MAISHAs goal is to build local and national human and material capacity to reduce maternal and newborn mortality and decrease the transmission of HIV from mother to child.

MAISHA and its partners collaborate with MOHSW on a national scale to achieve the national targets for MDGs Four and Five. MAISHA aligns with Tanzania's national health policies and strategies and USG's GHI initiative by building strong integrated service delivery platforms for key maternal and newborn health (MNH) interventions, contributing to building a sustainable health system, and leveraging other funds and efforts to increase the projects over-all impact.

MAISHA will assist MOHSW to strengthen the basic emergency obstetric and newborn care (BEmONC) and focused antenatal care (FANC) platforms through developing national and local resources for BEmONC and FANC, while advocating and coordinating with DHMTs and other key stakeholders to ensure funding is allocated for supporting quality service delivery. MAISHA is strengthening the PMTCT platform to address gaps in integrating MNH services for HIV positive women and children through a number of interventions, including establishment of cervical cancer prevention, improved postnatal care, and improving community health workers services. By working directly to provide technical assistance to PMTCT partners, MAISHA will continue to build capacity of the local communities to the national level. MAISHA also supports national infection prevention efforts as well as improvements in the quality of pre-service nursing/midwifery and medical education.

With FY 2011 funds, MAISHA is supporting MOHSW to review its overall community health strategy. Efforts to help determine the overall SOW for the national CHW that MOHSW hopes to produce in line with the MMAM is also being conducted. It is anticipated that this SOW will build upon the existing integrated MNCH community guidelines and add elements that will optimize the quality of life for patients, such as providing community home-based care for people living with HIV. Once strategies and policies are confirmed, FY 2012 funding will be used to complement and expand the PMTCT funded CHW component of the integrated PMTCT facility/community program in Morogoro and Iringa. Integration of selected home-based care services into the messaging and services provided by MAISHA-supported CHWs will also be targeted within these communities. This funding will enable existing CHWs to be trained in the new HBC components, while also supporting more CHWs to receiving the comprehensive training package (integrated MNCH and HBC).

The lack of standardization in pre-service training, particularly in the areas of performance and learning assessments, curriculum development, and training packages in medical schools undermines Tanzanias ability to train qualified health professionals to handle the management and technical challenges of the health system.

MAISHAs program will work with the medical schools to address issues of standardization by instituting a quality improvement approach, enabling faculty to conduct regular qualitative self-assessments that will help determine the level of standard educational practices being provided, including highlighting any gaps and other issues that may exist. Capacity building efforts of faculty members to improve their skills in designing, developing, implementing, and monitoring the processes and test items for student assessments will continue to be a focus. Following up on last years workshops that were conducted, complimentary materials will be incorporated into FY 2012s workshops to further expand the faculty members knowledge and build upon previously acquired skills. The MAISHA Program and the Tanzanian medical schools together will develop standardized HIV-related content to become integrated into the medical schools curriculum. The institutionalization and strengthening of the skills labs developed in previous years, along with supporting the implementation of the nationally approved skills lab coordination training package will help to ensure the proper use and maintenance of the equipment. Limited support will be made available to the Medical Association of Tanzania with the goal of strengthening the associations capacity.

Implementing the strategy of GHI, various funding sources will be leveraged through GHCS, the Presidents Malaria Initiative, along with PEPFAR funding, in order to coordinate the efforts of working with all nursing schools in Tanzania. Specific technical areas, such as BEmONC, FANC, interpersonal communications, and IPC, will be developed to compliment one another in the nursing/midwifery pre-service education, thereby building the technical knowledge and teaching skills of educators in strengthening the overall nursing education. Specifically with PEPFAR funding, the MAISHA program will continue to bolster the quality of nursing education using a continuous quality improvement approach that has been adopted nationally for all cadres. In consultation with MOHSW, skills labs that were established last year will be strengthened with the possibility of developing more skills labs at additional schools.In order to increase the projects impact, MAISHA will work in a consortium with other organizations to implement health systems strengthening and quality improvement work. Activities will take place in schools within MAISHAs designated zones (Lake, Eastern, and Southern).Development of a national CHW program will continue with the MOHSW to further a sustainable health system. Much of the work will center around defining job descriptions, contributing to MNCH component of curriculum and job aids, and strategies for development of trainers and supervisors.

With FY 2012 funding, the MAISHA program will continue to support the MOHSWs efforts to increase the skills and knowledge of healthcare providers and managers in infection prevention control (IPC). In addition, assuring quality improvement of IPC practices to help prevent medical transmission of HIV at health facilities is another key priority. Focus facilities include the six hospitals affiliated with Tanzanias medical schools, as well as health centers and dispensaries currently being supported under MAISHA for quality BEmONC and FANC service delivery.

Conducting quarterly self-monitoring assessments will be a main component of institutionalizing the development of quality improvement teams at each medical school hospital. These assessments will be critical to supporting the facilities ability to use pertinent information that will help develop specific action plans to address current and emerging gaps within each facility. External assessments will also be conducted, giving the MOHSW visibility to the gradual improvements made, thereby allowing for recognition to be made to the highest performing facilities.

At the MAISHA targeted facilities, HMIN funds will be used to support renovation of incinerators and establishment of placenta pits.

MAISHA will continue to support integrated PMTCT facility/community programs in Morogoro, Iringa, Lindi, Mtwara, Arusha and Kilimanjaro while scaling up in up to two additional regions where the MAISHA program is more mature. This program focuses on establishing postnatal care at health facilities where FANC and BEmONC services are being strengthened by MAISHA. This activity adds a CHW aspect to facilitate facility/community linkages to address missed opportunities, particularly focusing on HIV positive women. In Morogoro, Iringa, Lindi, and Mtwara, MAISHA will continue to support existing programs. In the two new regions, new components will be introduced to RHMTs and DHMTs, and MAISHA will work with facilities and their associated communities for strengthened BEmONC and FANC. Jhpiego will continue its partnership with D-Tree to incorporate mobile phone technology at both facility and community level, ensuring standardization and quality of care, as well as to support facility/community linkages.

Initiation and scaling of BEmONC and FANC will continue to require TA to regional PMTCT partners. To support these efforts, MAISHA will help to conduct assessments at sites identified by the RHMT for strengthening, conduct supportive supervision visits to assess quality of FANC, BEmONC, Post-natal care/Post-partum family planning, and CECAP services, as well as support data collection. MAISHA will also provide guidance on procurement of equipment and supplies as identified through assessments and supervision visits.

Since FY 2010, MAISHA has also been providing TA to MOHSW to implement national and regional cervical cancer prevention activities. MAISHA aims to continue building local capacity for the implementation of prevention efforts by continuing support for cervical cancer screening activities in Morogoro and Iringa regions; in consultation with the MOHSW, possibly expanding to additional sites within the Morogoro and Iringa regions; increasing community awareness and demand for screening services; strengthening referral services; and providing TA to regional PMTCT partners for initiation and scale-up of cervical cancer prevention services in their respective regions.

Women who access HIV services, such as ART and PMTCT, will continue to be offered cervical cancer screening services in addition to being linked to other appropriate services, such as HIV prevention, care, treatment, and support services. Orientations on cervical cancer prevention will be provided for all CTC providers, increasing awareness and encouraging CTC providers to refer all women to be screened. In an effort to implement MOHSW national PITC efforts, women who present directly at the RCH clinic for cervical cancer screenings who have not yet been tested for HIV will be tested for HIV as part of the over-all screening process.

Monitoring systems have been developed and implemented to assure the quality of cervical cancer prevention services. The project will continue to place a large emphasis on the collection and use of service delivery data. A M&E workshop will be held for trained providers, focused on strengthening their capacity to collect accurate and complete data. Ongoing discussions with MOHSW will continue in an effort to ensure reports on specific indicators are shared on a routine basis. Service delivery data will also be shared quarterly with USAID and used for program monitoring and re-direction, as necessary.