THIS ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

Work with district- and ward-level groups will have a particular emphasis this year on using public

expenditure tracking tools, building on USAID/Tanzania's particular success under the Millennium

Challenge Account Threshold Program in using public expenditure tracking systems (PETS) to promote

local-level accountability in resource use. Support for the training and formation of public expenditure

tracking committees will encourage accountability and good governance in health spending by providing

grassroots oversight mechanisms. PETS committees will work with Council Multisectoral AIDS Committees

(CMACS) and establish liaison with District Management Health Teams to ensure proper accounting of

health revenues and expenditures. Such mechanisms also will be useful in local-level monitoring of the

implementation of Global Fund for HIV/AIDS, Tuberculosis and Malaria (GFATM) monies by GFATM

recipients and sub-grantees.

*END MODIFICATION*

TITLE: Building an Enabling Environment for the Scale Up of Prevention, Care, and Treatment of HIV/AIDS

NEED and COMPARATIVE ADVANTAGE: The policy environment in Tanzania still presents many

challenges. The long-awaited AIDS Bill has not yet been signed into law. Many other policy barriers exist

in terms of use of lay counselors/testers, use of opioids for pain management, task shifting among health

providers, the need for a children's bill, stronger anti-stigma and anti-discrimination measures, provision of

nevirapine on first diagnosis, etc. As policy issues are identified, there is need for advocacy and direct

intervention to promote Government of Tanzania (GoT) policy change.

ACCOMPLISHMENTS: This activity will be competed for FY 2008.

Past efforts provided by POLICY II and HPI have catalyzed action among parliamentarians to generate

support for the omnibus AIDS Bill. With assistance from POLICY II, Ministry of Justice and Constitutional

Affairs (MOJCA) drafted a Bill presented in parliament this year. HPI trained policy champions, sharpened

NGOs' advocacy skills, and sensitized parliamentarians to provide input to AIDS Law processes.

Community groups were capacitated to provide input to the Bill through zonal meetings. HPI built capacity

of a range of national and community groups to fight stigma/discrimination. Through HPI activities, religious

leaders in the two regions have promoted public pronouncement of HIV status and formed post-test clubs.

HPI has also worked with media, faith-based organizations (FBOs), and networks of People Living with

HIV/AIDS (PLWHA) for advocacy and to reduce stigma and discrimination.

ACTIVITIES: With FY 2008 funding, the program will:

1) Identify key policy barriers for the scale up of prevention, care, and treatment activities, and develop

interventions to address those policy barriers: The partner will be proactive in identifying issues and well

considered approaches to address them. In addition, the partner will be involved in discussions with the

USG Strategic Results Units (Clinical Services, Community Services, Prevention/Testing) and the Cross

Cutting Strategic Unit encompassing Lab, Human Capacity Development, Strategic Information, Logistics,

etc.) to ensure that key policy barriers are identified. The partner will be integrally involved in discussions

with the technical teams charged with achieving scale-up results, as well as their key implementing

partners.

2) Work with influential groups: in serving in a potent advocacy role and as catalysts for change, the partner

will need to work closely with influential groups, such as parliamentarians, the press, organizations of

PLWHA, youth organizations, community organizations, religious organizations, and official bodies such as

the Council Multi-sectoral AIDS Committees (CMACS) and important government bodies. For example, to

move the HIV & AIDS Law passage/implementation along, the process has been arduous in terms of

necessary advocacy and technical assistance at every stop along the way from development to passage.

Parliament and other national authorities: This activity will involve coordination, networking, community

mobilization and planning with national authorities and, in particular, with Members of the Tanzanian

Parliament (MP). The goal of the working with the MPs will be to ensure they are positioned to advocate for

the meaningful involvement of PLWHA and affected communities in all aspects of the HIV/AIDS response.

MPs take an active role in advocating for the accountability of governments, private and public sector

agencies and others. They must also be accountable to the communities they are part of, work with,

represent, and serve, including those affected by or infected with HIV/AIDS.

Journalists and the Media: the partner will be expected to work closely with journalists to develop strong

relationships for advocacy and critical/factual coverage of HIV/AIDS issues. Since public opinion and public

education is so closely tied to the media, it provides an opportunity to ensure factual and complete reporting

of issues around health behaviors, and that will help to mobilize the public around HIV/AIDS, orphans and

vulnerable children, exposed pregnant women, etc. Responsible reporting of the news can be turned into

an educational opportunity for the public, and this should be a skill that journalists possess. In addition, the

partner will work with the Association of Journalists against HIV/AIDS in providing technical assistance to 20

media houses, predominantly in the private sector, in the implementation of workplace policies.

PLWHA: The activity will build capacity of PLWHA groups in selected districts to equip them with leadership

and advocacy skills to use evidence-based information for policy dialogue. For example, work with National

Council of People Living with HIV/AIDS (NACOPHA) to strengthen institutional capacity of PLWHA groups;

engage PLWHA groups in policy dialogue with district executives and councilors towards improving HIV

prevention, care, and support services, etc. Additional outcomes expected to result from this activity include

fostering meaningful involvement of PLWHA and affected communities, including the protection and

promotion of human rights in the workplace. The rights-based approach also presumes a gender

perspective, recognizing that both biological and socio-cultural factors play a significant role in influencing

the differential vulnerability to HIV infection and the impact of HIV/AIDS on men and women, boys and girls.

Activity Narrative: Stigma/Discrimination: The activity will take a new direction to strengthen the GoT's ability to provide

recourse in cases of discrimination in the workplace. This activity would build on the Millennium Challenge

Account (MCA) Threshold Program's rule of law initiative that focuses on curbing corruption, improving the

climate of human rights protection, and improving the efficiency and capacity of legal sector institutions

including the judiciary and the Department of Public Prosecution. A person with expertise in law and

litigations, human rights protection, investigations, and institutional capacity building will be seconded to the

Office of the Human Rights Commissioner, Commission on Human Rights and Good Governance

(CHRAGG) in order to build the capacity of the CHRAGG to respond more efficiently to human rights

complaints from PLWHA, especially women. The embedded advisor will assist the CHRAGG to conduct

investigations into, among other things, discrimination against PLWHA including illegal firings, illegal denial

of services, and inheritance claims. Where necessary, the advisor will also assist the CHRAGG to initiate

and conduct litigation against those engaging in discriminatory practices. The advisor will conduct training

of Commission investigators and also provide direct, day-to-day mentoring of the Commission's complaint

processing mechanisms, investigations into discrimination claims, court filings, and community outreach

activities. The mentoring of CHRAGG will focus on improving CHRAGG's outreach capacity and its legal

services for women living with HIV/AIDS who have been denied legal rights or have been discriminated

against in the workplace, within the health care system, accessing to community services, or in other

contexts.

Youth organizations, community organizations, religious leaders and official bodies such as the Council

Multi-sectoral AIDS Committees (CMACS): The partner will provide technical assistance to mobilize

communities against stigma and discrimination. The activity will develop packages for religious leaders to

facilitate community mobilization on stigma and discrimination reduction. In addition, religious organizations

such as BAKWATA and Christian Council of Churches (CCT) will be funded to train mosque and church in

HIV/AIDS and counseling in each of the districts. Other activities will help to disseminate materials for the

training of Madrasas and Sunday school teachers, as well as techniques for organizing interfaith Children's

festivals in stigma and discrimination.

3) Other mobilization/advocacy: Work with the Women's Legal Aid Center/Tanzanian Gender Networking

Program, and the National Institute of Medical Research to build capacity of community groups to advocate

against gender-based violence (GBV), a major contributor to women's vulnerability to HIV/AIDS. The

partner will build capacity of identified champions in the districts, focusing on male norms exacerbating

sexual coercion and GBV. Special awareness events will be organized around GBV.

LINKAGES: The activity will be tied to GoT ministries (e.g., MOJCA) and will collaborate with TACAIDS in

implementing of the National Multi-sectoral Strategic Framework through CMACs. TBD will work closely

with Tanzania Parliamentary Associations on HIV/AIDS (TAPAC). The discrimination work will tie with both

the MCC and Stradcom (for public messages).

M&E: Approximately five percent of the budget for this newly competed activity will used for M&E purposes

including documentation of project successes and results.

SUSTAINAIBLITY: Capacity strengthening to improve policy and address gender, advocacy,

stigma/discrimination, and NGOs/CSOs will contribute to a sustainable enabling environment.

Apr 09 Reprogramming: Action re-names TBD to The Futures Group (ITT approved).

New/Continuing Activity: Continuing Activity

Continuing Activity: 13594

Continued Associated Activity Information

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

System ID System ID

13594 5087.08 U.S. Agency for The Futures 6561 3616.08 Health Policy $1,775,000

International Group Initiative (HPI)

Development International

7806 5087.07 U.S. Agency for The Futures 4581 3616.07 Health Policy $1,578,686

International Group Initiative (HPI)

Development International

5087 5087.06 U.S. Agency for The Futures 3616 3616.06 Policy Project $1,000,000

International Group

Development International

Table 3.3.18: