The overall goal of American International Health Alliances (AIHA) programs is to strengthen human and organizational capacity to expand or scale up HIV/AIDS prevention and care and treatment services through volunteer-driven Twinning partnerships designed to enhance the HIV/AIDS skills of nurses, lab technologists, social workers, PSWs, and others to improve the lives of PLWHA and OVC in Tanzania.

In support of the national response to HIV/AIDS, AIHAs programs complement the five-year PF, particularly that of goal one of service maintenance and scale-up through the rollout of community focused PSW and palliative care programs; goal two of prevention through facilitating the implementation of a recovery system of care (ROSC)-substance abuse program for MARPs; goal three of leadership and management by strengthening the organizational capacity of national organizations and councils; and goal five of HRH through curricula development, skills labs, mobile libraries within the nursing program, and mentorship and supportive supervision opportunities within the laboratory program.

As AIHA is focused on capacity building of local institutions, investment will diminish over time as local partners gain the skills to support their own activities. AIHA partners develop work plans, which are approved by CDC, that outline deliverables and indicators that are measured over time. All activities are tracked at country level using AIHAs work plan and M&E plan.

In FY 2010, CDC approved the procurement of a vehicle for AIHA. Currently, more cost-effective options are being determined to purchase a vehicle that will enable more frequent staff and partner site visits throughout all regions.

AIHA will continue to work with palliative care partners, Evangelical Lutheran Church in Tanzania (ELCT)-Pare Diocese, together with the U.S. partners, such as Empower Tanzania and Southeastern Synod of the Evangelical Lutheran Church in America, in conducting palliative care trainings to community health workers (CHW) and supervisors (clinicians serving within facilities). The trainings utilize standardized URT curricula to ensure service provision is strengthened and linkages with the national systems are improved.

Support of palliative care services is integral to the efforts of PEPFAR. To support clients, the program shall prioritize family strengthening approaches that reinforce families long term caring capacities as the basis of a sustainable response to people affected by HIV/AIDS. Included under the rubric of family and economic strengthening are interventions that boost household food and economic capacity and improve family access to health care and support. Families in turn rely on safe and supportive communities to thrive. Therefore, AIHA palliative care program will continue to support capacity building to local community structures to respond to palliative care and support by mobilizing and integrating the palliative care services into Council Comprehensive Health Plans at the district levels, which will cascaded down to sub-district levels. In addition to the above activities, the program will invest in the monitoring and evaluation of the impact of the palliative care program and build on evidence based best practices.

AIHA has been working with the OVC implementing partners, URT and USAID, for the past five years to design and pilot responses to the needs of the social welfare workforce, including the overall pre- and in-service social work curriculum and professional development at all levels. The overall goal of the OVC and social work twinning partnership is to strengthen the social welfare workforce in Tanzania. The project aims to strengthen the capacity in the provision of quality social work services to OVC by equipping social workers, and others, with the necessary knowledge and skills to ensure comprehensive social services are offered to children affected by HIV/AIDS throughout Tanzania, as per the guidelines set forth in the National OVC Costed Plan of Action.

AIHA and its OVC partners, specifically Tanzania Social Workers Association (TASWA) and U.S. based National Association of Social Workers (NASW), will continue to partner on strengthening TASWAs capacity to serve as the national voice for social workers in Tanzania, enhancing the professional growth and development of its members, creating and maintaining professional standards, and advancing sound social policies within the Tanzania context. AIHA will also serve as a key stakeholder in the implementation of the National Social Welfare Workforce strategy, which seeks to set forth a comprehensive plan to address HRH challenges faced by the social work profession in Tanzania.

AIHA will continue to work with its partners, ISW and Jane Addams College of Social Work, while collaborating closely with IntraHealths Human Resource Capacity Project and other Pamoja Tuwalee partners, towards the further roll out of updated para social worker (PSW) trainings throughout the country. AIHA partners provide the lead training oversight with an end goal of producing more community-level PSW cadres and the ward level based social welfare assistant (SWA) cadre. This is a step towards decentralization of the system by bringing social welfare services to the local government authority levels.

AIHA will continue to build capacity of the Department of Social Welfare based on the previous assessment that was conducted. A key M&E component of ensuring PSW training is effective is to follow up PSWs during provision of service. Follow up activities will continue to be conducted by ISW, with JACSW, to provide technical assistance, as needed throughout the year, to inform training components and ensure materials and topics are relevant to meet the needs of the communities that PSWs serve. In addition, PSW and SWA curricula revisions will focus on comprehensive, family-centered care approaches that stress the overall well being of the child.

AIHA will also strengthen the 12 higher learning institutions under The Tanzania Education Social Work Program (TESWEP) to ensure standardized quality social work education. To ensure sustainability, AIHA will work directly with all local AIHA IOVC/social work partners, such as ISW, TASWA, and TESWEP schools to develop organizational capacity, financial and administrative capacity, and leadership and management skills.

AIHA will continue to support the efforts initiated by MOHSW of strengthening capacity of all regional laboratories towards three star Strengthening Laboratory Management Toward Accreditation (SLMTA) accreditation standards. Through its partnerships, AHIA will focus on quality improvement principles and expand on mentorship and supervision using local and international mentors. Mentorship activities will be done using the mentorship training curriculum which has been developed by AIHA lab partners from MOHSW-Diagnostic Services, Boulder Community Hospital, and with input and guidance from CDC. Implementation of the curriculum, training, and roll out will be done in partnership with local and international experts using the TOT model which promotes sustainability.

AIHA partners will develop standardized tools that will help to keep information as well as monitor and evaluate progress of lab activities towards accreditation. The program will continue to support the Health Laboratory Professional Council (HLPC) through the provision of technical guidance in the development of the Council Comprehensive Strategic Plan, which will guide the councils overall goal and objectives. Partners will develop council documents, including job aid booklets and other manuals; this support will strengthen HLPC to complement the efforts set forth in the national HRH URT strategy.

Finally, AIHA will establish a learning exchange program to expose lab professionals to best practices concerning accreditation adherence and maintenance. Exposure of mentors and Tanzanian lab partners to other successful accreditation models will be supported, as this opportunity will enhance competence and efficient operations of lab activities as well as accreditation processes. The criteria for selection of the candidates will include a laboratory that is under the accreditation program and has a minimum of four technologists. The selected candidate should either be a lab manager, quality officer, or a mentor who is knowledgeable, highly motivated, and can train others.

In FY 2012, one visit will be sufficient to allow selected laboratory professionals to gain exposure and learn best practices pursuant to a three star accreditation. The overall lab accreditation process will be tracked continuously using PEPFAR NGI H1.2.D and will provide CDC with feedback on the progress regional labs are making over time. Intermediary SLMTA progress will be submitted through quarterly, semi-annual, and annual program review reports. In terms of transitioning from PEPFAR Track 1.0, the AIHA model specifically engages MOHSW and regional government lab staff. Since initial implementation of the program, AIHA has worked with local in-country partners who see accreditation as an important step towards provision of high-quality diagnostic services in Tanzania.

Tanzania is currently facing an acute shortage of qualified healthcare workers that are able to provide comprehensive care and support for those with HIV/AIDS. Furthermore, the educational institutions that train Tanzania's nurses, social workers, and other health workers have not kept pace with the needs of emerging and existing professionals through the use of competency-based curricula, practical opportunities, and supportive supervision and mentorship. AIHA will provide support for lab skills development, mobile libraries, curriculum review with MOHSW, and pre- and in-service training as well as continued support to Tanzania National Nurses Association (TANNA) and Tanzania Nurses and Midwives Council (TNMC).

In order to adequately support the revised competency-based national nursing curricula from a certificate to a Bachelors level, complimentary support for curricula will be scaled to reach all 87 nursing schools in Tanzania. With FY 2010 and FY 2011 funds, AIHA Tanzania Nursing Initiative (TNI) supported 25 schools with skills labs. Therefore in FY 2012, equipment and supplies will be purchased for the remaining 20 schools that are within AIHA-TNI zones.

Skills lab training of all faculty from the 20 schools will be conducted. In addition, continuous assessment of instruction on HIV/AIDS within skills labs for the 25 schools that received skills labs in previous years will be conducted. An additional 10-15 mobile libraries will be purchased and capacity building of faculty will be done.

On-going supervision, mentorship, and assessment of the mobile libraries that have already been provided will be conducted, along with curricula review of seven BSc programs (within universities). PMTCT components and modules similar to other TNI revised curricula will be integrated as necessary into the BSc program. A faculty development package will be developed with PMTCT components included. Practicum books and orientation of tutors and standardized training materials for this program will be developed. In order to ensure sustainability and country ownership, work will be done within the system to leverage existing structures; all in-country partners are the identified long-term stakeholders and own these activities as their own responsibility.

Studies have revealed high HIV prevalence in people who use drugs (PWUD), particularly by injection, both in Mainland Tanzania, within the context of a generalized epidemic, and in Zanzibar where the epidemic is concentrated within identified most-at-risk populations. The HIV prevalence of the general population in Dar es Salaam City is 8.8% and 42% in people who inject drugs (PWID). In Unguja, Zanzibar HIV prevalence in the general population is 0.8%, however, it is 16% in PWID. Thus, substance abuse continues to be a main driver of HIV in Tanzania Mainland and Zanzibar.

AIHA Twinning Center will continue to support substance abuse programs (both Mainland and Zanzibar) by establishing partnerships among peers from AIHA substance abuse partners who provide technical support to the Drug Control Commission, Muhimbili University-Tanzania AIDS Prevention Program, the Mental Health and Substance Abuse Unit of MOHSW, and other stakeholders in Tanzania. With the aim of complementing efforts by other stakeholders in providing the UN recommended comprehensive package of HIV services for PWUD and PWID, AIHA will coordinate (establish, guide, and support) the development and implementation of the recovery oriented system of care (ROSC) by improving substance abuse prevention and rehabilitation (recovery support) services and facilitate linkages to other HIV prevention, care and treatment services for PWUD and PWID. The program will expand the recovery system of care and support groups to families affected by substance abuse in Tanzania Mainland and Zanzibar. In collaboration with stakeholders, including community, political, and religious leaders and NGOs, the program will continue to solicit support in mainstreaming ROSC as part of the comprehensive services for HIV prevention, care and treatment for PWUD and PWID in response to substance abuse.

Although AIHA and its partners do not provide direct services for PWID, partners are in the process of creating monitoring systems for the national ROSC to ensure a functional referral system for comprehensive care. This includes national referral tracking to and from clinical and community services such as Medication Assisted Treatment (MAT), sober houses, drop-in centers, and ancillary health and legal services for PWID and people in recovery. Partners are also developing a framework that will allow for active monitoring of peer recovery group meeting attendance and other non-clinical recovery services. AIHA and its partners feel that this type of anonymous monitoring of peer group attendance is a meaningful proxy for the number of active recovering addicts utilizing community-based care. Tracking attendance levels also allows MOHSW, CDC, and other stakeholders to examine utilization trends over time and help inform MAT implementation.

The AIHA-Tanzania Nursing Initiative (TNI) will continue to integrate PMTCT in all facets of the TNI program to ensure that nurses are equipped with necessary skills and knowledge to decrease the incidence of MTCT. Thus, addressing the broader GHI goal of decreasing the prevalence of HIV/AIDS in Tanzania through improved nursing PMTCT education and further provision of technical assistance to national nursing bodies that are able to establish national frameworks to better facilitate the implementation of PMTCT services at the workplace.

In 2012,the capacity of Tanzania nursing faculty will be further strengthened to better instruct and evaluate nursing students on PMTCT. This will be accomplished through the provision of faculty development packages that address quality delivery of PMTCT education in the classroom and within skills labs. AIHA-TNI partners will continue to collaborate with MOHSW in the continuous development and evaluation of PMTCT resources, such as learning materials to accompany PMTCT curricula modules that were integrated into all National Technical Award (NTA) Level 5 national curricula in 2010. Furthermore, intensive PMTCT modules, practicum books, and other learning guides will be developed and disseminated to accompany the national midwifery tract (BN specialization) curricula.

In terms of tangible support to the nursing schools, the fifteen new skills labs will include pelvic models and other necessary equipment for practical PMTCT instruction. In addition, AIHA-TNI will continue to procure and supply ICN mobile libraries to nursing schools. Mobile libraries will be equipped with several learning resources, including up to date PMTCT books, visual aides, such as PMTCT-specific CDs and DVD training materials, and PMTCT tool kits. These components will enable the AIHA-TNI program to prepare a nursing workforce that is competent in the provision of various PMTCT services.

Further, AIHA-TNI will support the Tanzania National Nurses Association to promote PMTCT adherence and skills development amongst its members through ICT campaigns as well as other forms of outreach. AIHA-TNI will also support the Tanzania Nurses and Midwifery Council to establish a regulatory framework that further supports the role of nurses in administering PMTCT services throughout all regions of Tanzania.