build on previous

accomplishments and provide continuity of TA.

ACCOMPLISHMENTS: FXB worked with the PMTCT Unit to 1) implement program management and

supervision training for regional and district health providers in both mainland Tanzania and Zanzibar 2)

develop standard operating procedures for PMTCT for healthcare workers; 3) develop PMTCT supportive

supervision checklist for the Zanzibar PMTCT program 4) adapt testing and counseling support tools for

both Mainland Tanzania and Zanzibar; and 5) Revision and update of the Tanzania National Guidelines for

PMTCT.

FXB was previously funded under the University Technical Assistance Program (UTAP) mechanism which

is expiring. To prevent a gap in activity implementation, I-Tech will serve as the funding mechanism until an

Federal Opportunity Agreement (FOA) can be developed and competed. Activities are the same as Activity

ID # 16509.08 but only cover the first half of the FY 2008 funding period. As soon as funds arrive an FOA

will be distributed and competed to cover the second-half of the funding period.

ACTIVITIES: 1) Initiate collaboration and establish system linkages between NACP's PMTCT and pediatric

teams. 1a) Gather relevant HIV/AIDS, PMTCT and pediatric HIV documents and review national strategic

plans and NACP-specific goals and objectives. 1b) Consult with PMTCT and pediatric HIV technical working

groups (TWGs) and MOHSW to prioritize response to identified gaps and needs for revision. 1c) Develop a

draft action plan and share with key stakeholders and TWGs during a 2 day retreat to revise and prioritize

objectives, discuss lead agencies and timeline 1d) Submit revised action plan to MOHSW for final approval,

allocation of work plan activities to respective Departments, identification of budgets, approval of a

monitoring plan and further dissemination

2) Provide technical assistance to NACP to scale up PMTCT, diagnosis, care and treatment of HIV infected

mothers and children, support integration in RCH services. Based on outcomes of joint PMTCT/Pediatric

HIV joint strategic plan: 2a) Work with MOHSW to identify 10 pilot sites to develop a model for systematic

linkages of PMTCT services and pediatric care and follow-up of mothers and HIV-exposed infants 2b) Work

with key MOHSW staff and TWGs to create a Care and Treatment Integration Plan for implementation of

the model at pilot sites. 2c) Train 40 staff on implementation of Plan 2d) Collaborate with MOHSW to build a

communication system between RCH and CTCs to monitor follow-up of exposed infants. 2e) Evaluate the

model's effectiveness at the sites 2f) Develop a strategic plan for replication of the model in other regions of

Tanzania in subsequent years.

3) Work with PMTCT and pediatric units to assist in work planning, report writing including monitoring of the

national program, evaluation of activities such as trainings and assist with dissemination of guidelines, BCC

materials, counseling tools and supervision checklists 3a) identify and discuss with national-level staff,

implementation gaps, program linkages and common problem areas in program implementation 3b) provide

mentoring on program management of PMTCT activities 3b) provide feedback and coaching on operations

management, evaluating, reporting and project planning, with reduced involvement over time 3c)develop

support tools and assist with dissemination of PMTCT guidelines, early infant diagnosis, counseling tools

(pediatrics and PMTCT) and dissemination of the PMTCT supervision checklist and PMTCT standard

operating procedures.

4) Coordinate PMTCT/pediatric HIV implementing partner's work to ensure unified goals and targets and

avoid duplication of effort 4a) Conduct a nationwide assessment of the number and scope of work of in-

country partners providing PMTCT services 4b) Develop a Collaboration Report and Catalogue that lists

service providers, their respective services/activities and contact information 4c) Provide leadership for

development of a regular management, reporting and monitoring system to streamline service provision and

coordinate activities

LINKAGES: The FXB Center aims to continue to strengthen the capacity of the national PMTCT program to

achieve its goals by expanding PMTCT services through system linkages with the national pediatric HIV

program and integration of these services in routine reproductive and child health services nationally.1)

Sustainable linkages between the currently vertical PMTCT/pediatric units of the NACP and the MOHSW

RCH Division will be established.

2) A practical model for linkages between these programs will be pilot tested at MOHSW PMTCT identified

sites 3) Work planning and operational activities of both the PMTCT and pediatric units of the NACP will be

coordinated with initial FXB facilitation 4) Stronger linkages with and between implementing partners will be

developed through catalogue of partners and their respective activities and regular reporting mechanism.

CHECK BOXES: Support standardization and scale-up PMTCT services and create linkages between

PMTCT and pediatric HIV program activities. Integrating PMTCT and pediatric HIV services into RCH.

Mentoring/coaching national level staff on program management and supervision and establishing a system

to coordinate the work of all PMTCT implementing partners to ensure unity in pursuit of PMTCT program

Activity Narrative: goals and targets. Increased capacity of national program and national staff will support scale-up of PMTCT

services, which target pregnant or recently-delivered women, women with HIV exposed infants.

M&E: Monitoring and evaluation is an integral component of each activity. The FXB Center will engage in

monitoring and evaluation activities that lead to continuous improvement and replication of the model for

continuous service delivery between PMTCT and pediatric HIV care. Using national indicators, PEPFAR

indicators and other established performance measures, FXB will build into the workplan monitoring tools to

evaluate objectives of the project for the one-year duration. FXB will develop evaluation forms for each

training and workshop using standard templates. FXB has systems in place for monitoring work plan

activities and timely deliverables; progress is reviewed, summarized and reported quarterly. Approximately

5% of budget is used for overall M&E purposes.

SUSTAINABILITY: The FXB Center's approach to technical assistance is to strengthen existing capacity

and foster new skills development. The FXB Center proposes a "strategic withdrawal" as opposed to an exit

strategy to ensure project continuation. The FXB Center's goal is to set in motion a sustainable initiative

owned by the MOHSW/NACP that MOHSW/NACP will maintain and improve. Strategic withdrawal is

achieved by developing: 1) collaborative agreement on the condition and status of the program prior to the

initiation of the proposed workplan 2) clearly written program roles and responsibilities for both the FXB

Center, partners and the MOHSW/NACP that delineates the programmatic expectations for each 3) a plan

that outlines the timeline, responsibilities, goals and evaluation methodology

Major Activities: 1) Establish system linkages between NACP's PMTCT and pediatric teams. 2) Provide TA

to scale up PMTCT, diagnosis, care and treatment of HIV infected children, support integration in RCH

services 3) Work with PMTCT and pediatric units to assist in program management 4) Coordinate

PMTCT/pediatric HIV implementing partner's work to ensure unified goals and targets and avoid duplication

of effort

New/Continuing Activity: Continuing Activity

Continuing Activity: 16509

Continued Associated Activity Information

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

System ID System ID

16509 16509.08 HHS/Centers for University of 8545 8545.08 PMTCT Support $0

Disease Control & Medicine and (UTAP)

Prevention Dentistry, New

Jersey - Francois-

Xavier Bagnoud

Center

Emphasis Areas

Gender

* Addressing male norms and behaviors

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 $20,000

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:

TITLE: Ensuring health care workers receive adequate in-service TB/HIV training

I-TECH will continue provide technical assistance to the National TB and Leprosy Program (NTLP) and

National AIDS Control Program to coordinate the rollout of the TB/HIV training. Trainer of trainers (TOT) will

be trained from Zonal to the district level. NTLP intends to create a team of TB/HIV trainers for each district

implementing TB/HIV collaborative activities. These will in turn conduct in-service training workshops for

healthcare providers in the hospitals and other health facilities. I-TECH will collaborate at national level with

NTLP and NACP to assist with the coordination of TB/HIV trainings including planning, implementing,

monitoring and evaluating the training. Capacity of Zonal training Centre (ZTC) to monitor and evaluate the

effectiveness of TB/HIV training activities in the zones will be developed. This is important to ensure high

utilization of the knowledge acquired during the training and provide information about improving the quality

of training materials and approach. ZTC affiliated trainers previously trained and others to be trained on

M&E of training will assist with monitoring and evaluating the TB/HIV trainings in each zone. The ZTCs will

be trained on the use of System of Monitoring and Reporting Training database to capture data on trainings.

I-TECH staff will provide technical assistance by developing a mentoring tool/checklist and attending the

trainings to mentor the trainer using the tool. The gaps identified using the tool will be used to strengthen

the skills of the trainers. In collaboration with national TB and Leprosy Program, I-TECH will conduct TB/HIV

TOTs in zones targeted by NTLP. This will increase the pool of qualified trainers for the TB/HIV in-service

course. Training of ZTC faculty on TB/HIV will be supported. I-TECH will also provide financial support to

enable ZTC faculty to attend the TB/HIV course that will be organized by the NTLP and partners. I-TECH

will also select some faculty to participate in the TOTs mentioned above. In the development of all TB/HIV

guidelines; I-TECH will also work/collaborate with WHO in country office to ensure that the guidelines are in

line with WHO recommendation and have new updates

NEED and COMPARATIVE ADVANTAGE: The National TB and Leprosy Program (NTLP) sought

assistance in the development of policy guidelines, improvement of coordination between the TB and HIV

programs, and for support for TB/HIV training. I-TECH responded to this need in FY 2007 by working

closely with the NTLP in these areas. However, the need for expanded in-service training and supportive

supervision has emerged as key to the scale-up of TB/HIV care and forms the basis for this application. In

addition, through capacity building of the Zonal Training Centers (ZTC), I-TECH will support the

coordination of TB/HIV collaborative activities at district and facility levels. Through its ongoing work with the

ZTCs and HIV/AIDS related training in Tanzania, I-TECH is well suited to support these needs.

ACCOMPLISHMENTS: By the end of FY 2007, I-TECH will have finalized the national TB/HIV policy in

collaboration with the NTLP and other stakeholders, developed an operational manual for implementation of

TB/HIV activities, and enhanced the TB/HIV in-service curriculum, including the incorporation of the

International Standards for TB Care. The TB/HIV in-service training and training of trainers course will have

been standardized and piloted.

ACTIVITIES: 1. Collaborate with the Zonal Training Centers (ZTCs) to promote, coordinate, and implement

TB/HIV training. This will contribute to efforts to decentralize training through Government of Tanzania

(GOT) institutions and will increase the quality of TB/HIV care and treatment. 1a) Through the ZTCs,

support TB/HIV in-service trainings to health care workers in each zone. 1b) Develop the capacity of the

ZTCs to coordinate TB/HIV activities by developing a cadre of master trainers and mentors through clinical

and classroom teaching skill development. 1c) Maintain an on-site inventory of learning and teaching tools,

curricula, educational materials, and presentations of various TB/HIV related topics at each ZTC.

1d). Provide support to the NTLP technical working group on TB.

2. Monitor and evaluate the effectiveness and quality of the TB/HIV in-service training. This is important to

ensure high utilization of the knowledge acquired during the training and provide information about

improving the quality of training materials and approach. 2a) Development of a process and timeline for a

quality improvement of the TB/HIV in-service training through regular feedback, training observations and

analysis of training reports and pre- and post-test evaluations. 2b) Monitor the training, delivery, and

transfer of learning, including on-site visits by district and regional partners to clinical sites.

LINKAGES: I-TECH works very closely with the Ministry of Health and Social Welfare (MOHSW), CDC and

other USG and non-USG partners. As in FY 2007, I-TECH will continue to work closely with Program for

Appropriate Technology in Health (PATH) which is supporting TB/HIV collaborative activities, particularly to

enhance public-private partnerships. In addition, I-TECH will continue to work with the Curry TB Center's

International Standards for Tuberculosis Care (ISTC) medical school project and Integrated Management of

Adolescent and Adult Illness (IMAI), with the aim of harmonizing materials and minimizing duplication. This

will be enhanced through I-TECH's attendance of the monthly USG meetings and regular TB technical

working group sessions in order to share work updates and materials. I-TECH documents meeting

proceedings with the aim of improving collaboration.

CHECK BOXES: Human Capacity Development/In-service training: This activity addresses the in-service

training needs of HIV and TB care and treatment providers. Local organization Capacity Development: In

combination with projects funded by OPSS, this activity will strengthen the capacity of the ZTCs to rollout

HIV related trainings.

M&E: Activity managers use a results-based framework and M&E plan for each activity that includes

benchmarks and indicators. Progress towards objectives is entered and reviewed quarterly via a progress

database. Each activity will also have a data-flow map to identify roles of implementing partners in data

collection and use. Tools and relevant methods are used to assess training participants' knowledge and

practice, facilitator skills, curricula products, and training program design. Data quality assurance and

support will be provided where relevant. Timely stakeholder review meetings will be held to ensure that data

collected is useful to program management and oversight. Approximately six percent of the I-TECH budget

Activity Narrative: supports M&E.

SUSTAINABILITY: By supporting decentralization of training to ZTCs, local capacity will be enhanced and

sustainability promoted. I-TECH also plans to develop a cadre of skilled trainers in each zone who will be

able to train on all health-related topics, including TB/HIV. With the additional focus of incorporation of

HIV/AIDS and TB education into pre-service medical and allied health school curricula, a stage will be set

for sustaining quality, state-of-the-art HIV/AIDS and TB care through development of a workforce

wellgrounded

in this area.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13598

Continued Associated Activity Information

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

System ID System ID

13598 12451.08 HHS/Health University of 6564 4960.08 I-TECH $200,000

Resources Washington

Services

Administration

12451 12451.07 HHS/Health University of 4960 4960.07 I-TECH $300,000

Resources Washington

Services

Administration

Emphasis Areas

Health-related Wraparound Programs

* TB

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

TITLE: Rollout of Provider-Initiated Testing and Counseling (PITC) Training through the Morogoro Region in

Eastern Zone

NEED and COMPARATIVE ADVANTAGE: GOT recognizes that access to HIV testing solely through VCT

centers is limited. Therefore, the National AIDS Control Program (NACP) has begun to implement Provider-

Initiated Testing and Counseling (PITC) to increase the number of Tanzanians who know their HIV

serostatus. In addition to scaling up HIV testing, PITC will help ensure that affected individuals access

prevention, care, treatment, and support services as early as possible. I-TECH is a collaborating partner in

this national effort, and has worked with CDC, NACP, IntraHealth, AMREF, Bugando Medical Center and

Muhimbili Health Information Center to finalize PITC training materials. I-TECH was also identified to be an

implementing partner for the PITC training rollout. PITC training coordinated by I-TECH will be done by

regional and district training teams that comprise clinical trainers from hospitals and trainers in other pre-

service institutions including Zonal Training Centres.

ACCOMPLISHMENTS: In FY08 I-TECH collaborated with NACP and other partners such as Intrahealth,

NACP to finalize the PITC training materials. I-TECH also recruited a PITC Training Coordinator and PITC

Field Officer. Accomplished also were the study tour to Arusha and Kilimanjaro to learn about PITC, a two

day sensitization meeting of Morogoro authorities and draft a brochure on PITC for HCWs.

In addition, the following activities will be accomplished by the end of the year: a rapid baseline assessment

of 10 sites providing care and treatment; finalization and printing of the PITC brochure; a one day planning

meeting with the regional and districts health authorities; finalization of the training materials including TOT

package; adaptation of standard tools for monitoring the quality of PITC trainings; train 200 healthcare

providers on PITC using the cascade approach through training Master Trainers and TOTs; and adaptation

of MOH&SW tool and orientation of RHMTs and CHMTs on monitoring, evaluation and supportive

supervision.

ACTIVITIES: I-TECH, using FY 2009 funds, will:

1. a) Train 100 additional HCWs from the 10 PITC providing sites to increase the number of HCWs

providing the service and therefore increasing patient access to services: a) Conduct whole site training in

the 10 sites to cover more HCWs from outpatient, inpatient wards, RCH, STI clinics and TB clinics. The

trainings will cover Medical Officers, Assistant Medical Officers, Nurses, Medical Attendants, Pharmacists,

and Laboratory Personnel. As a step towards sustainability, the training will also involve ZTC faculty for

them to be able to teach in and pre-service graduates. b) Monitor and evaluate trainings using the standard

tool developed in FY08.

2. Expand PITC services to 14 additional health facilities in the Morogoro region with co-located CTC sites:

a) Conduct baseline assessment of 14 sites. b) Print and disseminate PITC brochure for creating

awareness and sensitization among HCWs c) Conduct training to 100 HCWs from the 14 sites in outpatient,

inpatient wards, RCH, STI clinics and TB clinics d) Monitor and evaluate trainings using the standard tool

developed in FY08.

3. Monitoring and evaluation of PITC services at hospitals and health centers. This activity aims to ensure

that HCWs provide quality services using proper testing and counseling procedures, and to ensure the data

is accurately recorded: a) Provide technical assistance to RHMTs/CHMTs and assist in conducting quarterly

supportive supervision visits. Using this approach will ensure local ownership and sustainability b) Use

supportive supervision visits to monitor the quality of services provided c) Ensure reporting and recording of

PITC data is accurate d) Use supportive supervision visits to identify gaps for future refresher trainings. e)

Conduct follow-up assessment to measure the progress of this initiative against the initial baseline

assessment conducted in FY08.

*END ACTIVITY MODIFICATION*

TITLE: Rollout of Provider-Initiated Testing and Counseling (PITC) Training through the Zonal

NEED AND COMPARATIVE ADVANTAGE:

GOT recognizes that access to HIV testing solely through VCT centers is limited; therefore, the National

AIDS Control Program (NACP) has begun to implement provider-initiated testing and counseling (PITC) to

increase the number of Tanzanians who know their HIV serostatus. In addition to scaling up HIV testing,

PITC will help ensure that affected individuals access prevention, care, treatment, and support services as

early as possible. I-TECH is a collaborating partner in this national effort, and has worked with CDC, NACP,

IntraHealth, AMREF, Bugando Medical Center and Muhimbili Health Information Center to finalize PITC

training materials. I-TECH was also identified to be an implementing partner for the PITC training rollout.

PITC training coordinated by I-TECH will be done by zonal training teams that comprise zonal training

center (ZTC) faculty, clinical trainers from hospitals and trainers in other pre-service institutions. Training

Centres.

ACCOMPLISHMENTS:

In addition to its existing relationship with CDC, NACP, and the ZTCs, by the end of FY 2007, I-TECH will

have developed partnerships with IntraHealth, AMREF, BMC and MHIC to roll out PITC training. During this

period, I-TECH will have built the capacity of Central and Southern Highland ZTCs to provide PITC trainings

to 200 healthcare providers using the cascade approach through training Master Trainers and

trainers/training of trainers (TOTs) with the new algorithm on HIV testing. I-TECH, in collaboration with

NACP, CDC, AMREF, MHIC and BMC, will have developed standard tools for monitoring the quality of

PITC trainings including quality of services

. ACTIVITIES:

Activity Narrative: I-TECH, using FY 2008 funds, will:

1. Empower zonal training teams to become master trainers, who will in turn train trainers in PITC at the

hospital level. These hospital level trainers will train healthcare providers in regional and district hospitals

using the new algorithm on HIV testing and approved national curriculum. This activity will enable

healthcare providers to provide quality HIV testing and counseling services in clinical settings. Specific

activities include: a) Developing a training plan in collaboration with PITC partners. b) Conducting

sensitization meetings for Regional Health Management Teams (RHMTs), Council Health Management

Teams (CHMTs), principals of health training institutions, and NGOs in Central and Southern Highland

zones. c) Producing adequate PITC training materials including job aids in collaboration with other PITC

partners. d) Conducting TOTs for ZTC faculty, and facilitators from hospitals and health training institutions

in order to form zonal training teams. e) Integrating PITC content into the ZTC and pre-service curricula. f)

Conducting whole site training in regional and district hospitals for 200 healthcare providers (100 per zone).

Training will be given to hospital staff in outpatient and inpatient departments, reproductive health/PMTCT

clinics, STI clinics, and TB clinics. Training will cover all healthcare providers (e.g. doctors, assistant

medical officers, nurses, pharmacists and laboratory technicians) in order to provide appropriate care and

referral services to HIV affected clients.

2. Provide refresher trainings for trainers and hospital staff who receive PITC trainings. This activity will

ensure that tutors and healthcare providers receive updated information on PITC and provide an opportunity

for them to learn best practices. Specific activities include: a) Conducting refresher workshops for PITC

trainers in order to share best practices, and to update them on new developments. Prior to conducting the

workshops, a needs assessment will be done to determine areas which require emphasis during refresher

trainings. This will be followed by development or adaptation of the materials for the trainings. 2b)

Conducting refresher trainings for PITC health care workers in order to strengthen their knowledge and

skills, and share best practices.

3. Monitor and evaluate PITC trainings. This activity will ensure that the healthcare providers' record and

report PITC data accurately and timely, provide quality care by using correct testing procedures and by

providing proper counseling and referral services. This will be accomplished by working with regional,

district hospital management and partners to monitor the performance of healthcare providers in order to

determine how well they are able to apply the knowledge and skills learned.

LINKAGES: I-TECH will work closely with NACP, R/CHMTs, CDC, FHI, IntraHealth and ZTCs to ensure

successful implementation of PITC. Particularly, I-TECH will work together on building awareness, training,

monitoring and evaluation and supportive supervision. I-TECH will also collaborate with the partners in

rolling out the services. The teams will also ensure a functional referral system within the facility

departments, from one facility to another, partners and other support groups. Referral of clients from health

facilities to community support groups, where they exist, will be established or enhanced.

M&E: Emphasis will be placed on monitoring and evaluating the trainings during the actual training and

when healthcare workers return to their duty stations. M&E standard tools will be used to collect systematic

information, and use it to determine the quality and effectiveness of the training. The outcome of the M&E

will inform the need to improve training materials and/or the training approach. M&E will ensure that quality

PITC services are provided. PITC focal persons will be identified at each district and in each of the

implementing hospitals. All of the Morogoro health institutions and HCWs will be trained in data-collection

using the national tools, reporting, and utilization. Monthly reports will be submitted to I-TECH so that

progress can be tracked against the initial baseline assessment done in FY08. Approximately 25% of the

budget for this project will be spent on M&E.

SUSTAINABILITY : I-TECH's strategy is to strengthen the capacity of Morogoro region RHMT/CHMTs and

ZTCs /health institutions so that they can continue to organize and deliver PITC trainings with minimal

support from central level. The capacity of Ministry of Health and Social Welfare (MOHSW) at regional and

district levels, local organizations and ZTCs/health institutions will also be built in terms of ability to review

and revise training materials, as well as to conduct monitoring and evaluation of PITC trainings and

supportive supervision. Efforts also will be made to incorporate PITC contents in health institutions

curriculum.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13599

Continued Associated Activity Information

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

System ID System ID

13599 12467.08 HHS/Health University of 6564 4960.08 I-TECH $450,000

Resources Washington

Services

Administration

12467 12467.07 HHS/Health University of 4960 4960.07 I-TECH $300,000

Resources Washington

Services

Administration

Table 3.3.14:

ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY2008COP

This narrative combines activities 8981.08 and 8868.08 into one narrative. The funding for activity 8868.08

has changed from clinical services (HTXS) to health systems strengthening (OHSS), as a result the targets

have also changed to reflect their contribution to OHSS targets. In FY 2008 activity 8868.08 did not

contribute to HTXS targets.

TITLE: Enhancement of Pre-Service and In-Service Training for Health Professionals and Improvement of

Training Infrastructure to Enable Quality Provision of HIV/AIDS Care and Treatment.

NEED and COMPARATIVE ADVANTAGE:

Tanzania continues to face an acute shortage of health professionals, severely hampering the scale up of

HIV/AIDS-related services. Investing in the development of human resources for health lays the foundation

upon which HIV/AIDS interventions are built and ultimately ensures the achievement of PEPFAR goals. The

lack of comprehensive integration of HIV/AIDS prevention, care, and treatment in the pre-service curricula

of most cadres of health care workers is a significant obstacle to rapid scale up of quality HIV/AIDS

programs. The lack of adequate infrastructure, faculty, and resources at training institutions also hampers

the delivery of quality pre- and in- service education. After health workers complete their training it is

essential that the government has the capacity to distribute staff rationally to those facilities with the

greatest need. The government must also have the capability to retain qualified staff over the long term.

Currently, this capacity is weak given due to limited leadership and a myriad of disparate health information

systems for tracking health workers.

I -TECH has been working over many years in a number of countries to address the barriers to providing

high quality training to health care workers. I-TECH has worked to update and improve curricula for different

cadres of health care workers and has undertaken activities to enhance the quality and management of in-

service training. In Tanzania throughout FY 2007 and FY 2008, I-TECH worked with the Ministry of Health

and Social Welfare (MOHSW) to incorporate HIV/AIDS and tuberculosis (TB) into the pre-service curricula

for clinical officers (CO) and clinical assistants (CA). In FY 2007 I-TECH began strengthening the zonal

training centres (ZTCs) to improve their capacity to coordinate, implement, monitor, and evaluate HIV/AIDS

training. I-TECH has international experience in improving curricula, developing training systems, and

evaluating training programs; they will continue to apply this experience to activities in Tanzania

ACCOMPLISHMENTS:

In FY 2008, I-TECH will have completed the integration of HIV/AIDS and TB content into the first two

semesters of a revised pre-service curricula for COs and CAs. I-TECH also completed the revisions of

curriculum for ART in-service training. In doing this, I-TECH undertook a needs assessment; convened a

technical working group to address the full integration of HIV/AIDS related content into the teaching

programs; gathered content from existing curricula; designed interactive and participatory learning activities;

and produced training materials to support teaching. In addition, I-TECH has built collaborative relationships

with the MOHSW and the ZTCs. I-TECH has assisted many of the ZTCs in conducting stakeholder

meetings and in undertaking financial assessments to contribute to the sustainability of these institutions.

Essential equipment for training was provided and faculty received basic training in HIV/AIDS, as well as on

teaching methods, to enhance the quality of teaching.

ACTIVITIES:

1. Pre-Service Curricula

In FY 2009 I-TECH will finish revision of the curriculum for CO and CAs (semesters four, five and six). I-

TECH will also begin to enhance HIV/AIDS and TB components of the pre-service curricula for two new

cadres of health workers (e.g., assistant medical officers and pharmacy technicians) to ensure new

graduates are able to provide quality HIV care and treatment. I-TECH will coordinate with the MOHSW to

ensure ownership of the new curricula and to get approval/accreditation of the curricula. To facilitate quality

instruction with the new curricula, I-TECH will develop complementary teaching aids (e.g., facilitator guides,

student handbooks, practicum guide, PowerPoint slides, and other resources).

2. Faculty Development

I-TECH will strengthen the capacity of tutors in the CA and CO pre-service training institutions, of clinical

instructors at practicum sites, and of faculty in the ZTCs to teach effectively. I-TECH will continue to roll out

their basic teaching methods training. I-TECH will finalize the development of an HIV fundamentals course

for teaching faculty and roll out will begin. Based on an assessment undertaken of faculty needs, I-TECH

will also develop a package for more in-depth faculty development that includes further training on

curriculum development and lesson planning. This will increase the capacity of faculty to provide high

quality instruction in both pre- and in- service settings, as well as to adapt the curricula and lessons plans

whenever new HIV/AIDS-related innovations and guidelines become available.

3. Zonal Training Centres

In FY 2009, I-TECH will work to improve the ZTC's capacity to coordinate, implement, monitor, and evaluate

HIV/AIDS training. Spread throughout the country, the ZTCs are well positioned to provide maximum

access to quality training for healthcare professionals and to monitor training within each zone. I-TECH will

continue to equip ZTCs with basic training equipment, materials, and staff so they can provide quality

HIV/AIDS and TB/HIV trainings. I-TECH will continue to work with the ZTCs to build their capacity in

leadership and organizational development. Those ZTCs that did not hold stakeholders meetings and

financial assessments in FY 2008 will complete these activities in FY 2009. Based on the financial

assessments, I-TECH will provide technical assistance to the ZTCs to help these institutions become

financially sustainable.

4. National Resource Center

Based on a feasibility study undertaken in FY 2008, I-TECH will help the MOHSW create a national

HIV/AIDS resource center. The resource center will provide health policy makers, program managers,

Activity Narrative: teaching faculty, students, and researchers access to essential documents and materials on HIV/AIDS. I-

TECH will also develop an exit strategy whereby the MOHSW will have the management and financial

capacity to take over complete management of the resource center within three years.

5. Supply of Health Workers

One of the USG's priorities in FY 2009 is to address the shortage of health care workers in Tanzania. To

this end, the USG has set aside one million dollars for scholarships to train new health care workers in the

cadres most needed. I-TECH will design and implement the national scholarship program. Due to the fact

that the existing pre-service institutions in the country are not readily able to absorb new numbers of

students, I-TECH will work with existing training institutions to create model pre-service institutions with the

capacity to train the increased in-take of students. I-TECH will work with the most-at-need districts, and

partners such as the Capacity project and the Mkapa Foundation to bond the students, find them placement

in difficult to fill posts, and ensure retention.

6. Distance Learning

Distance learning offers the opportunity for health care workers to improve their skills and upgrade from one

cadre of worker to another more skilled cadre. In addition, the availability of distance learning can

contribute to health worker retention and allows workers to receive training without long absences from their

facility. Based on an assessment of the current status of distance learning programs in Tanzania and their

potential for expansion, in FY 2009 I-TECH will work to increase the quality of several existing distance

learning programs.

7. Monitoring and Evaluation of HIV/AIDS and TB Training

This activity will improve the quality of HIV-related training. A stronger culture for data demand, data use,

and a strengthened monitoring and evaluation system for training will enable the MOHSW and health care

facilities to identify training success, gaps, and redundancy more readily. In FY 2009, I-TECH will work with

the MOHSW, Capacity project, and other partners to adopt a training information management system. As

part of this activity, I-TECH will train partners in data demand, data use, and data quality assurance. I-TECH

will also work with the ZTCs to conduct evaluations of new or revised curricula, as well as of in-service

trainings to ensure they meet quality standards. Lastly, I-TECH will work with MOHSW, ZTCs and USG

partners to develop and implement a quality improvement plan to enhance HIV/AIDS training.

8. Stigma Workplace Program

In FY 2007, I-TECH developed a video to increase awareness and knowledge among health care workers

on the impact of stigma and discrimination in healthcare settings. This video has been rolled out through

the government's Workplace Intervention Program (WIP) and accompanying HIV/AIDS training materials

have been developed. In FY 2009, I-TECH will work with referral and district hospitals to maximize the use

of I-TECH Tanzania's documentary on stigma and discrimination, including providing technical assistance to

create support groups, like those in the video, for HIV-positive health care workers.

LINKAGES:

To accomplish all of the activities listed above, I-TECH will work closely with the MOHSW, the National

AIDS Control Programme (NACP), the National TB and Leprosy Program (NTLP), and the ZTCs. I-TECH

will also collaborate closely with the other USG partners who are working in each zone and are

implementing training activities, such as Capacity and NIMR. I-TECH will also collaborate with the Mkapa

Foundation.

M&E: In line with I-TECH's program standards, all I-TECH trainings have an evaluative component and

new training activities are informed by previous evaluation. I-TECH Tanzania has a comprehensive M&E

plan to track progress against output, outcome, and impact indicators. Activity managers use a results-

based framework and M&E plan for each area of activity to regularly review progress. Further, quarterly

progress reports provide an overview of progress against output and outcome indicators. Timely

stakeholder review meetings are held to ensure that data collected is useful to program management and

oversight. I-TECH employs a Quality Improvement Director in Tanzania to provide technical support to the

activity managers and stakeholders in developing M&E tools and in strengthening M&E systems. Further

technical support is provided from headquarters on major M&E developments, including baseline

assessments and end of project reviews. Approximately six percent of the I-TECH budget supports M&E.

SUSTAINAIBLITY:

I-TECH is strategically decentralizing curriculum development capacity to country offices, health ministries,

and other in-country partners to allow for continuous improvement to pre-service curricula over time. I-

TECH is also strengthening the capacity of the ZTCs, the institutions designated by the MOHSW, to

coordinate, manage, monitor, and evaluate HIV/AIDS trainings throughout Tanzania. As the capacity of

individual ZTCs increases, they will assume greater leadership and responsibility, and TA will move to

strengthen other ZTCs. In addition, by ensuring new graduates are adequately trained in HIV/AIDS and TB,

this activity will ensure that the health workforce is better prepared to implement large-scale HIV care and

treatment programs.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13601

Continued Associated Activity Information

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

System ID System ID

13601 8981.08 HHS/Health University of 6564 4960.08 I-TECH $1,458,983

Resources Washington

Services

Administration

8981 8981.07 HHS/Health University of 4960 4960.07 I-TECH $1,005,000

Resources Washington

Services

Administration

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $3,802,441

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.18: