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: Providing PMTCT services to Tanzania Police, Prisons and Immigration Department
NEED and COMPARATIVE ADVANTAGE: The Tanzanian Prisons Service, and the Tanzania Police Force
have a network of hospitals, health centers and dispensaries through out the country, supporting a total of
over 27,000 enlisted personnel and estimated 60-90,000 dependants for the Police, and 12,000 enlisted
personnel, plus an estimated 40-50,000 dependants and approx 45,000 inmates for the Prisons. These
hospitals do not only service the uniformed forces their dependents and inmates, but also civilians living in
the vicinity of the health facilities. In fact 80% of the patients are civilian. Five zonal Police and five Prison
hospitals offer district level services. The largest hospitals are, Kilwa Road (for the police) and Ukonga
Prison, both located in Dar es Salaam and serve as national referral centers for medical services. An
average HIV prevalence of 8.7% among pregnant women in the general population of Tanzania, and over
90% of the HIV infection in children below 15 years is attributed to mother-to-child-transmission (MTCT); the
rates are thought to be higher in the police and prison setting.
The MOHSW goal is providing PMTCT services to 80% of the projected HIV positive mothers by September
2009. The national PMTCT coverage is still low, at 15%. Based on previous support, PAI is poised to
continue to address the needs to improve coverage and access to strengthen and expand PMTCT activities
in the police and prison hospitals and health centers/satellite sites across Tanzania and ensure a close
service linkage of the HIV programs of the respective forces being implemented in line with the national
Health Sector HIV strategy.
ACCOMPLISHMENTS: Under FY 2007 funding, Police and Prisons offered PMTCT services at five zonal
Police and five zonal Prison hospitals in: Dar es Salaam, Moshi, Mwanza, Mbeya and Zanzibar.
ACTIVITIES: Eight Police and eight Prison health centers will start PMTCT services in FY 2008. A total of
10 hospitals (five police and five prisons) and 16 health centers (eight police and eight prisons) will then
serve as PMTCT sites. Testing will be opt-out based on the new national algorithm. Women will be tested
in ANC, LW, and post natal, with rapid test and results given on same day
Based on capacity, both single-dose NVP, and more complex regimens will be provided with the goal of
accessing more women to more efficacious regimen.
Police and Prisons personnel, their dependents, inmates, and civilians living in the vicinity of the hospitals
and health centers will be informed through prevention and awareness campaigns of each center.
Information about the available services of the facilities, including PMTCT, will be presented and promoted
to through drama, music and other presentations at different occasions, including Open-house days for
civilians living in the communities around the clinics.
1) Support the role-out of the new national PMTCT guidelines in the 10 hospitals and 16 satellite health
facilities. (50% of the HIV+ women are expected to receive NVP, 30% AZT+NVP and 20% ART. 50% of the
HIV-exposed infants will receive CTX)
2) Using the national curriculum, carry out training of three health care workers per hospital (30) and per
satellite health center (48)
Train PMTCT service providers in staging of HIV+ mothers and provision of anti retroviral therapy (ART)
where capacity exist. If capacity is not available on-site, then patients will be referred to the nearest
Police/Prison, District, or Regional Hospital
3) Renovation or refurbishing of counseling and delivery rooms at 16 new satellite sites/health centers
4) Conducting community education to increase access to services and partner testing.
5) Providing test materials and protective safety gear through the District Medical Offices (DMOs) and
Medical store department (MSD) under the national PMTCT program. Limited quantities of these materials
will be procured under this Program to prevent stock-outs. Kilwa Road Hospital and Ukonga Hospital will
serve as the coordinating bodies for services, and oversee quality assurance following national standards
for follow-up at district or regional hospitals.
6) Establishing a referral system for HIV+ women and their HIV-exposed infants from the satellite sites to
Police and Prison hospitals or District and Regional hospitals for additional ANC services, infant diagnosis,
ART, and TB/HIV at CTC, where needed.
7) Training of volunteers/social support providers, transport and incentives for home-visits, organization of
post-test clubs and other activities.
8) Provision of infant feeding.
LINKAGES: Expansion of PMTCT activities in FY 2008 will ensure a close linkage of implementation to
national strategies and programs supporting MOH goals of providing this service to 80% of the projected
HIV positive mothers by September 2009. Coverage will increase through the 10 hospitals and 16 health
centers. PharmAccess will ensure linkages with organizations of women living in the barracks. We
anticipate that these women will also operate as care providers within the barracks. No NGO or other
private social support organization or social support organization is allowed to work/operate within the
military barracks. However for clients in the surrounding communities, we anticipate to form linkages with
Activity Narrative: existing local NGOs operating in those communities to ensure continuum of care. In addition, linkages will
be established as well as referral for HIV+ people from the satellite sites to the Police and Prison hospitals
or district hospitals for CD4, TB testing, and complicated cases.
Linkage will be strengthened with Prevention activities under the Police and Prison Program, including
promotion and counseling of preventive measures for HIV+ persons, provider initiated testing and
counseling (PITC), C&T, TB/HIV and OVC programs supported by PAI. 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, as these programs are all provided in these facilities.
Furthermore, linkages will be established with nearest District and Regional Hospitals for referral of complex
clinical cases and laboratory testing. PAI will continue to collaborate with facilities supported by the Partner
organizations and Global Fund.
CHECK BOXES: This funding will fully develop PMTCT services in the network of police and prisons
hospitals and satellite health centers. Funding will support the introduction and/or improvement of PMTCT
services. More emphasis will be put into training of health care workers per hospital and from satellite health
center, renovation or refurbishing of counseling and delivery rooms, community education, and providing
test materials and protective safety gear.
M&E: PAI will support the police and prisons facilities teams to collect and report PMTCT data based on the
national protocol and provide feedback on tool performance. PAI will work with these institutions to
strengthen and implement the PMTCT quality framework and provide regular supervision. PAI will continue
to support the district and regional teams with supportive supervision visits to monitor the collection of data,
and the continued on-site training of facility staff.
Data will be collected both electronically and by paper-based tools. PAI will work with the MOHSW in rolling
out the revised PMTCT M&E: the patient-based registers, the Monthly Summary Forms for both ANC and
L&D, and the commodity logistic (LMIS) tools to all of the sites it supports. Electronic data entry will take
place. All sites will have laptops with a data base and output functions as developed by UCC for the
National C&T program. To that end, PAI, in collaboration with UCC, will train 52 health care workers and
provide technical assistance to 26 facilities.
PAI will continue to promote the synthesis and use of data by facility staff, and strengthen its use for
decision-making for facilities and the district and regional management teams.
Data will be provided to Regional and District Health Management Teams, the National AIDS Control
Program (NACP) and PEPFAR for reporting purposes and stakeholders meetings.
SUSTAINAIBLITY: PAI will encourage the Office of the Director Medical Services of the Police, and of the
Prison Service to integrate PMTCT activities in their respective Health Plans and budgets at the facility and
national level. To improve administrative capacity, the PAI will work with Prison and Police authorities to
build local authority's technical and managerial capacity to manage the program.
The facilities provide staff and health infrastructure. Most costs of this program are for training and for
infrastructure improvement. Investments are done at the start-up phase of the Program It is therefore
expected that the costs per patient will decrease dramatically over time. In the Police and Prison setting,
turnover of medical staff is low.
Health facilities of the Prison Service is under the administration of the Ministry of Home Affairs and the
Police Force under the Ministry of Public Safety and Security, not under the Ministry of Health. This PMTCT
program will be implemented under the rules, regulations and guidelines of the National AIDS Program.
Training, treatment, treatment guidelines, M&E etc is all part of one large program.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16409
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16409 16409.08 U.S. Agency for PharmAccess 7408 7408.08 $360,000
International
Development
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 $56,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $20,000
and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
UNCHANGED FROM FY 2008. The program began in earnest in June 2008.
TITLE: Providing HIV/AIDS Prevention programs for the Tanzania Police Forces, Prisons Service and
Immigration Department
NEED and COMPARATIVE ADVANTAGE:
The HIV prevention and awareness-raising activities under this program concentrate on 30,000 police
officers (including 2,500 recruits per year), 30,000 prison officers (including 2,500 recruits per year), 5,000
immigration officers (400 recruits per year), their dependants and thousands of civilians living in the vicinity
of the police and prison health facilities. The program is a continuation of the program started under FY
2007 funding, as well as FY 2007 plus-up funds, which devoted resources specifically to looking at critical
gender issues, such as gender based violence (GBV) among this target population. Tools and materials
developed under the DOD/PAI/TPDF program can be used for all police, prisons and immigration
departments and vice versa.
GBV can be defined as any unlawful act perpetrated by a person against another person on the basis of
their sex that causes suffering on the part of the victim and results in among others, physical, psychological,
and emotional harm or economic deprivation. Attention is increasingly being directed at the possible role
military personnel could play in preventing HIV/AIDS within their ranks and in the civilian communities they
come in contact with. The Tanzania Police Forces, Prisons Service and Immigration Department, like any
other uniformed services groups are grappling with how to best stem the spread of HIV/AIDS among its
workers.
ACCOMPLISHMENTS: This activity is scheduled to begin in the middle of FY 2007, with 0207 plus-up
funding.
ACTIVITIES: A core activity of the initial funding is to develop a comprehensive HIV/AIDS education
program, based on life-skills modules which were developed by the Tanzania Peoples Defense Forces
(TPDF) through Emergency Plan funding with PharmAccess. A critical component to this work is to assure
that the module that is developed to specifically assess and address a host of issues related to HIV, gender
and other critical topics, as they relate to newly recruited policemen and policewomen as well as new
recruits into other uniformed services in Tanzania. Specific materials to work with the uniformed services to
address GBV issues will be developed and implemented including materials to increase positive male
involvement, to reduce alcohol abuse that leads to high risk behavior, and to reduce the acceptance and
practice of GBV among uniformed personnel. Materials will be distributed to appropriate locations such as
police stations, prisons, border crossings, and park ranger stations targeting all such personnel working in
Tanzania. Training specific to GBV will be conducted throughout Tanzania; both sensitization throughout
the general forces, as well as specific prevention and counseling training with medical personnel to create
an environment conducive to reporting and addressing such issues.
Specific activities include: 1) Develop and distribute new IEC and life skills materials, as well as newly
designed materials and prevention components on GBV, positive male involvement, and issues around
alcohol abuse. 2) Provide prevention IEC and life-skills materials and services to all service members, their
dependents, and the communities in the vicinity of police and prison health facilities. 3) Special efforts will
be put on counseling of HIV+ persons to raise awareness about the risks of HIV transmission. USG funding
will support the (re-) training of approximately 100 clinicians and HIV counselors of approximately 25 health
facilities. 4) Establish post-test group sessions of HIV+ persons. 5) Re-train 60 TOTs and train 1200 peer
educators, at least two per police station or prison. Activities will be directed to all police stations,
prisons,and offices of the immigration department. 6) Enhance the awareness of HIV/AIDS by training
commanders so that they consistently give high visibility to HIV/ AIDS in their proceedings and activities.
LINKAGES: The 16 new health facilities where counseling, testing, and care and treatment services will be
provided will be linked with: 1) Nearby regional and district hospitals for ELISA and CD4 testing and for
referral of late-stage AIDS patients. 2) Organizations of women living in the barracks around these police
stations and prisons. Two hundred women will be trained and involved in providing HIV/AIDS IEC and life-
skills materials in and outside the barracks. 3) NGOs and other community support organizations to do
home-visits, provide home-based care and other support functions to HIV+ persons living in the vicinity of
these heath centers and outside the barracks.
CHECK BOXES: The emphasis is to keep personnel of Police, Prisons and Immigration Services (TPPI or
the Forces), their dependants, and civilians living in the vicinity of the health facilities of these Forces free
from HIV infection. The areas of emphasis were chosen because activities include providing prevention
education, materials and services to all service members, their dependents and the communities in the
vicinity of police and prison health facilities, equipping new recruits with the necessary knowledge and skills,
and provide ongoing access to information and services to prevent HIV/AIDS among themselves and other
youths in and outside these Forces and lastly enhancing the awareness of HIV/AIDS by training peer
educators and commanders so that they consistently give high visibility to HIV/ AIDS in their proceedings
and activities.
M&E: Data will be collected and reported by the management of the health facilities. Management will be
trained and instructed for that purpose to guarantee as much standardization as possible in reporting. PAI
will prepare a written M&E plan and will begin implementation no later than receipt of FY 2008 funds. The
plan will outline procedures for data collection, storage, reporting, and data quality, and will outline plans for
data use for decision-making within the organization and with stakeholders. PAI will allocate 7% of FY 2008
funds to M&E. PAI, as they develop and revise data collection tools, will work to harmonize with other
PEPFAR AB and OP partners, as appropriate.
Activity Narrative: SUSTAINABILITY: 1) Most costs of this program are for training and for developing and distributing IEC
materials. Investments are done at the start-up phase of the program. It is therefore expected that the costs
per patient will decrease dramatically over time. 2) Turnover of medical staff is low. Training is needed.
Once trained, this capacity will stay within the Forces. 3) Health facilities of the uniformed forces are under
the administration of their respective ministries, not under the Ministry of Health. This prevention program
will be implemented under the rules, regulations, and guidelines of the National AIDS Program. Training,
treatment, treatment guidelines, and M&E etc are all part of one large program.
Continuing Activity: 16386
16386 16386.08 U.S. Agency for PharmAccess 7408 7408.08 $250,000
* Increasing women's legal rights
* Reducing violence and coercion
Table 3.3.02:
TITLE: Providing HIV/AIDS Prevention programs for the Tanzania Police Forces, Prisons Service, and
The HIV prevention and awareness-raising activities under this program will concentrate on 30,000 police
immigration officers (400 recruits per year), their dependants, and thousands of civilians living in the vicinity
2007 funding. Tools and materials developed under the DOD/PAI/TPDF Program can be used for all police,
prisons, and the immigration department and vice versa. Immigration officers are linked to police and prison
health facilities for treatment. Over the next several months, PharmAccess International will explore the
possibility of extending services to prisoners through a partnership with the United Nations Office of Drug
and Crime.
ACCOMPLISHMENTS: The Prevention program for the police, prison and immigration forces is expected to
start in the second half of 2007, funded by PEPFAR/USAID.
ACTIVITIES: With FY 2008 funding, PharmAccess will be involved in the following activities: 1) Developing
and distributing of new IEC and life skills materials by dedicated taskforces for each of the police, prison
and immigration services. 2) Providing prevention IEC and life-skill materials and services to all service
members, their dependents, and the communities near police and prison health facilities. 3) Equipping new
recruits with the necessary knowledge and skills, and provide ongoing access to information and services,
to prevent HIV/AIDS among themselves and other youths in and outside the uniformed forces. 4) Special
efforts will be put on counseling of HIV-positive persons to raise awareness about the risks of HIV
transmission. USG funding will support the (re-) training of 104 clinicians and HIV counselors of 26 health
facilities. 5) Establishing post-test group sessions of HIV-positive persons 6) Re-training of 60 TOTs and
training of 1200 peer educators, at least two per police station or prison. Activities will be directed to all
police stations, prisons and offices of the immigration department. 7) Enhancing the awareness of
HIV/AIDS by training commanders so that they consistently give high visibility to HIV/AIDS in their
proceedings and activities 8) Training of groups of women living within the barracks and near the police
stations and prisons to advocate HIV testing and less risky behavior. 9) Distributing condoms as well as
carrying out education services on prevention efforts and as part of CT services at all police stations,
prisons, and offices of the immigration department. Condoms will be obtained through District Medical
Officers in the respective districts. In incidental cases, when the public system does not deliver and when
stock-outs may occur, condoms will be procured and distributed through Tanzania Marketing and
Communications company (T- MARC).
LINKAGES: The 16 new health facilities providing counseling, testing, and care and treatment services will
link with nearby Regional and District hospitals for Elisa and CD4 testing and for referral of late-stage AIDS
patients, organizations of women living in the barracks around these police stations and prisons. 200
women will be trained and involved in providing HIV/AIDS IEC and life-skills materials in and outside the
barracks. In addition, the facilities will link with NGO's and other community support organizations to do
home-visits, provide home-based care, and provide other support to HIV-positive persons living in the
vicinity of these heath centers and outside the barracks.
CHECK BOXES: The emphasis is to keep employee police, prisons, and immigration services (TPPI or the
Forces), their dependants, and civilians living near the health facilities of these forces free from HIV
infection. Activities include providing prevention and education materials and services to all service
members and their dependents within communities near police and prison health facilities. In addition,
PharmAccess will equip new recruits with the necessary knowledge and skills (and provide ongoing access
to information and services) to prevent HIV/AIDS. Lastly, PharmAccess will enhance HIV/AIDS awareness
by training peer educators and commanders so that they consistently give high visibility to HIV/AIDS in their
proceedings and activities.
trained and instructed to guarantee as much standardization as possible in reporting procedures. PAI will
prepare a written M&E plan and will begin implementation no later than receipt of FY 2008 funds. The plan
will outline procedures for data collection, storage, reporting, and data quality in addition to outlining plans
for data use for decision-making within the organization and with key stakeholders. PAI will allocate 7% of
FY 2008 funds to M&E and will harmonize with other PEPFAR AB and OP partners to develop and revise
data collection tools.
SUSTAINAIBLITY: 1) Most costs of this program are for training and for developing and distributing IEC
materials. Investments are pledged at the start-up phase of the program, therefore, it is expected that the
costs per patient will decrease dramatically over time. 2) Medical staff turnover is low, therefore upon
completion of training, this asset and capacity will remain with the forces to ensure sustainability. 3) Health
facilities of the uniformed forces are under the administration of their respective Ministries. This prevention
program will be implemented under the rules, regulations, and guidelines of the National AIDS Control
Programme. Training, treatment, treatment guidelines, and M&E are all part of one large program.
Continuing Activity: 16371
16371 16371.08 U.S. Agency for PharmAccess 7408 7408.08 $337,500
Table 3.3.03:
THIS IS A NEW ACTIVITY.
TITLE: Providing HIV/AIDS Facility-based Care and Support to the Tanzania Police Force and Prisons
Service (staff, dependents, inmates and civilians living near the TPPI health facilities)
NEED and COMPARATIVE ADVANTAGE: The Police and the Prisons Service has a network of hospitals,
health centers, and dispensaries throughout the country, supporting a total of over 39,000 enlisted
personnel, an estimated 100,000 dependants, 40,000 prisoners and tens of thousands other civilians. The
hospitals offer district-level services with the largest hospitals, Kilwa Road Police and Ukonga Prison
Hospital, both located in Dar es Salaam, serving the role of national referral centers for this population.
Currently, the smaller police and prison hospitals and health facilities need to be refurbished, significant
improvements in healthcare worker training and quality of clinical services need to be made, and laboratory
services need to be expanded. Many of these sites are unable to fulfill the minimum criteria for HIV/AIDS
care and treatment as defined by the Ministry of Health and Social Welfare (MOHSW). Currently only one
police (Kilwa Road) and one prison hospital (Ukonga) participate in the National Care and Treatment
Program (NCTP). The Prisons Service started antiretroviral therapy (ART) services for eligible HIV-positive
clients in two hospitals and nine health centers; however, these services were initiated without proper
laboratory capacity, training of staff, quality and needs assessments, and monitoring and evaluation
processes as required by the NCTP, with the exception of the hospital at Ukonga Prison.
The hospitals and health centers of the Police and Prisons Service do not only serve enlisted personnel and
their dependents, but also civilians living in the vicinity of the health facilities; 80% of the patients are
civilians. HIV prevalence in Tanzania is estimated to be 7%, though rates are thought to be higher in the
Uniformed Forces. PharmAccess International (PAI) has a memorandum of understanding to work with the
Police and Prisons Service, and is well-poised to continue to provide technical and financial support to their
hospitals and health centers to improve coverage, and strengthen and expand care and treatment activities.
For example, there is little home-based care presently available to complement the facility-based services.
The program has introduced provider-initiated HIV testing and counseling (PITC), and this will lead to the
identification of a large number of personnel requiring care and treatment. The police and prison health
facilities need to be prepared for the resulting increase in patient load. Immigration officers are also
included in this initiative; PAI will ensure that they are informed about the availability of HIV/AIDS services
provided by Prison and Police health facilities. They will be encouraged to use the services of these
facilities, free of charge.
ACCOMPLISHMENTS: PAI has worked with the Police, Prisons, and Immigration Department (TPPI) to
provide comprehensive quality care and treatment services in five zonal police and five zonal prison
hospitals, and is presently expanding to another 13 police and 13 prison health facilities. Contributions
made by PAI to the HIV program are in line with the national Health Sector HIV strategy
ACTIVITIES: During FY 2009, PAI will:
1. Increase the number of hospitals and health centers under the TPPI providing care and support to HIV-
positive individuals, and expand services to the homes of people living with HIV/AIDS
- Renovate counseling rooms, laboratory, and pharmacy space at ten police and ten prison health centers
- Conduct initial and refresher ART training of 120 medical staff from the health centers
- Train 200 volunteers from the barracks in basic home-based care (HBC), and promote HBC services for
psychosocial support, for nutrition counseling and support, prevention and treatment of opportunistic
infections (OIs); and case finding for other vulnerable members of the household
- Conduct community education and mobilization through "Open House" days at each facility to increase
access to services and partner testing
- Strengthen the referral system between the TPPI health facilities, district, and regional hospitals for
antenatal services, adult and infant diagnosis, ART, and TB/HIV at care and treatment centers
2. Scale up provision of comprehensive care and support
- Ensure complementary home-based care services are in place, particularly for bed-ridden patients
- Reinforce PITC as part of all inpatient and outpatient services
- Procure drugs to treat OIs when not available through the central mechanism
- Evaluate patients for malnutrition and provide nutritional counseling and support
- Continue to improve patient record/data collection, working with Police and Prison headquarters and
facility staff to collect, record, and analyze data
- Improve quality of ART services through quarterly with site representatives and experts in specific fields
(e.g., ART developments, pediatrics, HIV/AIDS, nutrition, and TB)
- Monitor quality of services at the hospitals through linkages with regional supportive supervisory teams
and Kilwa and Ukonga Hospitals
- Provide prevention with positives messages to people living with HIV/AIDS, including provision of
condoms, importance of safe water and good hygiene, counseling about adherence and disclosure, and
referral for family planning or sexually transmitted diseases, as needed
3. Ensure proper lab capacity is developed at all eight hospitals for patient monitoring and OI diagnosis
- Provide CD4 equipment to Kilwa Road Police and Ukonga Prison Hospital
- Provide standard operating procedures and training in quality assurance and control at regional and
district hospitals
- Provide refresher trainings for technicians in TB and HIV diagnosis, routine laboratory testing and
equipment maintenance
- Procure reagents and consumables when not available through national supply chain
LINKAGES: Administration of the hospitals and health centers of the TPPI falls under the Ministry of Home
Affairs, rather than the MOHSW. Care and treatment services under this program will ensure a close
linkage with the National AIDS Control Programme (NACP) and the National TB and Leprosy Programme.
Activity Narrative: Clients found to be HIV-positive will be referred for further evaluation and qualification for prevention of
mother-to-child transmission (PMTCT), TB screening and treatment and care services within the facility, and
home- or community-based services. PAI will strengthen linkages with prevention activities under the
HIV/AIDS program of Police and Prisons, including promotion and counseling of preventive measures for
HIV-positive persons, PITC, counseling and testing, PMTCT, TB/HIV and support for orphans and
vulnerable children.
The program will establish linkages and referrals between health centers and TPPI or district and regional
hospitals for CD4 and TB testing, and provide referrals for complicated cases. PAI will also ensure linkages
with organizations of women living in the barracks. These women will operate as caregivers within the
barracks, as neither non-governmental organizations (NGOs) nor other private social support organizations
are permitted to work within the barracks. For clients in the surrounding communities, PAI will work with
existing local NGOs in order to provide a continuum of care and to ensure access with potential wraparound
programs (e.g., nutritional supplementation, income generating activities, psychosocial support, etc.).
Linkages have been established with the Regional and District Health Management Teams. PAI will
continue this collaboration, and work together with other implementing partners, for supportive supervision
purposes and technical assistance.
M&E: Data will be collected electronically and by paper-based tools. All sites have or will have laptops with
a database and output functions as developed by University Computing Center for the NACP. To support
M&E processes, PAI will provide training for 76 data-entry clerks. PAI will continue to promote the
synthesis and use of data by facility staff, TPPI headquarters, NACP and the District and Regional Health
Management Teams. For monitoring HBC services, PAI will use the national system for tracking HBC
services as soon as it is completed and available for use.
SUSTAINAIBLITY: In the TPPI Forces, turnover of medical staff is low. Once trained, this capacity will stay
within the Forces. TPPI health facilities are under the administration of the Ministry of Home Affairs, rather
than the MOHSW. PAI will encourage the Offices of the Directors Medical Services to integrate care and
treatment activities in their health plans and budgets at the facility and national level. To improve
administrative capacity, PAI continues to work with administrators to build the local authority's technical and
managerial capacity to manage the program, as well as incorporate data collection and analysis as part of
regular health service planning and management.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $20,000
Table 3.3.08:
ACTIVITY UNCHANGED FROM FY 2008.
TITLE: Treatment Buy-In to Insurance Fund PPP
PEPFAR Tanzania has developed an integrated plan to provide direct support to HIV/AIDS-impacted
people while simultaneously investing in the development of a robust private sector health care capacity.
Recent studies show that, at the country's current level of development, the private sector must be
leveraged to assist in health care provision if the government is to realize its goal of ensuring access to
health care services to all who need it.
This activity collaborates with an innovative public-private partnership designed to provide basic employer
provide
health insurance to 50,000 low-income wage earners. The program provides insurance premium
subsidies of 50% - 90% of the total cost to ensure affordability. The private sector match comes in the form
of the employee payment (10% - 50%) plus the private sector in-country insurer agreement to take only 3%
profit rather than the standard 18% (resulting in a 15% insurer contribution).
This activity will extend the basic health care coverage package by covering the treatment costs associated
with all eligible workers and their families within the 50,000 covered workers. The treatment will be provided
in certified private, non-governmental health facilities which will have the dual effect of increasing national
testing capacity while also encouraging the development of a parallel private sector health care network
designed to encourage and support employer-sponsored health care coverage. Studies show that for
countries in which less than 20% of GDP is collected in taxes (a dual measure of formal sector maturity and
sophistication of governmental monitoring infrastructure), resources for ‘government-only' health care are
insufficient to provide popular protection and the system must be augmented with a private sector health
care system designed to service ‘those who can pay'.
The initial target of 50,000 workers will focus on several geographically-centralized groups, including a large
coffee cooperative in Moshi and the micro-entrepreneurs at the Kariakoo market and the fish market in Dar.
Additional groups will be added once identified as meeting the program entrance criteria.
The funding will be provided to an existing partner organization, PharmAccess, who will in term pass it
along to the Dutch fund as a subgrantee. The funding is intended to spur the development of a
privateprovider
network of HIV/AIDS focused health professionals geared to service employer-sponsored plans
here in Tanzania. It is also intended to blaze a path for our focus countries to follow in teaming with the
innovative health insurance fund. We will initiate discussions with the O/GAC public-private partnership
group to monitor and evaluate program success and to determine feasibility of program extension within
and beyond Tanzania.
The initial workers targeted to benefit from this innovative fund are a coffee cooperative in Moshi,
creditworthy microfinance loan holders from the National Microfinance Bank (NMB), and stall holders at
both of the major markets in Dar es Salaam; the fish market and Kariakoo. The workers share some of the
key requisite attributes, including representing the lower wage earning end of the engine of commerce in the
country, and being formalized enough so that they can form a risk pool and have their wages garnered for
premium payments.
ACCOMPLISHMENTS:
ACTIVITIES:
LINKAGES: The other activities leveraging the insurance fund
SUSTAINAIBLITY: PPP
Continuing Activity: 16973
16973 16973.08 U.S. Agency for PharmAccess 7408 7408.08 $200,000
Table 3.3.09:
ACTIVITY UNCHANGED FROM FY 2008 COP.
FY 2009 Narrative HTXS
TITLE: Providing HIV/AIDS ARV Treatment to the Tanzania Police Force and Prisons Service (staff,
dependents, inmates and civilians living near the TPPI health facilities)
PharmAccess will work with Police, Prisons and Immigration Department to provide comprehensive quality
care and treatment services in 5 zonal Police and 5 zonal Prison hospitals in FY07 and, 13 Police and 13
Prison health facilities in FY08 and 23 Police and 23 Prisons health facilities in FY09
The Police and the Prisons Service have a network of hospitals, health centers and dispensaries through
out the country, supporting a total of over 39,000 enlisted personnel and estimated 100,000 dependants,
40,000 prisoners and tens of thousands other civilians. The hospitals offer district level services with the
largest hospitals, Kilwa Road Police and Ukonga Prison Hospital, both located in Dar es Salaam, serving
the role of national referral centers for these Forces. The other Prison and Police hospitals and health
facilities need to be refurbished, the level of training of the health care providers and the quality of clinical
services is very poor and laboratory services are often non-existent. All sites are, by far, not fulfilling the
minimum criteria for HIV/AIDS Care and Treatment as defined by the MOHSW. Currently only one Police
(Kilwa Road)and one Prison Hospital (Ukonga) participate in the National Care and Treatment Program
(NCTP). Prisons Service started ARV services in 2 hospitals and 9 health centers without the necessary
laboratory capacity, training of staff, assessments, M&E, etc, as required by the NCTP, with the exception of
the hospital at Ukonga Prison.
The hospitals and health centers of Police and Prisons do not only service personnel from these Forces and
their dependents, but also civilians living in the vicinity of the health facilities. In fact 80% of the patients is
civilian. With an average HIV prevalence of 6-7% Tanzania is amongst the highest hit countries in Africa.
The rates are thought to be higher in the Uniformed Forces. PharmAccess is poised to continue to address
the needs to improve coverage and access to strengthen and expand care and treatment activities in the
Police and Prisons hospitals and health centers/satellite sites across Tanzania for their personnel and
civilians, including inmates. PAI's contributions ensure a close service linkage of the HIV program of these
Forces being implemented in line with the national Health Sector HIV strategy.
Provider-initiated HIV testing and counseling will be introduced in FY07 and FY08. It is anticipated that this
will lead to the identification of a large numbers of personnel requiring care and treatment. The police and
prison health facilities need to be prepared for a stark increase in capacity to test and in an increase in
patient load.
Immigration officers will be informed about the availability of HIV/AIDS services provided by Prison and
Police health facilities. They will be encouraged to use the (free) services of these facilities. Personnel from
Immigration will therefore be mentioned in and be part of all COPS that are written for Police, Prisons.
The ART Program the Police, Prisons and Immigration Forces, funded by PEPFAR/USAID, is expected to
start in the second half of 2008
Increase the number of health facilities under the TPPI that will include hospitals and health centers.
Interventions will include: Renovations of counseling rooms, laboratory and pharmacy space at police and
prison health centers; Conduct initial and refresher ART training of medical staff from the health centers
and dispensaries; Train volunteers from the barracks in basic home-base care; Conduct community
education and mobilization through "Open House" days at each facility to increase access to services and
partner testing; Strengthen the referral system between the TPPI health facilities and District and Regional
hospitals for ANC services and adult and infant diagnosis, ART and TB/HIV at CTC.
Provide ART to Police, Prison and Immigration staff including their families; Reinforce provider initiated
counseling and testing (PITC) as part of all in and out-patient services; Procure OI drugs when not
available through central mechanism; Evaluate patients for malnutrition and offer nutritional counseling and
support; Continue to improve patient record/data collection, working with Police and Prison HQ and facility
staff to collect, record and analyze data; Discuss and improve quality of ART services through 3-monthly
meetings with representatives of the sites and experts in specific fields (ART developments, pediatrics,
AIDS and TB etc); Monitor quality of services at the hospitals through linkages with regional supportive
supervisory teams and the National Referral Hospitals from Police and Prisons.
Ensure proper lab capacity is developed at all eight hospitals for patient monitoring and OI diagnostics;
Provide CD4 equipment to the National Referral Hospitals from Police and Prisons.
Provide standard operating procedures and training in QA/QC at Regional and District hospitals;
Train and re-Re-train through refresher courses technicians in TB- and HIV diagnosis, routine laboratory
testing and equipment maintenance; Procure reagents and consumables when not available through
national supply chain.
LINKAGES:
Administration of the hospitals and health centers of the Police and Prisons is not under the MOHSW but
under the Ministry of Home Affairs. Care and treatment services under this Program will ensure a close
linkage with national HIV/AIDS program coordinated by NACP and the National TB and Leprosy Program+
(NTLP).
HIV-infected men and women will be referred for further evaluation and qualification for PMTCT, TB
screening and treatment and Care services within the facility. Linkage will be strengthened with Prevention
activities under the HIV/AIDS Program of Police and Prisons, including promotion and counseling of
preventive measures for HIV+ persons, PITC, C&T, PMTCT, TB/HIV and OVC.
Linkages will be established as well as referral for HIV+ from the health centers to Police and Prison
hospitals or District and Regional hospitals for CD4, TB testing and for referral of complicated cases.
PharmAccess will ensure linkages with organizations of women living in the barracks. We anticipate that
these women will also operate as care providers within the barracks. No NGO or other private social
support organization or social support organization is allowed to work/operate within the barracks. However
Activity Narrative: for clients in the surrounding communities, we anticipate to form linkages with existing local NGOs operating
in those communities so as to ensure continuum of care.
Linkages have been and will be established with the Regional and District Health Management teams. PAI
will continue to collaborate with Regional and District Health Management teams and with Partner
organizations, for supportive supervision purposes, and technical assistance.
M&E:
Data will be collected electronically and by paper-based tools. All sites have or will have laptops with a
database and output functions as developed by University Computing Center (UCC) for the NACP. 76 data-
entry clerks will be trained for that purpose. PAI will continue to promote the synthesis and use of data by
facility staff, Police and Prison HQ, NACP and the district and regional management teams.
SUSTAINAIBLITY:
In the Police, Prisons and Immigration Forces, turnover of medical staff is low. Once trained, this capacity
will stay within the Forces. Health facilities of these Forces are under the administration of the Ministry of
Home Affairs, not under the Ministry of Health. PAI will encourage the Offices of the Directors Medical
Services to integrate treatment activities in their Health Plans and budgets at the facility and national level.
To improve administrative capacity, PAI continues to work with administrators to build local authority's
technical and managerial capacity to manage the program as well as incorporate data collection and
analysis as part of regular health service planning and management.
Continuing Activity: 16480
16480 16480.08 U.S. Agency for PharmAccess 7408 7408.08 $800,000
* Increasing women's access to income and productive resources
Military Populations
Refugees/Internally Displaced Persons
Workplace Programs
Estimated amount of funding that is planned for Human Capacity Development $40,500
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP
TITLE: Providing HIV/AIDS Pediatric Care and Support to the Tanzania Police Force and Prisons Service
personnel, an estimated 100,000 dependants, 40,000 prisoners, and tens of thousands of other civilians.
The hospitals offer district-level services with the largest hospitals, Kilwa Road Police and Ukonga Prison
improvements in health care worker training and quality of clinical services need to be made, and laboratory
police hospital (Kilwa Road) and one prison hospital (Ukonga) participate in the National Care and
Treatment Program. The Prison Service started antiretroviral therapy (ART) services in two hospitals and
nine health centers; however, these services were initiated without proper laboratory capacity, training of
staff, quality assessments, and monitoring and evaluation processes as required by the National Care and
Treatment Program, with the exception of the hospital at Ukonga Prison.
The hospitals and health centers of Police and Prisons Service do not only serve enlisted personnel and
their dependents, but also civilians living in the vicinity of the health facilities. Approximately 80% of the
patients are civilians. HIV prevalence in Tanzania is estimated to be 7%, though rates are thought to be
higher in the Uniformed Forces. PharmAccess International (PAI) is well poised to continue to address the
needs of the Police and Prisons Service hospitals and health centers to improve coverage, and strengthen
and expand care and treatment activities. Contributions made by PAI to the HIV program are in line with
the national Health Sector HIV strategy.
The program has introduced provider-initiated HIV testing and counseling (PITC), which should lead to the
facilities need to be prepared to increase capacity for testing, as well as the resulting increase in patient
load. Immigration officers are also included in this initiative; PAI will ensure that they are informed about the
availability of HIV/AIDS services provided by Prison and Police health facilities. They will be encouraged to
use the services of these facilities, free of charge. They also will be encouraged to bring children for testing
and, when necessary, care and support. Presently, only a small proportion of patients under care and
support are children.
hospitals. Presently, services are being expanded to another 13 police and 13 prison health facilities.
ACTIVITIES: IN FY 2009, PAI will:
1. Expand the number of hospitals and health centers under the TPPI, strengthening their focus on
pediatric care and support
- Conduct initial and refresher ART training of 120 medical staff from the health centers, providing additional
focus on the care and support of children who are HIV-positive
- Train 200 volunteers from the barracks in basic home-based care, who can be helpful in identifying
exposed children
access to services and partner/family testing
- Strengthen the referral system between the TPPI health facilities, district and regional hospitals for
antenatal services, adult and infant diagnosis, Prevention of Mother-to-Child Transmission, (PMTCT), ART
and TB/HIV at care and treatment centers (CTC)
2. Provide care and support to a total of 200 children: 70 from police facilities, 90 from prison facilities and
15 from Immigration
- Include ‘prevention with positives' as a critical part of all HIV services
- Evaluate patients for malnutrition and offer nutritional counseling and support, especially for women in the
breastfeeding period, and recently weaned children
- Procure drugs to treat opportunistic infections when not available through the central mechanism
- Reinforce PITC as a part of all inpatient and outpatient services
- Scale up early infant diagnosis through dry-blood spot/DNA Polymerase Chain Reaction laboratory
networks
- Manage complications including malaria and diarrhea (providing access to pharmaceuticals, insecticide
treated nets, and safe water interventions)
and Ukonga Prisons and Kilwa Road Police Hospital
- Improve quality of care and support services through quarterly TPPI meetings, attended by all chief ART
staff
- Provide supervision of services at all facilities
3. Ensure proper lab capacity is developed at all hospitals for patient monitoring and OI diagnosis
- Provide standard operating procedures and training in quality assurance and control, and link with regional
and district quality assurance systems
- Provide refresher trainings for technicians in TB and HIV diagnosis (adults and infants), hematology and
biochemistry analysis and proper equipment maintenance
Activity Narrative: - Procure lab reagents and consumables when not available through the national supply chain system
linkage with National AIDS Control Programme (NACP) and the National TB and Leprosy Programme.
Clients found to be HIV-positive will be referred for further evaluation and qualification for PMTCT, TB
screening, and treatment and care services within the facility. PAI will strengthen linkages with prevention
activities under the HIV/AIDS program of Police and Prisons, including promotion and counseling of
preventive measures for HIV-positive persons, PITC, counseling and testing, PMTCT, TB/HIV and support
for orphans and vulnerable children. The program will also link with the new Baylor International Pediatric
AIDS Initiative to take advantage of their experience, best practices, tools, and materials related to pediatric
care and support.
continue this collaboration, and work together with implementing partners, for supportive supervision
hospitals for CD4 and TB testing, and provide referrals for complicated cases. PAI will ensure linkages with
organizations of women living in the barracks; it is anticipated that these women will also operate as
caregivers within the barracks. Neither non-governmental organizations (NGOs) nor other private social
support organizations are permitted to work within the barracks; however, for clients in the surrounding
communities, PAI will form linkages with existing local NGOs in order to provide a continuum of care.
M&E Processes, PAI will provide training for 76 data-entry clerks. PAI will continue to promote the
synthesis and use of data by facility staff, TPPI headquarters, NACP, and the District and Regional
Management Teams.
within the Forces. PAI will encourage the Offices of the Directors Medical Services to integrate treatment
activities in their health plans and budgets at the facility and national level. To improve administrative
capacity, PAI continues to work with administrators to build the local authority's technical and managerial
capacity to manage the program, as well as incorporate data collection and analysis as part of regular
health service planning and management.
Geographic Coverage Areas: Dar es Salaam, Mwanza, Mbeya, Moshi, Zanzibar
Please list the regions
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $1,000
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Total Planned Funding for Program Budget Code: $8,573,486
Total Planned Funding for Program Budget Code: $0
Table 3.3.11:
TITLE: Providing HIV/AIDS Pediatric ART to the Tanzania Police Force and Prisons Service (including
children from and inmates)
PharmAccess will work with Police, Prisons and Immigration Department to provide comprehensive
pediatric care and treatment services in 10 zonal Police and Prison hospitals in FY08 and 16 Police and
Prison health facilities in FY09.
services, including pediatric services, is very poor and laboratory services are often non-existent. All sites
are, by far, not fulfilling the minimum criteria for HIV/AIDS Care and Treatment as defined by the MOHSW.
Currently only one Police (Kilwa Road)and one Prison Hospital (Ukonga) participate in the National Care
and Treatment Program (NCTP). Prisons Service started ARV services in 2 hospitals and 9 health centers
without the necessary laboratory capacity, training of staff, assessments, M&E, etc, as required by the
NCTP, with the exception of the hospital at Ukonga Prison. None of the police and prison hospitals or health
centers has trained staff on pediatric HIV/AIDS services.
civilian. PharmAccess is poised to address the needs to improve coverage and access to strengthen and
expand care and treatment activities for adults and children in the Police and Prisons hospitals and health
centers/satellite sites across Tanzania for their personnel and civilians, including inmates and children of
female inmates. PAI's contributions ensure a close service linkage of the HIV program of these Forces
being implemented in line with the national Health Sector HIV strategy.
Provider-initiated HIV testing and counseling will be introduced in FY07 and FY08. PMTCT services start in
5 police and 5 prison clinics under FY08 funding and will be extended to 26 sites in FY09. HIV+ persons will
be counseled to advocate HIV-screening of family members, including children. For the same purpose,
counselors and home-base care providers will be trained to do home visits. PCR testing of new-borns starts
under FY08 funding. Blood samples from HIV-exposed children will be taken at all police and prison VCT
and PMTCT sites and will be sent to the four referral hospitals in Tanzania capable of doing pediatric PCR
testing.
It is anticipated that these actions together will lead to the identification of a large numbers of adults and
children requiring care and treatment. Therefore the police and prison health facilities need to be prepared
for a stark increase in testing and in an increase in patient load, including children.
Police health facilities. They will be encouraged to use the (free) services of these facilities. Personnel and
dependents from Immigration will therefore be mentioned in and be part of all COPS that are written for
Police, Prisons.
The ART Program the Police, Prisons and Immigration Forces, funded by PEPFAR/USAID, has only started
in July 2008
The program will increase the number of health facilities under the TPPI Program providing pediatric
services in both hospitals and health centers: Specific activities will include:
Conduct initial and refresher ART training, including pediatric ART training, to medical officers and
counselors / nurses from the targeted hospitals and health centers; Train and re-train clinicians, nurse-
counselors, laboratory technicians and pharmacy assistants in HIV and TB diagnosis of infants; Renovate
and furnish pediatric ward and clinic space dedicated for counseling of parents and children at Kilwa Road
and Ukonga Hospital, the national referral and training hospitals for Police and Prisons; Strengthen the
referral system between the TPPI health facilities and CTCs of District and Regional hospitals for ANC
services, infant diagnosis, care and treatment.
Provide ART children from both Police, Prison and Immigration facilities; Reinforce provider initiated
counseling and testing (PICT) as a regular part of all pediatric services. Blood samples through dried blood
spots (DBS) from HIV-exposed children will be taken at all police and prison VCT and PMTCT sites and will
be sent to the four referral hospitals in Tanzania capable of doing pediatric PCR testing Muhimbili in Dar es
Salaam, KCMC in Moshi, Bugando in Mwanza and the Referral Hospital of Mbeya.
Provide ART and drugs for OI to the HIV+ children fulfilling the criteria for treatment at the police and prison
health facilities or at the nearest District or Regional Hospital; Monitor quality of pediatric services at 10
hospitals and 16 health facilities through linkages with regional supportive supervisory teams and Ukonga
and Kilwa Road Hospitals as well as through quarterly TPPI ART meetings (attended by all chief ART staff);
Continue to improve patient record/data collection, working with Police and Prison HQ and facility staff to
collect, record and analyze data to inform improvement of services.
Ensure proper lab capacity is developed at ten police and prison hospitals and 16 health centers or ensure
that this capacity to monitor infants on ART is available at the referral hospitals; Provide standard operating
procedures and training in QA/QC, linking with regional and district QA systems; Train and re-train
technicians in TB and HIV diagnosis (adults and infants), hematology and biochemistry analysis and proper
equipment maintenance; Procure lab reagents and consumables when not available through national
supply chain system.
Activity Narrative: under the Ministry of Home Affairs. Care and treatment services under this Program will ensure a close
linkage with national HIV/AIDS program coordinated by NACP and the National TB and Leprosy Program
HIV-infected men, women and children will be referred for further evaluation and qualification for PMTCT,
TB screening and treatment and Care services within the facility. Linkage will be strengthened with
Prevention activities under the HIV/AIDS Program of Police and Prisons, including promotion and
counseling of preventive measures for HIV+ persons, PITC, C&T, PMTCT, TB/HIV and OVC.
hospitals or District and Regional hospitals for CD4, TB testing and for referral of complicated pediatric
cases. PharmAccess will ensure linkages with organizations of women living in the barracks. We anticipate
that these women will also operate as care providers within the barracks. No NGO or other private social
for clients in the surrounding communities, we anticipate to form linkages with existing local NGOs operating
:
Estimated amount of funding that is planned for Human Capacity Development $4,800
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
TITLE: Providing comprehensive TB/HIV diagnoses and treatment at Police and Prisons health facilities
PharmAccess with the support from U.S. Agency for International Development will continue to provide
support for implementation of collaborative TB/HIV activities in police and prison hospitals. The activities
provided will include those for reducing burden of TB among people living with HIV/AIDS as well as
reducing burden of HIV among TB patients. The activities described below are to be conducted in
collaboration with the Ministry of Health (MOH) through the National Tuberculosis and Leprosy Program,
National AIDS Control Program and the Regional and Council Health Management Teams. PharmAccess
will provide technical assistance to implement Intensified TB case finding (ICF) TB infection control (IC). ICF
will be strengthen to all health facilities providing HIV care and treatment services including hospitals lower
level facilities, ensure regular and proper use of the TB screening questionnaire; establish systems to
prevent TB infection. Work with MOH in the development and finalization guidelines for ICF, IC and
provision of Isoniazid preventive therapy. Guidelines will be printed and distributed to all supported health
facilities. All HIV infected patients receiving HIV care and treatment will be screened for TB disease
routinely and those found to have active TB will be referred to TB clinic to initiate an uninterrupted treatment
using Directly Observed Therapy (DOT). Diagnosis of TB will follow national TB and Leprosy guidelines.
Referral, linkages and patients follow up from care and treatment clinic to laboratory, TB clinic and to other
HIV related services e.g. home based care will be improved. At TB clinic all TB patients offered HIV
counseling and testing. TB patients who will be co-infected with HIV will e referred to CTC for care and
treatment services. All TB-HIV co infected patients will be counseled on HIV prevention including condoms
promotion and provision. Prevention messages will be provided to all HIV infected patients with
encouragement to disclosure HIV sero status to their sexual partners. HIV co-infected TB patients will be
encouraged encourage to advise their partners to undergo HIV test. Patients will be liked to STI, PMTCT
and family planning services according to the need of the patient. PharmAccess will provide support in the
Health System Strengthening by refurbishing heath facilities to have counseling rooms which will provide
privacy and confidentiality during HIV counseling and testing. Human capacity will be supported through
training of heath care providers on TB/HIV integration and co-management. Health care providers including
laboratory technologists from Police hospitals, health centers and mobile centers will train using national
TB/HIV training curriculum. The focus will be on Intensified TB Case Finding among PLWHA attending care
and treatment services, TB infection control in HIV clinics and congregate settings, referral system, linkage
and patients follow up. Referral system from care and treatment clinic (CTC), Laboratory, TB clinics, STI
and PMTCT clinics will be improved. Laboratory capacity for TB diagnosis will be strengthen by providing
microscopes for TB diagnosis and laboratory supplies. PharmAccess will support health facilities with
Cotrimoxazole supply for TB/HIV patients to ensure continuum of care for PLWHA. Strengthen Community
awareness through "Open House" days to increase access to services partner testing. Military personnel,
their dependents and civilians living in the vicinity of the hospitals and health centers will be informed
through ‘Open House' days and other awareness campaigns for each center. Information about the
available services of the facilities, including HIV-screening, PMTCT and TB treatment will be presented and
promoted through drama, music and other presentations. Conduct nutritional and dietary assessments of
TB+ persons and provide nutrition counseling and support. Management and data-handling for M&E and
patient and program monitoring purposes will be strengthen so as to improve data quality for patient and
program management. Supportive supervision will be conducted regularly to improve quality of services
NEED and COMPARATIVE ADVANTAGE: The PharmAccess International (PAI) Police, Prisons and
Prisoners Service has a network of hospitals, health centers and dispensaries through out the country,
supporting a total of over 39,000 enlisted personnel and estimated 100,000 dependants.
PAI will work with Police, Prisons and the Immigration Department to provide comprehensive quality care
and treatment services in five Police and five Prison hospitals and 16 health centers/satellite sites.
ACCOMPLISHMENTS: FY 2007 was the first year that the USG requested Emergency Plan funding for
PharmAccess (PAI) Police and Immigration Forces. Those funds have only just been awarded; though PAI
is proceeding with many important aspects of coordinating initiation and development of work plan for
TB/HIV program.
These hospitals and health centers do not only service personnel from these forces and their dependents,
but also civilians living in the vicinity of the health facilities. The hospitals offering district level services with
the largest hospitals, Kilwa Road Police and Ukonga Prison Hospital, are both located in Dar es Salaam,
and serve the role of national referral centers for these forces. With an average HIV prevalence of six to
seven percent, Tanzania is amongst the hardest hit countries in Africa. The rates are thought to be higher in
the Uniformed Forces. PAI is poised to continue to address the needs to improve coverage and access, and
to strengthen and expand care and treatment activities in the Police and Prison hospitals and health
centers/satellite sites across Tanzania for their personnel and civilians, including inmates. PAI's
contributions ensure a close service linkage of the HIV program of these forces being implemented in line
with the national Health Sector HIV strategy.
A HIV/AIDS Policy to make HIV testing an integrated part of the yearly medical check-up for all Police,
Prisons and Immigration personnel is expected to be authorized within 12 months. Consequence of the
policy will be that large numbers of personnel will be tested and that an extensive increase of HIV+ and TB+
persons who need care and treatment can be expected.
Approximately 40-50% of TB patients are HIV-infected and, conversely, it is estimated that roughly one-third
of HIV-infected patients develop clinically-overt TB. Expanded case identification and treatment of TB is
needed in order to reduce morbidity and mortality associated with HIV infection. In addition, aggressive HIV
counseling and testing of TB patients represents an important public health strategy which will be key in the
further identification and treatment of other HIV-infected individuals. The program is planned to start in
September 2007.
ACTIVITIES: 1) Assesments/reassessments, refurbishing, furnishing of patient counseling rooms at 16 new
Activity Narrative: satellite sites/health centers
2) Training/retraining of staff at five Police hospitals and eight of their satellite sites/health centers and five
Prison hospitals and eight of their satellite sites/health centers will be organized. Four clinicians and two
laboratory technologists from 10 hospitals along with two clinicians and one laboratory technician from 16
health centers (60 + 48 = 108 in total) will undergo two to four week trainings. Health care providers of the
counseling and testing centers (CTC) will be trained on TB diagnostic methods to increase detection and
referral of TB cases among their HIV positive patients. Health care providers of the TB-Units will be trained
on provider initiated HIV testing and counseling of all confirmed TB positive patients.
These trainings will be organized in collaboration with the TB Unit of the National AIDS Control Program
(NACP) and the National TB and Leprosy Programme (NTLP).
3) Providing microscopes for TB diagnosis, lab-materials and protective safety gear and support to improve
laboratory capacity for TB diagnosis at all 26 health facilities. Kilwa Road Police and Ukonga Prison
Hospital will serve as the coordinating bodies for services and oversee quality assurance following national
standards for follow-up at district or regional hospitals.
4) TB/HIV patients will receive cotrimoxazole prophylaxis administered in accordance with existing NTLP
guidelines.
5) Establishing a referral system for HIV+ persons from the 16 health centers to the 10 Police and Prisons
hospitals and/or to nearby Regional and District hospitals: for CD4 testing and for care and treatment of
complicated cases.
6) Conducting community education and Open House days to increase access to services and partner
testing. Military personnel, their dependents and civilians living in the vicinity of the hospitals and health
centers will be informed through ‘Open House' days and other awareness campaigns for each center.
Information about the available services of the facilities, including HIV-screening, PMTCT and TB treatment
will be presented and promoted through drama, music and other presentations.
7) Nutritional support and infant feeding.
8) IT, Data management and data-handling for M&E and patient and program monitoring purposes
9) Project management.
LINKAGES: Administration of the hospitals and health centers of the Uniformed Forces is not under the
MOHSW but under the respective Ministries of these Forces (Defense, Security and Home Affairs). TB/HIV
services under this Program will ensure a close linkage with national HIV/AIDS and TB strategies and
programs of the TB Unit of the NACP and the National TB and Leprosy Programme (NTLP).
Coverage will increase through the 10 military hospitals and 16 health centers. All HIV-infected men and
women will be referred for further evaluation and qualification for TB treatment and ART within the facility.
Linkage will be strengthened with prevention activities under the HIV/AIDS Program of Police and Prisons,
including promotion and counseling of preventive measures for HIV+ persons, provider-initiated counseling
and testing (PITC), counseling and testing (C&T), PMTCT, TB/HIV and OVC.
Linkages will be established as well as referrals for HIV+ patients from the satellite sites to Police and
Prison hospitals or District and Regional hospitals for CD4, TB testing and complicated cases.
support organization or social support organization is allowed to work/operate within the military barracks.
However, for clients in the surrounding communities, we anticipate forming linkages with existing local
NGOs operating in those communities to ensure continuum of care.
Linkages have been, and will be established with the Regional and District Health Management teams for
supportive supervision purposes and technical assistance.
CHECK BOXES: The areas of emphasis were selected because the activities will include support for
training of medical staff, purchase of TB-specific laboratory diagnostic equipment and reagents,
consumables for HIV confirmatory diagnosis and isoniazid (INH) and cotrimoxazole for treatment and
prophylaxis purposes. It is expected that a total of 1,500 people, representing approximately 50% of the
3,000 HIV-infected patients who will be on care or treatment by September 2009, will be found to be
coinfected
with TB and will require TB services.
M&E: Data will be collected both electronically and by paper-based tools. All sites use the paper forms
developed by National TB and Leprosy Program (NTLP) and NACP. TB screening and HIV-screening
registrars need to be adapted to keep track of TB+ patients referred for HIV-screening and HIV+ patients
referred for TB-screening. Registrars need to be checked by a member of the referring clinic to ensure that
referred patient reached.
On-site data entry will take place. All sites will be provided with PCs, a database and output functions as
developed for the National C&T program. 52 Data clerks from the 10 hospitals and the 16 health centers will
be all trained by or in collaboration with UCC. PAI and UCC will provide supportive supervision and the
hospitals will support the satellite sites. Data will be provided to NTLP, NACP and OGAC for reporting
purposes.
SUSTAINAIBLITY: PAI will encourage the Office of the Director Medical Services of Police and of Prisons to
integrate HIV/AIDS TB harmonization activities in their Health Plans and budgets at the facility and national
level. To improve administrative capacity, PAI will work with the respective authorities to build local
authority's technical and managerial capacity to manage the program.
Activity Narrative: The facilities provide staff and health infrastructure. Most costs of this program are for training and for
infrastructure improvement. Investments are done at the start-up phase of the program. Turnover of
medical staff is low. Training is needed. Once trained, this capacity will stay within the forces.
Health facilities of the Military Forces are under the administration of the Ministry of Defense, not under the
Ministry of Health. This HIV/TB program will be implemented under the rules, regulations and guidelines of
the National AIDS Program and NTLP. Training, treatment, treatment guidelines, M&E etc is all part of one
National Care and Treatment Program
Continuing Activity: 16444
16444 16444.08 U.S. Agency for PharmAccess 7408 7408.08 $300,000
Table 3.3.12:
THIS IS A NEW ACTIVITY
TITLE: Protection of Orphans and Vulnerable Children through Child-Friendly Police Program
NEED and COMPARATIVE ADVANTAGE: Parents are ideally the primary caretakers and guardians of
their children; however, friends, neighbors, and family members often contribute to the safety and wellbeing
of the 10%-12% of children who are orphaned or made vulnerable because of a parent's chronic illness or
death. Extended families and community caretakers, who have taken in orphans and provided safety nets,
are being overwhelmed as the numbers of needy children increase. According to the rapid assessment of
orphans and vulnerable children (OVC), more than 50% of OVC are cared for by their grandparents, many
of whom struggle to provide sufficient care. A UNICEF-funded situational assessment of most vulnerable
children in six districts indicated that vulnerable children are susceptible to sexual abuse, child domestic
work, and child commercial sex work. Sometimes children resort to living on the streets, especially in urban
settings, to avoid extended family harassment and abuse. In some instances, vulnerable children have
engaged in delinquent behavior, and end up in conflict with the law or even in prison.
Aside from the trauma and bereavement that OVC suffer at the loss of parents, many also lack authority
figures. This situation is exacerbated by Tanzanian customs and cultural norms that prevent children from
talking to their elders. Tanzania also lacks a well-developed social protection system for children, and only
one-third of the 133 districts even have a social welfare officer. Once children begin misbehaving, most
caregivers and basic service providers lack the adequate skills to ameliorate the behavior problems. In
addition, there is not a well-established infrastructure to support referrals if a child is in need of protection,
including legal aid and police intervention. Influential service providers, such as police, health workers, and
teachers could make a difference in the lives of vulnerable children, so as to avoid delinquency or
imprisonment, but need the tools to be effective. Police, who are on the front line when children are in
trouble, could play a pivotal role.
Issues of different forms of child abuse have recently captured public attention through increased visibility in
electronic and print media. There are instances where police, residential care service providers, and prison
wardens, who should be protectors of those under their care, are among the perpetrators of offences
against children. The police also lack an understanding of social problems and the etiology of behavior that
leads children and youth into lives as commercial sex workers or into lives on the streets. During city
patrols, police frequently arrest, harass, and abuse the child commercial sex workers and street children,
and report them as delinquents. With the number of street children, abused minors, and delinquents on the
rise, policymakers, law enforcers, and service providers at all levels are increasingly at a loss as to how to
handle the situation.
Training of police officers and others who conduct assessments with children is of critical importance to
protecting them. This training is followed by linking with colleagues in social work, health, education and a
range of voluntary organizations that could assist in reversing undesirable behavior before it is too late.
PharmAccess International (PAI) presently implements HIV/AIDS prevention, care, and treatment activities
through workplace programs for police, prison guards, and immigration officials (funded by USAID) and the
military (funded by DOD). The program would capitalize on PAI's expertise and existing collaboration with
police, prisons, and immigration to implement the child-friendly police program. In addition, it would take
advantage of the PAI experience in Mbeya, where their program supports OVC who are living in military
barracks.
ACCOMPLISHMENTS: This is a new activity. However, PAI has already contributed in FY 2008 to care for
OVC linked with programs for the Tanzanian People's Defense Force for in Mbalizi, Mbeya. Plans are also
underway to create successful linkages between PAI with the Dutch Government to implement OVC
activities. That program will include extending the basic healthcare coverage package by covering care
costs incurred by households who are willing to take in OVC.
ACTIVITIES: In FY 2009, PAI will undertake the following activities in support of child protection in order to
initiate a child-friendly police program. Police stations have been selected for this project, as they are all
over Tanzania, in most wards. PAI will:
1. Work with the Juvenile Justice Unit and the Child Welfare Unit in the Department of Social Welfare
(DSW), the Tanzania Police Force (TPF), and selected children in prisons to develop a supporting guideline
for "Interactive Services for Children." This will provide basic guidance on appropriate and effective
language and handling of children when police interact with them.
2. Develop a team in the pilot area including police, educators, health workers and community people who
are willing to work as the child protection team and be trained together in principles and techniques of child
protection and juvenile justice.
3. Work with the DSW and TPF to develop a strategy for Police and Prisons to work with children to ensure
the supporting guideline to be developed is integrated in the daily police job descriptions, trainings, and
routines.
4. Train police trainers of trainers, peer educators, and recruits on how to work with children and OVC and
in the team approach to child protection.
5. Train 100 police, prison personnel, and available community team members in appropriate "handling" of
OVC, abused children, street children, and other vulnerable children during detention and in the streets
using the developed guidelines.
6. Support the TPF to establish the national directory of referral sites for child support and protection
services, including the Most Vulnerable Children's Committees in the villages.
7. Pilot the plans for child-friendly police program in the vicinity of Kilwa Road Police and Ukonga Prison.
8. Share experiences and training materials with a comparable program in Zambia and investigate other
countries' "best practices."
9. Integrate appropriate "handling" of OVC in the peer education life skills training program for police and
prison officers.
Activity Narrative: To the extent possible, a team approach will be explored to support the role of the police in dealing with
vulnerable children. Though human resources are in short supply in Tanzania, wherever possible
community teams of health workers, teachers, and social workers or paraprofessional social workers should
be trained to work together, to understand the perspective of each discipline and to improve the response to
abused, neglected, and delinquent children and youth through a collaboration of community services. By
working together, members of the team can provide more comprehensive service while minimizing the
trauma of multiple interviews as an investigation is completed.
Teams also allow the possibility of a mixed gender response to children who are abused. Sexually abuse
females may be reluctant to talk with a male police officer and be more comfortable talking to a para-social
worker or an educator or health provider. Delinquent youth may benefit from a joint police /education
approach.
Approaches to be employed in designing this activity will consider the underpinnings of the UN Convention
on the Rights of the Child. A team approach creates the nucleus of a community group, which can develop
expertise in this philosophy, and help educate other community members.
LINKAGES: PAI will work in collaboration with the DSW and TPF to develop the police "Interactive Services
for Children" guidelines and to make linkages with other professionals (health professionals, teachers,
social workers/paraprofessional social workers) who can work to support the role of the policy in addressing
the behaviors of vulnerable children. In addition, PAI will collaborate with police and prison training
institutions to integrate the guidelines and approaches to reduce gender-based violence in the peer
education and life skills training programs. PAI will continue to collaborate with partner organizations for
M&E: The national OVC Data Management System will be used to record the number of police officers
trained on the interactive services with children. Specifically, PAI will report on the number of police stations
and prisons that receive training, and utilize the developed user guide manual for the "Interactive Services
for Children" and a child support services referral directory. In addition, PAI will develop specific tools to
capture the number of referrals which were used for children in the trained police stations and prisons, and
number of police stations which established a child supporting unit.
SUSTAINABILITY: This is a pilot program to be implemented in the city of Dar es Salaam. The lessons
learned are expected to be integrated in the TPF strategic plans for further nationwide scale up in all the
prisons and police stations.
Estimated amount of funding that is planned for Human Capacity Development $2,625
Table 3.3.13:
THIS IS AN ONGOING ACTIVITY FROM FY 2008. ONCE AN AGREEMENT IS AWARDED, ACTIVITIES
WILL PROCEED DURING FY 2009. ACCOMPLISHMENTS WILL BE REPORTED IN THE FY 2008 APR.
PLEASE NOTE THAT THE ACTIVITY NARRATIVE REMAINS UNCHANGED FROM FY 2008.
TITLE: Providing Insurance to Strengthen Households with Orphans and Vulnerable Children (OVC).
PEPFAR Tanzania has worked with the Government of the Netherlands to apply an integrated plan to
provide direct support to HIV/AIDS-impacted people, while simultaneously investing in the development of a
robust private sector health care capacity. Recent studies show that at the country's current level of
development, the private sector must be leveraged to assist in health care provision if the government is to
realize its goal of ensuring access to health care services to all who need it.
provided health insurance to 50,000 low-income wage earners by leveraging the in-place program to offer
insurance benefits to caregivers and their families who are willing to take in OVC. The program provides
insurance premium subsidies, which the private sector in-country insurer matches by agreeing to take only
3%, profit rather than the standard 18% (resulting in a 15% insurer contribution).
ACCOMPLISHMENTS: new activity
ACTIVITIES: The USG/Tanzania has linked with the Dutch Government to implement an integrated plan to
provide direct support to HIV/AIDS-impacted people while simultaneously investing in the development of a
robust private sector health care capacity. This activity will extend the basic health care coverage package
by covering the care costs associated with households who are willing to take in OVC. The care will be
provided in certified private, non-governmental health facilities, as well as through home-based care
providers. The arrangement will have the dual effect of increasing household support for families caring for
OVC, while also encouraging the development of a parallel private sector health care network designed to
encourage and support employer-sponsored health care coverage. No targets have been set because the
beneficiaries will be served by USG-funded implementing partners and will be reported under those
partners programs.
LINKAGES: This activity links to the other insurance program activities in treatment and the on-going
activity in counseling and testing. Collaboration on the pilot programs will occur with Deloitte TUNAJALI
OVC activities, and possibly with other USG-funded OVC implementing partners.
CHECK BOXES: The program will serve OVC and their households, strengthening the household and
contributing to economic security.
SUSTAINAIBLITY: By building interest in health insurance, the program is expected to strengthen families
and develop the practice of using health insurance to strengthen health services.
Continuing Activity: 17032
17032 17032.08 U.S. Agency for PharmAccess 7408 7408.08 $200,000
Minor changes compared to the FY08 COP, except the increase in number of sites, from 10 in FY07, to 26
in FY08 to 46 in FY09. The increase in sites has consequences for the budget.
TITLE: Counseling and Testing services at Police and Prisons health facilities
NEED and COMPARATIVE ADVANTAGE: With more than 65,000 police, prison and immigration officers
and 40,000 prisoners, this population constitutes high-risk because of their migratory nature, lack of family
support during assignments and imprisonment, as well as the ‘power of the uniform'. HIV/STI prevention
and education for counseling and testing (CT) will be targeted at all employees, with a special focus on
recruits and those who are transferred to service outside their region, those sent on missions, and
prisoners. In FY08 provider-initiated HIV testing and counseling (PITC) will be introduced; police and prison
health facilities need to be prepared for a stark increase in capacity to test and in an increase in patient
load. Immigration officers will be informed about the availability of HIV/AIDS services provided by Prison
and Police health facilities and will be encouraged to use these services.
ACCOMPLISHMENTS: PharmAccess initiated CT services in 8 health facilities with funds from Global
Fund. 320 persons from the police, prisons and from the surrounding communities have tested HIV+ at
these sites so far. The prevention program for the Police, Prisons and Immigration Forces, funded by
PEPFAR, began in June 2008.
1) CT services at 23 Police/23 Prison facilities under FY09 (five Police/five Prison facilities under FY07, 13
Police/ 13 Prison facilities under FY08): 1a) Renovate CT rooms at 20 satellite sites/health centers; 1b)
Conduct initial and refresher CT and PITC training of 104 medical staff; 1c) Strengthen the referral system
between the health facilities and District/Regional hospitals for ANC services and adult/infant diagnosis,
ART and TB/HIV.
2) Provide CT to 4,000 individuals through Police/ Prisons health facilities: 2a) Reinforce PITC as part of all
in- and out-patient services; 2b) Include counseling of HIV+ persons on risk behavior and HIV prevention;
2c) Continue to improve patient record/data collection, working with Police and Prison HQ and facility staff
to record and analyze data; 2d) Improve quality of services through 3-monthly meetings with
representatives of the sites and experts (ART developments, pediatrics, AIDS and TB); 2e) Monitor quality
of services through linkages with regional supportive supervisory teams and Ukonga Prison and Kilwa Road
Police Hospital.
3) Develop community linkages to improve service up-take and strengthen prevention component: 3a)
Conduct training for nurse-counselors from each CT site for home visits to offer CT to relatives of HIV+
index patients; 3b) Train 200 volunteers from the barracks in home visits and home-base care; 3c) Organize
post-test clubs (separate ones for negatives and positives); 3d) Provide prevention messages targeted to
the clients' HIV status upon testing, encouraging negatives to remain negative and prevention with positives
counseling; 3e) Organize HIV/AIDS sensitization campaigns, advocating CT, through home-visits and
"community events" in the barracks.
4) Ensure proper lab capacity is developed at all eight hospitals for HIV/STI screening purposes: 4a)
Provide CD4 equipment to one Police and one Prison hospital; 4b) Provide standard operating procedures
and training in QA/QC at Regional and District hospitals; 4c) (Re-)train technicians in TB, STI and HIV
diagnosis, routine laboratory testing and equipment maintenance; 4d) Procure reagents, consumables and
safety gear (gloves, materials for safe disposal of sharps and other wastes) when not available through
LINKAGES: The 46 health facilities will be linked with: 1) Organizations of women living in the barracks
around these police stations and prisons (200 women will be trained and involved in providing HIV/AIDS life
-skills materials). 2) NGOs and community support organizations will conduct home-visits and provide home
-based care. 4) Condoms will be obtained through MSD and District Medical Officers. 5) CT activities will
be linked to HIV prevention, PMTCT, and care and treatment activities. 6) Expansion of CT will ensure a
close linkage of the Police and Prisons' HIV/AIDS programs with national strategies implemented under the
Ministry of Health and Social Welfare.
M&E: Data will be collected electronically and by paper-based tools. All sites will have laptops with a
facility staff, Police and Prison HQ team, NACP and the district and regional management teams.
SUSTAINAIBLITY: In the Police, Prisons and Immigration Forces, turnover of medical staff is low. Once
trained, this capacity will stay within the Forces. PAI works with administrators to build local authority's
capacity to manage the program as well as incorporate data collection and analysis as part of regular health
service planning and management.
TITLE: Counseling and Testing Services at Police and Prison Health Facilities
NEED and COMPARATIVE ADVANTAGE: With more than 65,000 police, prison, and immigration officers,
this population constitutes high-risk because of their age, the migratory nature of their work, lack of family
support during assignments, as well as the ‘power of the uniform', etc. HIV/AIDS and STI prevention, ABC,
other ‘life-skill' education messages and advocacy for counseling and testing will be targeted at all
employees, with a special focus on recruits, those who are transferred to service outside their region, those
sent on missions, and those sent to training camps. A HIV/AIDS policy introducing yearly HIV testing
(mandatory) and safeguarding the position of those HIV+ persons is currently being considered by the
management of these forces.
ACCOMPLISHMENTS: PharmAccess has managed to initiate VCT services in eight health facilities for
these forces (four for the police and four for the prisons) with funds from Global Fund. One hundred and
forty persons from the police, prisons, and from the surrounding communities of the respective health
facilities have been HIV+ at these sites. PAI has started providing nutritional supplements to 100 PLHA in
these sites. This activity is funded by Global Fund round four and subcontracted by PAI to Counsenuth
Activity Narrative: ACTIVITIES: PharmAccess provides services through the police and prison health facilities and links
immigration officers and employees to these sites.
With FY 2008 PEPFAR funding PharmAccess will:
1) Initiate counseling and testing services at four additional police and prison facilities and eight police and
prison facilities under FY 2009. Provider-initiated testing and counseling (PICT) will be offered free of
charge to servicemen and women, their dependents, and civilians living in the communities surrounding
these facilities. Civilians make ample use of the health services of the forces. Testing for new conscripts is
mandatory. Only conscripts who test HIV-negative join the police and prison forces. Testing and counseling
will be in accordance with the latest MOHSW algorithm and guidelines, including simple provision of blood
samples (needle prick rather than blood draw), same day testing and results, parallel testing with SD
Bioline, and confirming with HIV Determine. All sites will be provided with test kits and safety gear (gloves,
materials for safe disposal of sharps and other wastes, etc.). HIV-screening will be linked with prevention
activities and will be used as entry point activities related to gender-based violence (GBV) for both offenders
and victims. 2) Capacity building is a key element of the program. Four week PICT trainings will be
organized, following the curricula of the National Care and Treatment Program. Four medical officers, nurse
counselors, and laboratory technologists from the 16 new health centers will be trained and four from the
sites which started already will be retrained for a total of 96 health care workers. 3) Refurbishing of 3-4
counseling rooms for the 16 new sites is needed so that confidentiality for HIV-screening and for treatment
counseling is ensured, proper testing can take place, and stocks of medicines and laboratory materials can
be adequately stored. 4) Organize HIV/AIDS sensitization campaigns; organize home-visits and home-
based care services etc. in the barracks. Police and prison officers will be trained and organized to operate
as home-based care, nutritional and other support providers within the barracks. No NGO or other social
support organization is allowed to work/operate within the military barracks. For civilians living in the
surrounding communities, we anticipate to form linkages with existing local NGOs operating in those
communities so as to ensure continuum of care. 5) Organize post-test clubs and conduct counseling for
HIV+ individuals on the prevention of HIV transmission. Distribute life-skills and IEC materials to all who test
negative or positive. 6) HIV+ persons will receive care and treatment services at the facilities. Patients will
be referred for TB-testing within the site and will be referred to nearby regional and district hospitals for CD4
-testing and start of ARV treatment. When patients are stable on ART they will be referred back to the
health center. 7) Conduct community education and open—house days to increase access to services and
partner testing. Police and prisons personnel, their dependents, and civilians living in the vicinity of the
hospitals and health centers will be informed through ‘open house' days and other awareness campaigns of
each center. Information about the available services of the facilities including HIV-screening, ART, PMTCT,
and TB treatment will be presented and promoted through drama, music, and other presentations. 8)
Supportive supervision: teams of experts of the police and prisons HQ, referral hospitals, and PAI will
assess the capacity of the sites, develop strengthening plans, plan and oversee refurbishments, trainings,
M&E, relate with district and regional HMTs and regional partner organizations in close collaboration with
staff from the sites.
LINKAGES: Administration of the hospitals and health centers of the uniformed forces is not under the
MOHSW but under the respective ministries of these forces. TB/HIV services under this program will ensure
a close linkage with national HIV/AIDS and TB strategies and programs of the TB unit of the NACP and the
National TB and Leprosy Programme (NTLP). HIV-infected men and women will be referred for further
evaluation and qualification for PMTCT, TB, and malaria screening and treatment and ART within the
facility. Linkage will be strengthened with prevention activities under the HIV/AIDS program of police and
prisons, including promotion and counseling of preventive measures for HIV+ persons. Linkages will be
established as well as referral for HIV+ from the satellite sites to police and prison hospitals or district and
regional hospitals. For clients in the surrounding communities, linkages with existing local NGOs operating
in those communities will be formed as to ensure a continuum of care. Linkages have been and will be
established with the regional and district health management teams for supportive supervision purposes
and technical assistance. PharmAccess will explore linkages with the UN Office of Drug and Crime in order
to be able to extend these services to prisoners in the future.
M&E: The sites PAI work will use CT registrars and the national CTC monitoring system. By supporting the
national CT MS, PAI builds local capacity and helps to strengthen the national M&E system. An electronic
system will be developed by PAI at the facility-level in collaboration with UCC and NACP, as has been done
for the DOD/TPDF Program. National CT guidelines and training materials will be used to strengthen M&E
capacity in these facilities.
SUSTAINABILITY: PAI will encourage the Office of the Director Medical Services of Police and of Prisons to
integrate HIV-screening activities in their health plans and budgets at the facility and national level. To
improve administrative
Continuing Activity: 13393
13393 12466.08 U.S. Agency for PharmAccess 7408 7408.08 $400,000
12466 12466.07 U.S. Agency for PharmAccess 8841 8841.07 PharmAccess- $220,000
International USAID
Construction/Renovation
Table 3.3.14:
