ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP

TITLE: Support for Orphans and Vulnerable Children (OVC) Affected by HIV/AIDS

NEED and COMPARATIVE ADVANTAGE: Since 2004, Catholic Relief Services (CRS) has implemented

PEPFAR grant programs for OVC affected by HIV/AIDS in Tanzania. CRS' technical approach reaches out

to HIV-affected families through durable indigenous institutions such as churches, parish coordinating

committees, and village Most Vulnerable Children's Committees (MVCCs), supported through resource

mobilization initiatives, program funding, financial and technical assistance. This approach has not only

demonstrated program effectiveness, but has also extended OVC wellbeing activities that contribute to the

sustainability of integrated human development of OVC in Tanzania.

ACCOMPLISHMENTS: With PEPFAR funding to CRS/Tanzania, substantial progress continues in the

support of national efforts to establish sustainable programs for OVC. CRS reinforces national coordination,

partnership, and Monitoring & Evaluation mechanisms for OVC care and support. Notable achievements

from 2004 to date include an increase in the number of OVC receiving care and support services from 3,750

to 35,000 by the end of September 2008. Of these, 16,500 OVC were reached in FY 2008, and a

cumulative 18,500 continue to be supported since 2004. Fifty-two percent of the 16,500 OVC supported in

FY 2008 have received at least three different types of services from seven core program areas. The

education-support initiative has reached 30,000 out of 35,000 OVC with scholastic materials, uniforms, and

payment of required school fees. Additionally, over 15,000 OVC have received life-skills education and 750

have acquired skills in vocational training and trade. Other educational supports include periodic tracking of

school attendance and performance of individual children.

In health support, 15,000 OVC have been fully insured through two health insurance schemes, one focusing

on agreements with a local health fund and another accessing the newly introduced Community Health

Fund, operated by the district councils. The project has also increased community leadership in OVC care

initiatives and collaboration with local, districts and the national Department of Social Welfare (DSW). At

the community level, communities are fully engaged in resource mobilization, advocacy to address issues of

stigma and discrimination, and food support to needy households and people living with HIV/AIDS.

Regarding coordination, program review, and planning, a total of four meetings and three trainings focusing

on strengthening of OVC systems were organized. District authorities participated in these meetings and

trainings, demonstrating community involvement in OVC care and support initiatives. The number of OVC

on antiretroviral therapy (ART) has increased from 82 in 2004 to approximately 1,400 by September 2008.

Finally, the national OVC data management system (DMS) is now functional at all CRS OVC program sites

and all key program staff, field officers, and community volunteers have been trained on the national M&E

framework including periodic reporting tools.

ACTIVITIES: The FY 2009 proposed activities are based on lessons learned and the periodic reassessment

of OVC project outcomes conducted during the implementation of the FY 2008 work plan. FY 2009

outcomes will ensure that: 1) OVC are actively engaged in their own care and have the opportunity to invest

in their future; 2) community members take a leadership role in the care of OVC in their catchment area; 3)

community-based service providers provide effective, high-quality core services to OVC and their

families/caregivers; 4) community-based service providers engage in good resource stewardship; 5) local

authorities and systems are strengthened to provide long-term programs, quality services, and resource

support needed to sustain their community partners; and 6) CRS and national HIV technical resource

institutions (such as district social welfare officers, council health management teams, local health facilities,

and diocesan leadership) provide the necessary technical and material support to parish coordinating

committees, MVCCs and the community home-based care (HBC) networks. These supports will strengthen

families, build critical capacities, provide integrated quality services, and support the capability of the

national M&E system to obtain quality and reliable data for decision-making at various levels including local,

district, and national to ensure maximum integrated human development of OVC through uninterrupted

delivery of quality services. These sustainable outcomes will ultimately foster strong partnerships and

develop project sustainability among local authorities, and within the community, diocese, and household

levels.

One major goal for FY 2009 is to enhance the quality and sustainability of services. Efforts will facilitate

local ownership and leadership for quality service programs, while transitioning CRS' role from overall

management of the portfolio to one that provides key technical assistance in programming, accounting,

administrative skills, and auditing practices. FY 2009 activities will focus on building the institutional

capacity of partners to plan, implement, evaluate, and manage OVC programs, as well as providing quality

services including community nutritional support.

In FY 2009, there will be a greater emphasis on nutritional assessments. Community volunteers will use

mid-upper arm circumference tapes to determine the nutritional status of OVC. OVC identified with faltered

growth, or who are severely or moderately malnourished, will be referred to health clinics for HIV testing and

food supplementation, if available. For OVC identified with an immediate need, living in a food insecure

household, CRS will provide interim support, while linking the household to a livelihood activity.

LINKAGES: This activity will link to the Tanzanian National Costed Plan of Action (NCPA) for Most

Vulnerable Children and with the entire USG-funded OVC Implementing Partner Group (IPG) network.

CRS will continue to collaborate with the Ministry of Health and Social Welfare (MOHSW), the Prime

Minister's Office for Regional and Local Government, and the Institute for Social Work through a learning

and internship program for undergraduate students. Under this program, students in their third year of

studies participate in short-term assignments and deploy to different sites where CRS implements programs

benefiting OVC. CRS will continue to collaborate with the OVC IPG and the Quality Improvement Sub-

Taskforce in the development of standards in OVC care and to share best practices and lessons learned.

Furthermore, in FY 2009, health care initiatives will extend their focus to support vulnerable children whose

parents are living with HIV/AIDS. HIV-positive children will access ART services through linkages and

Activity Narrative: improved referral systems as well as through the provision of bus fare. Most importantly, this activity will be

linked to the work of the MVCCs at the local level.

CRS OVC programs will also be linked with the national Malaria voucher scheme for insecticide treated nets

and child survival initiatives at local health facilities.

M&E: Developing strong supervisory systems is essential to maintaining the quality of services achieved

through competency-based training, which also contributes to the implementation of the NCPA. In FY 2008,

CRS adapted and harmonized supervision tools to monitor quality of services at different program levels

systematically. Under the M&E framework and standards of quality programming, CRS trained over 23 key

program staff in six geographical sites in the Data Management System (DMS), information management

skills, reporting and computer skills, and problem solving solutions. At the central level, through the DSW,

the MOHSW has requested capacity building trainings to its District Social Welfare Officers, and supports

national efforts to roll out and disseminate the NCPA, national DMS and quality standards. In order to

sustain and strengthen the capacities of partners to monitor the program effectively, CRS will invest more

resources to strengthen the overall M&E and DMS. The grant will support more M&E activities, increase

technical assistance to key government stakeholders, supportive supervision, and training of staff.

Consultancies will be included in the M&E and DMS development in order to put clear monitoring and

evaluation mechanisms into place for all programs. Inadequate staff, a lack of data processing skills, and

deficient tracking systems are key impediments to effective M&E systems. CRS will address these issues

throughout the implementation of this work plan and cost extension period.

SUSTAINABLITY: In FY 2009, the CRS program team and diocesan partners will work together with local

communities, households, and district authorities to develop and market a culturally acceptable

sustainability strategy, which will promote key fundamental competencies and coping mechanisms. These

will be delivered through open dialogues among OVC, families, clans, parish-based OVC support

committees, self-help groups, and MVCCs. The FY 2009 CRS OVC programming strategy focuses on

interventions that safeguard the best interests of OVC and promote the CRS Integrated Human

Development strategy. To achieve this goal, CRS will provide comprehensive, and quality-based

interventions for OVC across the following seven core program areas; education and vocation training

support, food and nutrition, healthcare, psychosocial support, child protection, shelter and care, and income

generation. In addition to child-centered interventions, special focus will be on systems strengthening and

human capacity development. CRS has developed a vision to guide the implementation strategy: OVC are

resilient, healthy, and see purpose in their lives now and in the future and reside in self-sufficient, vibrant,

nurturing communities and households.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13453

Continued Associated Activity Information

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

System ID System ID

13453 6522.08 U.S. Agency for Catholic Relief 6505 5027.08 $1,350,000

International Services

Development

7691 6522.07 U.S. Agency for Catholic Relief 5027 5027.07 $700,000

International Services

Development

6522 6522.06 U.S. Agency for Catholic Relief 11905 11905.06 $200,000

International Services

Development

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

* Increasing women's access to income and productive resources

Health-related Wraparound Programs

* Child Survival Activities

* Malaria (PMI)

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $192,775

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $18,300

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Estimated amount of funding that is planned for Economic Strengthening $44,500

Education

Estimated amount of funding that is planned for Education $380,000

Water

Table 3.3.13: