Goal and objective

This implementing mechanism will support Zanzibar National blood transfusion Service to provide oversight and coordination of blood safety activities in Zanzibar so as to improve the availability of safe blood and blood products to all health facilities conducting transfusion in Zanzibar. The range of activities includes but are not limited to improve community mobilization, donor recruitment and selection, develop safe donor pool from repeating and voluntary non remunerated blood donors (VNRBD), transportation and cold chain, storage, testing and component production and ensure availability of safe blood in the Pemba island.

Also the fund will support capacity building activities of NBTS Zanzibar management as well as health care workers, training of transfusion facilities on rational use of blood and blood component. The funds will support partner coordination and guide activities of partners and Technical Assistance provider (TA) in different blood activities and processes.

Although Zanzibar has show good progress in safe blood facility coverage, the major challenge is to ensure quality systems so as to lower the prevalence of HIV in donated blood. This funding will assist Zanzibar BTS to step up quality measures which include, review guideline, policy and standard operation procedures (SOP), implement the blood computer which helps to track donors from vein to vein and develop o safe donor pool, oversees their proper utilization of guidelines so as to further lower the prevalence of HIV in donated blood.. Training of staff build the staff capacity to correct perform procedures, carry out the blood processes as required from donor recruitment, testing and processing and implant of quality measures that leads to laboratory accreditation. MOHSW Zanzibar will provide leadership and TA assuring highly functional and operational blood transfusion services while assuring sustainability and quality system integration for the support of HIV/ AIDS prevention care and treatment.

Contribution health system Strengthening:

For sustainability, the NBTS Zanzibar will continue seeking government for its budgetary support and recognition as a sole entity with necessary registration/ regulations, responsibility and mandate for blood transfusion services. Zanzibar. Continued high quality and evidence based interventions (such as blood donor clubs) through local and indigenous organization.

NBTS will foster development and implementation of budgeting and finance systems to ensure a sustainable blood program through costal recovery and contributions from the government funding and other national and international donors

Crosscutting program and key issue

Linkages to HIV prevention activities to integrate prevention education into donor recruitment, counseling and notification of test result with appropriate referral for the TTIs positive to care and treatment services. Linkages with care and treatment and other hospitals /facilities for TTIs positive donors to ensure sound referral mechanism, Linkages with Malaria program to develop malaria interventions for blood donors. Linkages with Phones for health to deliver massages to blood donors as motivational

IM strategies to become more cost efficient overtime

To facilitate efficiency of the service, the funding will be used to promote component production, appropriate utilization of blood and blood products, donor clubs formation for repeat blood donors, integration of safe blood activities within regional and district plans and strengthening of transfusion committees. Part of sustainability plan, MOHSW NBTS Zanzibar will ensure a gradual transition from donor funding to Government of reliance.

Geographical coverage

The program activities covers Zanzibar island (Pemba and Zanzibar) and targets the general population but especially youth.

How IM links to PF goal

The funds will be use to implement the Government of Tanzania's and USG PEPFAR HIV/AIDS and Partnership Framework strategies and HIV/AIDS prevention goals of preventing new HIV infection through unsafe blood by selecting and maintaining of low risk donor pool (VNRBD), counseling and testing of potential donors and testing of donated blood to exclude transfusion transmissible infections (TTIs) especially HIV

M&E plan

The partner to ensure coordination and monitor the appropriate clinical use of blood and blood outcomes of transfusion (haemovigalence) and the establishment of a comprehensive quality system covering the entire transfusion process which includes use of blood computer system. The emphasis is to have quality systems in place while at the same time implementing evidence based strategies and improving on program organization, management and monitoring and evaluation

The program outcome to be monitored through program outcomes, that ensures increased safe blood supply, equitable distribution, as well as TTIs levels are going down. The progress to be monitored through supervision site visits, quarterly and annual reports.

Strengthen and improve community Home-based Care/ Palliative Care program in Zanzibar. This will be accomplished through strengthen coordination and collaboration between donors and implementing partners and provide guidance for provision of integrated high-quality care and support for PLWHA from the time of diagnosis throughout the continuum of illness as well as ensuring that the services are accessible, develop/update, print and distribute guidelines and tools, coordinate trainings, monitor and evaluate program and supportive supervision. This activity is for the national level

Maintenance and expansion of comprehensive Care and Treatment services in Zanzibar. This will be accomplished through collaboration and coordination with partners to strengthen linkages and referral between care and treatment services related services i.e. PMTCT, TB, HBC, psychosocial support, legal support, and Nutritional support and Provide supportive supervision to ensure quality of service. Funds will also be used for piloting study on HIV/Hepatitis co-infection.

10% reduction because of pipeline: Continue support for VCT Mnazi Mmoja, PITC, mobile CT for MARPs and in prisons in Zanzibar

?Provide technical assistance for strengthening M&E and surveillance activities. -This will be done through ANC surveillance, behavioral and biological surveys of most at risk populations. This activity will also include the development of an M&E framework for ZACP/MOHSW.

Continue support for coordination of IEC/BCC efforts on Zanzibar; Funding decreased to free up funds for TA and capacity building for ZACP IEC/BCC Unit; Previously funded for AB only - funding now split between AB & OP to allow for broader and comprehensive approach.

Support for coordination of IEC/BCC efforts on Zanzibar as the lead entity for the government health sector HIV response on Zanzibar. ZACP previously received funding for AB only - funding now split between AB & OP to allow for broader and comprehensive approach. Longer-term capacity building for BCC in the IEC/BCC unit of ZACP and the Institute of Social Work to strengthen behavioral interventions on Zanzibar. Adaptation of BCC capacity assessment tool and monitoring local partner activity on Zanzibar.

Continuation of support for MARPs coordination and services in MOH health facilities; establishment of a service center that will provide comprehensive HIV/AIDS and DU/IDU services to MARPs/IDUs (rehabilitation funded through previous year funding, ongoing funds will support staffing and functioning of the service center); sub-grant to DSAPR Znz for specific coordination tasks and support, and M&E for MARPs/IDU efforts on Zanzibar. Support for establishment and functioning of first Medication Assisted Therapy (MAT) service site for Injection Drugs Users (IDUs) on Zanzibar

Unguja and Pemba have a total of 10 'districts' and a prevalence of 0.8 and 0.3 respectively. Funds will support ZACP to carry out coordination role and program monitoring. Will scale up PMTCT services to 15 new sites. Will counsel and test 80% of pregnant women and provide prophylaxis to 80% of those identified.

Other services include:

HIV testing (in ANC, LW), including partner testing and the transfer of mom's information to the baby's health card

Counseling on FP, infant feeding (IF) and referrals

Clinical staging, CD4 determination and linkage to CTC

Provision of ART to eligible pregnant women. Introduce More combine efficacious regime

Screening for opportunistic infections (OIs) including TB

Use of cotrim in prophylaxis and the management of OIs

Follow up of mother and infants pairs

-Training of staff on PMTCT and refresher training to HCW Follow up of mother and infants pairs

Link HIV+ babies and orphans and vulnerable children (OVC) to care and treatment, TB/HIV services and EID

In collaboration with ICAP engage with community support groups such as Mom 2 Mom (M2M), psychosocial support groups, CHWs, child psychosocial support groups and community outreach

Train nurses, nurse midwives and other cadres in PMTCT, IF, MCH, EID, ART

Mentoring

Use expert patients to provide education, provide adherence counseling and carry out non-medical chores

Ensure guidelines and M & E tools are available, robust data collection system, electronic data base, monitor and track HIV+ mothers and babies

Ensure quality of service is improved through feedback mechanism

Support MOHSW to coordinate and lead PMTCT/RCHSC partners, supervise and support implementation. Also there will be a revision of PMTCT guideline and training package basing on the new up-dated WHO guideline. Will conduct refresher training for PMTCT, training new staff, and support demand creation at community level.

Sensitize the community through different media on the improved MCHC/RCHC services with emphasis on PMTCT, EID services, maternal mortality, FP, etc

Engage men through different avenues to participate in RCH services (clinic name change, use of invitation card, priority treatment etc)

Consider supporting the revival of TBA implementing HIV programs, and give non monetary incentives

Provide technical support to TB/HIV implementing partners. Review, update, finalize, print and distribute guidelines (CTC2 card and data base to incorporate TB information), coordinate and supervise implementing partners regarding the implementation of the Three Is'. Improve coordination between ZACP, GF and other partners. Services will be provided at central level in Zanzibar.