Ministry of Health and Social Welfare Mechanism 9917 has been split into two mechanisms to more efficiently manage the mechanisms. Goal and Objectives: The goal of this mechanism is to strengthen the Tanzanian National Health Laboratory Services through the MOHSWs Diagnostic Services Section and the National Health Laboratory Quality Assurance and Training Center which will provide leadership and technical assistance in assuring highly functional and operational national health laboratory services while assuring sustainability and quality systems integration for the support of the HIV/AIDS prevention, care and treatment programs in Tanzania. The national health laboratory services network (NHLSN) in Tanzania consists of tiered system of the National Health Laboratory Quality Assurance and Training Center ( NHLQATC), six referral hospital laboratories (including a referral military hospital), 24 regional and 133 district laboratories located in mainland Tanzania. Some larger health centers have laboratory facilities while dispensaries, supported by nearest district laboratory, perform quick diagnostic procedures not requiring laboratory personnel. The Ministries of Health and Social Welfare (MOHSW) Diagnostic Sections oversee laboratory services at the national and referral level while operations at the regional, district and health center level are administered by the Ministry of Local Government. The NHLSN has been the weakest link in the provision of quality HIV/AIDS Prevention, Care and Treatment due to lack of a centralised public health function, staff recruitment and retention strategies, and limited budgetary allocation. Through PEPFAR funding, MOHSW has developed an operational plan to improve the quality of laboratory services in collaboration with CDC and other Development Partners. Specific objectives for this mechanism include: 1. To expand access and equity of laboratory services to support care and treatment of HIV/AIDS and opportunistic infections including malaria, tuberculosis and HIV/AIDS related malignant tumors in both adults and infants. 2. To strengthen laboratory infrastructure and equipment maintenance services 3. To strengthen laboratory supply chain management system. 4. To increase recruitment, retention and training of laboratory and biomedical engineering personnel through linkages with existing programs, training institutions within and external to Tanzania. 5. To strengthen laboratory information systems (LIS) to support early and correct diagnosis, prompt management of patients, management of laboratory logistics, supplies, and operational research. 6. To establish a National Laboratory Quality Standards and to facilitate implementation of laboratory quality systems through the National Health Laboratory Quality Assurance and Training Center (NHL-QATC) 7. To coordinate and oversee the planning and execution of laboratory infrastructure strengthening and capacity building activities to implement organizational quality assurance monitoring, advocacy and public relation strategies. Contribution to Health System Strengthening: The National Health Laboratory Service Network is an integral component for the diagnosis, care and treatment of those infected and affected by HIV / AIDS, opportunistic infections and other non communicable diseases. Strengthening the laboratory network will enhance diagnosis care and treatment and assist in providing the evidence on which decisions for care and treatment are based. The training strategies utilizing Training of Trainers builds national capacity; implementation of quality management system through mentorship works to improve quality of services; physical facility, equipment maintenance and information infrastructure improvement will assist in ensuring continuous services in a safe environment; data capture, retrieval and utilization will inform other programs and policy makers. Revision of training curricula in the pre-service institutions to include new technologies, laboratory management and quality assurance will enhance the production of a work ready pool of laboratorians. This ties in with strengthening the physical infrastructure of the schools to include a larger intake of students, updating the skills and numbers of trainers which will also address the human resource capacity shortages.

Cross-cutting program and key issues: MOHSW will promote sustainability through building the capacity of local indigenous organizations to carry out laboratory strengthening activities. MOHSW will streamline coordination and work closely with the Ministry of Local Government in order to strengthen laboratory services in regional, district hospitals, health centre and lower facilities. MOHSW will also strengthen the linkage with Faith-Based Organization (FBO), Non-Government Organization (NGO), and private health facilities to ensure provision of quality laboratory services at all levels.

Strategies to become more-cost efficient over time: Implementation of quality management systems will ensure cost efficiency in service provision.. MOHSW will be expected to diversify the funding base by applying for GOT MTEF funding, orient districts and regions on budgeting, quantification and forecasting for laboratory staffing, supplies and commodities in their comprehensive district plans utilizing cost recovery mechanisms. MOHSW will be expected to continue applying for and disbursing Global Fund and other donors, foster private public partnerships and solicit additional grants from other international development and national funding agencies.

Geographical coverage and target populations: This is a national wide program focusing on strengthening of laboratory services at all levels of healthcare system. The laboratories being targeted include public, FBO, NGO and private-not for profit.

Links to Partnership Framework: This mechanism contributes to all six goals of Partnership Framework through system strengthening of laboratory services at all levels of healthcare system. This will include improving the numbers and skill levels of laboratory technicians as well as defining staff recognition, motivation and retention mechanisms based on quality performance; scale up of Early Infant Diagnosis (EID), improvement of laboratory logistics and commodities management; provision of equipment maintenance, infrastructure improvement, improvement on quality of laboratory services through accreditation, and capacity building for the MOHSW Diagnostics Section.

Monitoring and Evaluation Plans: Program progress will be monitored through quarterly, semi annual reports and supervision visit to laboratories. Periodic assessment of number of laboratories accredited by national/international standards will be done to define achievement in relation to initial set target. Programmatic indicators include number of laboratories with capacity to perform clinical laboratory tests, percentage of laboratories accredited according to national/international standards, percentage of laboratories with satisfactory performance in External Quality Assessments (EQA) for CD4 (patient monitoring) and percentage of testing facilities with satisfactory performance in EQA for HIV Rapid testing ( HIV diagnostics) and for AFB microscopy.

Operationalize National health labortaory quality assurance and training center (NHLQATC) as National implementing center for Quality assurance and continue medical education for laboratorians.

Build MOHSW diagnostic unit capacity to manage national health laboratory services (NHLS).

Implement the NHLS strategic plan.

Training on equipment, supplies and commodity management.

Coordinate laboratory development partners efforts in NHLS capacity building