Goal: To ensure yield of quality data for decision- making that will ensure the long- term capability of HIV/AIDS response.

The objectives for this Implementing Mechanisms are; 1) To strengthen and coordinate multi- sectoral M&E system; 2)To improve data flow vertical and horizontal; 3) To improve data use, HIV/AIDS data triangulation through health and social service sectors; 4) Strengthen capacity to partners on Monitoring and Evaluation activities; 5) Improve HIV incidence measures; 6) To adopt best practices on evidence- based and strategic decision making

System strengthening:

To support the GoT efforts, DOD SI Team will work collaboratively with local partners, USG SI Team and other stakeholders on establishing the M&E program for district health workers to address some of the M&E challenges arise in the districts. This will provide access to trainings which develop a solid understanding M&E and how can be used to improve planning, budgeting and policy formulation processes. Also to ensure that data analysis and the use of data to improve service delivery is included in existing Pre-Service and/or In-Service programmes. DOD SI team will ensure that the deployment of M&E systems and training fits with national visions. DOD SI Team will undertake Data Quality Assessments aiming at improving the data and capacity of the implementing partners and the GoT counterparts. DQA will be done to both Treatment and Community outreach Partners.

Cross-Cutting programs and key issues (policy and tools)

Good policies and comprehensive monitoring and evaluation tools will contribute to overall strengthening of national AIDS response in Tanzania under the principle of the "Three Ones": one agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of all partners; one National AIDS Coordinating Authority, with a broad-based multi-sectoral mandate; one agreed country-level Monitoring and Evaluation System, in order to achieve the most effective and efficient use of resources, and to ensure rapid action and results-based management. DOD SI Team will build capacity on policy development to implementing partners, and also will ensure that Monitoring and Evaluation tools are available at all levels.

IM strategy to become more cost-efficient over time

DOD SI Team will work hand-in-hand with GoT through partners to establish strong units within the MOHSW (RMOs, and DMOs) and TACAIDS that can help bring all the various data sources together and create meaningful feedback products for the sector as a whole. Information Sources include internal and external data sources (from an MOHSW perspective, aggregate data systems and operational data systems from all vertical programs, and link with other GOT entities like POPSM, PMORALG, National Bureau of Statistics (NBS). This coordination will help to bring about cost effectiveness status.

Geographic coverage and target populations

DOD is serving three regions of southern highlands these are; Mbeya region, Rukwa and Ruvuma. DOD supports both treatment as well as community services. For treatment DOD has four major (Prime) partners which are Mbeya Regional Medical Office, Mbeya Referral Hospital, Rukwa Regional Medical Office and Ruvuma Medical Office and for Community services DOD supports four major partners (prime) KIHUMBE and Mbeya HIV network in Mbeya, RODI in Rukwa and SONGONET in Ruvuma but each prime works closely with sub-partners, number of sub-partners vary from one major partner to other. DOD SI Team has a responsibility of supporting all these partners on M&E/SI issues. So in this case targeted population is data managers, M&E officers and decision makers at various levels.

How IM links to PF goals

This Implementing Mechanism adheres directly to sixth goal in the partnership framework which is (Evidence-based and Strategic Decision-making goal). DoD SI will build capacity of its implementing partners on M&E issues ranging from understanding the indicators, data collection tools, data collection procedures and data compilation, analysis and interpretation then dissemination of results for use. DOD SI Team will make sure that data flow is consistent and partners understand reporting timelines, but also more emphasis will be put on yielding quality data and data triangulation practices.

M&E plans

DOD SI Team will continue to build a sustainable M&E plan in DOD supported regions (Mbeya, Rukwa and Ruvuma) to address M&E issues through regular comprehensive trainings and strong supportive supervisions. The above mentioned activities aiming on harvesting quality data that will avail on better planning and proper decision making. DoD SI Team will work on harmonizing data collection tools, make use of established National Data Management Systems. Data Quality Assessment will be conducted (DQA) to ensure yield of accurate, reliable and precise informations.

Mbeya regional medical office (RMO) will coordinate and provide facility based care services in all facilities in the region where care and treatment program is set up. This will include the intergration of Positive prevention services, supporting nutritional assessment and counseling. Mbeya RMO will support improving linkages of facilities with other services including home based care in Mbeya region.

Maintain Quality HIV services at existing sites and scaling up to cover private hospitals and previously underserved areas. This will be accomplished through regular supportive supervision, clinical and nutrition mentoring, patient monitoring, and ensuring uninterrupted supply of drugs and reagents through cental procurement mechanism,Capacity building to local partners in financial accountability, technical support, program oversight and M&E. Partner works in eight district and currently covers 15298 patients on treatment. As much efforts are done in TB/HIV and prevention program including PITC and PMTCT we expect an increase in number of new HIV positive patients refered to existing Care and Treatment Clinic. Additional funds will be used to support passive growth of approximately 500 new patients coming to existing Care and treament clinic managed by Mbeya Region.

Maintain and improve quality of existing pediatric HIV Care services. This will be achieved through provisison of CTX, Screening and Treatment for OIs, Nutritional Assessment and support and Linkages with other programs such as OVC and HBC, PMTC, TB/HIV. The services will be provided in Mbeya Region

Maintain and improve quality of existing pediatric HIV services. This will be achieved through support supervision visits, inservice training including on site mentorship, infrastructure devolopment and supplies of essential commodities including drugs. Reprogrammed funds will be used to support linkages between facilities and communities.

Base funds

Mbeya has ANC HIV prevalance of 15.9%. The Mbeya RMO will cont inue to implement PMTCT services in all 8 districts of Mbeya Region.

Activities to be supported using base funding

The program will scale-up PMTCT services to cover 80% of the facilities providing RCH services in the region . Mbeya RMO will technical and financial Support to respective districts and these services will include but not be limited to: HIV testing (in ANC, L&D), including partner testing, Counseling on infant feeding options (IF), Strengthen counseling on FP methods to HIV+ mothers during postpartum visits, offer HIV testing at the FP clinic and offer referrals to CTC and vice versa, Clinical staging of the HIV+ pregnant women at the RCH clinic by the PMTCT service providers with linkages to CTC, Rolling out of more efficacious regimen to facilities with the capacities, Provision of ART prophylaxis to HIV+ pregnant women who are not eligible for HAART, Provision of Cotrimoxazole to all eligible pregnant women and exposed infants, Conduct PMTCT outreach services in hard to reach areas, Quarterly supportive supervision by the RHMT to ensure quality of services. In collaboration with MOH, bi-annual supportive supervision will also be done in both regions.

Mbeya RMO will collaborate with community support groups including M2M program to form psychosocial support groups, which will provide psychosocial support and increase adherence and retention to care. Expert patients will carry out non-medic chores in the facilities.

In addition, mother to mother program and other partners within the regions will follow up mother-infant pairs in the community.

The programs will Renovations, procurement and materials as follows:

Renovate and equip facilities to provide space for offering integrated PMTCT services. Mbeya RMO will ensure availability of HIV test kits by procuring to fill gaps, ensure adequate supply of drugs for more efficacious regimen, based on needs, support printing and distribution of IEC materials and job aids.

The program will also train nurses, nurse midwives and other cadres in PMTCT, IF, drug monitoring and stock outs, including WHO staging.

The program will carry out Mentoring of HCW and support use of retired nurses to provide integrated PMTCT services in the region

It will ensure guidelines and M & E tools are available, improve data collection systems, and train service providers on filling of the PMTCT monitoring tool.

The program will strengthen and facilitate RHMT annual review meetings, formation and integration of regional PMTCT task forces into Reproductive and child health. Support regional quarterly partners meeting and strengthening linkages and referrals.

PF Funds:

Activities to be supported using PF Funding

Mbeya RMO will work with Reproductive health partners and with the respective districts, will carry out facility infrastructure improvement after carrying out facility audit; subsequently they will renovate and equip facilities to provide space for offering integrated PMTCT services at RCHC and L&D, FP, FANC and BEmoc

The RMO will Improve conditions in the maternity wards so as to attract more women to deliver at the facilities by procuring appropriate equipments such as delivery beds/kits, suction machines, weighing scales, protective gears etc.

The RMO will strengthen PMTCT-ART Integration by supporting Hospitals, Health Centers and Dispensaries to develop capacity to provide more efficacious PMTCT regimen, training PMTCT HCP at RCH on ART so that they can refill ARV drugs at the RCH; Ensure availability of PMTCT guidelines and job aids; Support transportation of CD4 samples of HIV+ pregnant women; Ensure availability of PMTCT M&E tools and Integrate HIV counseling and testing in all the RCH services, including Pediatric wards

The RMO will focus on community and demand creation activities that include: sensitize the community through different media on the improved MCHC/RCHC services with emphasis on PMTCT, EID services and FP), Engage men through different avenues to participate in RCH services (use of invitation letters, priority treatment, through involvement of village authorities etc), Collaborate with Mother to Mother program to establish psychosocial support groups in the 4 regions. Also, will integrate its FP program and link with partners supporting Emergency obstetrics, new born and pediatric health and cervical cancer screening services.

Mbeya RMO will ensure program ownership and sustainability by working with districts to ensure that PMTCT/pediatric AIDS activities are planned and prioritized.

Implement PMTCT and improve MCH and PMTCT services (see PF package)

Continue implementing activities to reduce burden of TB among PLHIV, strengthen collaboration with Mbeya referral hospital, NTLP and GF, supportive supervision, training, linkages as well as referral systems. Additional funds ($100,000) will be used to improve coverage because of the high HIV prevalence of 9.2% . Service will continue being provided in Mbeya region