The Balm in Gilead (BIG) works to enhance and strengthen the capacity of national faith-based organizations (Tanzania Interfaith Partnership/TIP) to respond effectively to the impact of HIV/AIDS in Tanzania. The overall goal is to contribute to efforts to reduce HIV/AIDS transmission and help mitigate the effects of the epidemic. The program addresses key priorities identified in Tanzania that respond to emerging needs, integrating prevention with continuum of care, while monitoring and evaluating services for quality in order to support indigenous responses, local government strategies, and community sustainability.

BIG works with FBO networks in the eight regions of Dar es Salaam, Mtwara, Lindi, Shinyanga, Mara, Dodoma, Singida, Kigoma, Iringa), and Zanzibar. The ability of FBO networks to mobilize communities with limited resources offers a critical entry point for HIV/AIDS service provision. However, effective service provision, in contrast to the ad hoc 'culture of donation' in which many religious institutions are rooted, requires a paradigm shift towards systematic project management and accountability, which is a new concept for many FBOs.

BIG responds to the challenges faced by FBO network members of both capacity building and technical assistance for TIP. Systematic organizational and leadership development is a key component of BIG's strategy. The OD model seeks to engage FBOs with effective management structures, financial and grants administration, systems and programmatic planning, implementation and reporting systems, and effective delivery of services and mobilization. BIG's exit strategy includes plans with TIP partners that monitor progressive milestones, which are reviewed and monitored annually, towards achieving sustainability.

BIG will continue to provide technical guidance to Tanzania Interfaith Partnership (TIP) in implementation of community home-based care services to PLWHAs and their families in Kigoma region. BIG will also strengthen the capacity of TIP partners to provide integrated and high quality HBC services to PLWHAs from the time of diagnosis throughout continuum of care. This program is in line with the PF that guides the USG and URTs HIV/AIDS response.

To ensure client retention and referrals, BIG will strength the linkages of this program with care and treatment sites, ICAPs facility-based HBC program, and regional and council health management teams (RHMT and CHMT). This will enable tracking of clients from the community up to the facility and vice versa, building synergy within the system tolenhance quality of care to PLWHAs. The BIG will further continue with capacity building to TIPs partners in the implementation of Positive Health Dignity and Prevention (PHDP) by providing training to TOT who will go and train HBC service providers at community levels. This will go hand in hand with linking this program to other providers of PHDP supplies and commodities, including PSIs WASH products, FANTA 2 for food and nutrition support, and IMARISHA Program for income generating activities.

Balm in Gilead will provide TOT for FBO network staff in community sensitization and strategies to reduce stigmatization and marginalization of PLWHAs that include knowledge about availability of and access to services. BIG will also provide technical assistance to TIP in the designing of the training to HBC volunteers and service provision to PLWHAs, support to clinical services and referral system. In service provision, technical assistance will strongly emphasize linkages between PLWHAs, HBC volunteers, and facility-based care.

In the monitoring of quality of care and support services, the project will use NACP tools and guidelines in the provision of community HBC. The service providers will be trained by NACP certified trainers and will use NACPs HBC training guideline to train the providers. The technical oversight will be provided to monitor HBC activities, including updating of monitoring toils to improve the performance of persons providing care and ensure uniformity, monitoring of adherence to national guidelines and service standards that include the national HBC reporting system.

Balm In Gilead (BIG) will continue to support and provide technical assistance (TA) and guidance to Tanzania Interfaith Partnership (TIP) in implementing and supporting MVC/OVCs and their households, which is aligned with the USG/URTs Partnership Framework.

The main goal for TA provision is to enable TIP to support a total of 4,000 MVCs/OVCs and families in Kigoma region (mainland) through evidence-based implementation that improves the knowledge base for the provision of effective care and support for children affected by HIV/AIDS. The target population to be supported would include, under age of 6: male 240, female 240; age 6-14: male 1200, female 1200; age15-17: male 480, female 480; and age above 18: male 80 and female 80. In addition, the program intends to support about 400 OVCs in Zanzibar.

Technical oversight will be provided to TIP to insure that the MVCs/OVCs interventions are aligned with the revised National Costed Plan of Action. Strategically, the TA to TIP-FBOs would focus on strengthening families as primary caregivers of children, supporting the capacity of communities to create protective and caring environments, building the capacity of social service systems to protect the most vulnerable, and allocating resources for children according to need in the context of HIV/AIDS.

TA in MVCs/OVCs intervention will include training of caregivers and MVCC facilitators, facilitation of MVCC capacity building, MVCs/OVCs nutrition enhancement, and household improvement.

In addition, TIP/FBO partners will be supported to ensure that program monitoring is in line with the national MVCs/OVCs M&E plan, an essential component of the National Costed Plan of Action. Trainings will be provided to local government authorities in Kigoma, TIP/FBOs, and the community on updating and maintaining MOHSWs automated MVC/OVC data management System.

In FY 2011, the TA provider would carry out a mapping exercise and support establishment of child protection teams in MVCs/OVCs activities in the region, including training to the teams on child protection related issues that integrate appropriate monitoring tools as well as obtaining relevant training materials.

Supportive supervision to and across all implementation levels will be a key role for the TA provider to ensure effective and efficient implementation of the program. The TA provider will engage and orient TIP/FBOs and the communities to the use data as a way of making informed decisions for the beneficiaries and communities at large.

The FBO network has proved to be effective in supporting vulnerable children in their respective homes and localities, particularly in mobilizing and providing psychosocial as well as spiritual support. The TA provider plans to carry out an economic performance evaluation, which will be paramount to creating a sustainable community program. Getting every sector on board for the MVC/OVC thematic area has been a challenge, however, the current efforts by the URT advocating for the public-private partnership will bring more stakeholders closer to better understanding and supporting vulnerable groups towards becoming good active members of the society.

The Balm in Gilead (BIG) will support the scale-up of the "Sasa Tuzungumze" (Time to Talk) intervention, an evidence based, community based, group-level behavior change intervention for couples who live among Muslim or Christian faith communities. In high prevalence areas of Africa, such as Tanzania, cohabiting couples (including married couples), make up a large proportion of the groups at risk from HIV-infection; the greatest risk for women in these unions are their husbands or regular partners.

The primary goal of the Sasa Tuzungumze intervention is to promote safer sex behaviors among married couples by improving the ability to communicate, increasing risk perceptions, encouraging male involvement, and promoting as well as providing access to HIV testing and counseling services. Attention will be paid to counseling and support to help reduce gender based violence.

BIG will support the scale-up of Sasa Tuzungumze, which will be implemented by the Tanzania Interfaith Partnership (TIP) and its partners, in three regions (Coast, Dodoma, and Kigoma). It is estimated that over 7,000 couples will be reached in the three regions with each couple attending a three day Family Life Workshop. Key activities will include support for the training of Family Life Workshop facilitators and provide programmatic support for implementation of the workshops, including quality assurance and training of 40 additional facilitators. BIG will also work with TIP to ensure that the intervention is linked to service provision including couples HTC services.

BIG will work with Muhimbili University to conduct an outcome evaluation of the intervention, in partnership with TIP. In addition, BIG will work with TIP to support the implementation and M&E of the Families Matter Program (FMP). Tools for conducting routine monitoring of activities and summary reports will be used, while data quality will be assessed on a regular basis.

The Balm In Gilead (BIG) will continue with strengthening capacity of TIPs partners in the area of community-based HIV testing and counseling (HTC), including an increased focus on couples, in Shinyanga region. The overall HIV prevalence of Shinyanga is 7.4% (8.4% females and 6.3% males (THMIS 2008), which is much higher than the national average of 5.7% (6.6% females and 4.6% males). The prevalence rate by marital status shows that in 1.2% both partners are HIV-infected, while around 4.5% the male partner is HIV-infected and around 3.5% the female partner is HIV-infected (THMIS 2008).

The program will continue using FBO networks to provide outreach and mobile HTC services where high risk groups are present, particularly those living in hard to reach areas or have no or limited facility-based HTC and services due to poor infrastructure. Balm in Gilead will provide technical support to TIPs partners to strengthen and scale up the use of churches and mosques as platforms for provision of education and HIV/AIDS services, including HTC with emphasis on couple HTC and support for discordant couples.

Technical oversight will be provided to TIP to ensure that interventions are aligned with the national guidelines, recommended approaches are strengthened, and that effective collaboration exist with the MOHSW and the National AIDS Control Program. For greater impact, TIP partners will also conduct activities that raise awareness, promote couples communication, reduce stigma, and promote HTC. Technical assistance in HTC will include linkages to MOHSW to ensure availability of HIV test kits, ensure TIPs partners adhere to standard operating procedures, that protocols for implementing HTC are applied, and facilitating linkages include referrals for HIV-infected clients to access HIV and health care, including ARV treatment for eligible patients and other social services.

BIG will assist TIP in providing close over-sight on data collection, information management, and monitoring using the approved national tools. TOT training for TIPs FBOs network will be supported to prepare couples' community mobilizers trainings and activities. BIG will also provide technical assistance for the training of counselors to improve and upgrade skills in accordance with national guidelines and provision of refresher training for couples HTC.

The Balm in Gilead (BIG) will support the scale-up of the "Sasa Tuzungumze" (Time to Talk) intervention, evidence based, community based, group-level behavior change intervention for couples who live among Muslim or Christian faith communities. In high prevalence areas of Africa, such as Tanzania, cohabiting couples (including married couples), make up a large proportion of the groups at risk from HIV-infection; the greatest risk for women in these unions are their husbands or regular partners.

The Sasa Tuzungumze program includes promotion of consistent and correct condom use as a key prevention component. Many of the FBO partners are willing and already involved in the implementation of this component. They also play an important role in advocating for open promotion of condom use with other religious leaders and within more traditional or conservative religious environments. In addition, special attention is being paid to working with couples living and/or working along transport corridors or hot-spots within the three target regions to address prevention issues and needs related to greater vulnerability and specific risk behaviors. Note: BIG does not provide direct services but rather provides technical assistance to an umbrella of faith based organization in the country.