ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

This is an ongoing public-private partnership activity that will continue to build on the foundation put in place

in FY 2008.

ACCOMPLISHMENTS: The USG support provided partial tuition through a block grant at Weill Bugando

University College of Health Sciences (BUCHS) for eight health worker cadres, including: 91 Assistant

Medical Officers, 19 Anesthesiologists, 107 lab technicians, 212 medical doctors, 122 nurses, 25 post-

graduate specialists, 92 pharmacists, and 46 radiologists. At a time when there is significant need for

greater throughput at Tanzanian training facilities for all of these cadres, this is an important contribution. In

addition, Touch supported visiting US faculty from Cornell University at BUCHS to help improve the quality

of medical training. Lastly, Touch initiated work on their Lake Zone Initiative, performing a comprehensive

diagnostic on the systems needs for effective and comprehensive health services, using pro-bono

consultation from McKinsey and Company with travel and related costs supported by the USG.

ACTIVITIES: In FY 2009, the Touch Foundation will:

1. Support additional pre-service training of health workers across eight cadres at BUCHS. This activity will

provide support to at least 817 students in the 09/08-08/09 academic year, and 885 in the 9/09-08/10 year.

Overall, this activity will amount to nearly half of the US Government (USG) portion of funding, primarily for

student scholarships and university operations. Particular efforts will be made to identify children who have

lost one or both parents to fill at least 20 of those slots.

2. Facilitate a structured medical twinning program, bringing US expertise and teaching methods to BUCHS.

This twinning program will be allocated about 20% of the total USG funding, with that funding focused on

supporting a visiting professor for a year to provide instruction in US-based teaching methods, diagnosis,

and patient care. This individual will supplement the three other physicians-in-residence who will continue to

work and teach at BUCHS with complementary Touch Foundation support. This twinning program and

faculty support will be linked with the pediatric faculty provided by the Baylor International Pediatric AIDS

Initiative (BIPAI).

3. Develop cascaded training, leveraging regional and district hospitals as clinical sites to maximize the

capacity of training schools. Beginning in early FY 2009, the Touch Foundation expects to be working

through a Gates Foundation learning grant to develop a cascaded training model to pilot in the Lake Zone,

aimed at increasing the number of clinical care facilities that are used as clinical training sites for health

workers. In time, this will be linked with the cascaded support to be provided in pediatric AIDS by the BIPAI

Initiative. USG funds will be used to initiate a pilot project based on the outcome of the Gates -funded

diagnostic in order to put learning into action.

4. Help to strengthen approaches to increase retention of health workers and deal with the serious issues

that result in some 12% to 25% of deployed health workers leaving their jobs annually. Touch will learn

from the experiences of the Capacity Project, which is presently working on retention interventions at the

district level, as well as assessments of the impact of those interventions conducted by Tanzanian National

Institute of Medical Research (NIMR). Touch will develop an implementation plan for a pilot project

targeting retention of health workers in the Lake Zone through use of performance management, incentive

alignment, etc., drawing on the diagnostic study performed by the McKinsey team in FY 2008 and the

experiences of the Capacity Project. With USG funding, Touch will initiate planning for the pilot project, in

partnership with the district-level leadership in two districts of the Lake Zone. The pilot will be evaluated

and lessons learned will be shared with the Capacity Project, NIMR, the President's Office for Public

Services Management, the Prime Minister's Office for Regional and Local Government, and the Ministry of

Health and Social Welfare Department of Human Resources. Expansion of successful practices will occur

in FY 2010. In the meantime, the Touch Foundation will assist in advocating for accelerated reform of the

compensation package and payment mechanisms for health workers to facilitate greater attraction to the

profession and increased retention.

These activities will lay the groundwork for potential expansion of health worker training and manpower

expansion that may be possible through support from the Global Fund Round 8.

*END ACTIVITY MODIFICATION*

TITLE:Human Capacity Building at Bugando and the Lake Zone Catchment Area

NEED and COMPARATIVE ADVANTAGE:

In Tanzania, the severity of the HIV/AIDS problem is compounded by an acute shortage of skilled health

workers. The program at Weill/Bugando strives to increase the numbers of skilled health workers across the

spectrum of medical professionals. They have expanded training capacity at Bugando University College of

Health Sciences from 10 medical students to 60 per class. In addition, they have established a twinning

program with Weill Cornell Medical School to enhance training. Bugando is the second-largest zonal

training and health facility in Tanzania. It trained over 600 HCWs across eight cadres in 2007. Touch has

been working closely with the Ministry of Health and Social Welfare (MOHSW) and Bugando for nearly

three years, and provides on-the-ground management capacity, technical assistance, and funding. Touch

has significant expertise in the Lake Zone and strong relationships with the key players. The combined

experience of McKinsey & Company, the Weill Cornell Medical School, and Touch form a formidable

partner to address human resource issues.

ACCOMPLISHMENTS:

The Touch Foundation has just been awarded a three-year agreement to focus on human resources and

systems strengthening in Tanzania. Therefore, there have been no accomplishments to date with USG

funding.

Activity Narrative: ACTIVITIES:

The program is a Global Development Alliance, partnering the Touch Foundation (and their key private

partners, McKinsey & Company, Citigroup, Stroock & Stroock & Lavan) and the USG to address health

worker and health systems issues in Tanzania.

Key components of the work with Touch will focus on pre-service training of health workers across eight

cadres. Touch expects to train approximately 130 nurses, 100 lab techs, 100 pharmacists, 100 Assistant

Medical Officers, 210 Medical Doctors, 40 post-graduate specialists, 50 radiographers, and 20 anaesthetists

(a total of 750) in Government of Tanzanina (GoT)-accredited programs. The funds requested for preservice

training complements the funds requested by Bugando for in-service training in HIV/AIDS care and

treatment and early infant diagnosis.

In addition, the program will identify ways to help link graduates to health facilities; e.g. through an incentive

packages for deployment to remote, hard to fill posts after receiving full tuition in their training. This is similar

to the arrangement made for clinical staff under the Global Fund sponsored Emergency Hiring Plan. There

has been strong support from the GoT for this approach. In addition, special slots will be allotted to the

training programs for children who have been orphaned.

Trainees from the Bugando University training program will be used to staff various tiers of the health

system to help enrich the staff already assigned there, and to provide experiences to students at all levels of

the health system.

The program will also have a systems strengthening component that will cover primarily the Lake Zone.

Because of the potential for replication in other parts of the country, the program will link with the MOHSW

for scaling up the lessons learned. It will identify ways to provide the appropriate skill mix, staffing, and

support at all levels of the health system from dispensary level up through tertiary care facilities, and

strengthening the referral mechanisms. The program will also leverage the work of the USG partners who

provide clinical services in the Lake Zone.

Lastly, at the national policy level, Touch will assist the USG and USG-funded programs to address the

bottlenecks and barriers to the recruitment process. The issues have been identified through an

assessment done by the Capacity Project, and Touch would leverage their relationships at the national level

to convene a high-level task force to address the issues that preclude the streamlining of many aspects of

the recruitment process.

LINKAGES:

Touch has a formal agreement with the GOT through an MoU with the MOHSW. Touch would also link with

other partners in the area of Human Capacity Development, especially the Capacity Project, and treatment

partners who are involved with Bugando, including AIDSRelief and Columbia University. Touch also works

closely with the six regional governments in the Lake Zone and the RMOs of each region.

CHECK BOXES:

Areas of emphasis selected are based on anticipated human capacity development work.

M&E:

Touch monitors all training activities through an international staff based in Mwanza and our local partners.

Training programs are evaluated in partnership with the Bugando University College of Health Sciences. In

terms of fiscal accountability, Touch reviews each expense on a monthly basis before transferring further

funds. Touch also works to systematically analyze all programs that fail to or succeed in meeting expected

outcomes.

SUSTAINABILITY:

Touch's focus on sustainability relies on strengthening the health system by enabling increased production

of skilled health workers and building management capacity within Tanzania to problem-solve and

implement solutions.

Systemic improvements at Bugando will stimulate best practices in patient care, which can then be

replicated by posting students to other facilities. Touch ensures that, where possible, all elements of the

program are led by Tanzanian university and hospital staff. In addition, Touch operates under the premise

that visiting experts maximize transfer of knowledge.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18649

Continued Associated Activity Information

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

System ID System ID

18649 18649.08 U.S. Agency for Touch Foundation, 7922 7922.08 $1,000,000

International Inc.

Development

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $400,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.18: