PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Subdivisions of Program Areas, these track general higher level sub-classifications of expenditure.
Subdivisions of Major categories, these are the most detailed expenditure data.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008
TITLE: MoHSW Prevention of Mother to Child Transmission of HIV (PMTCT)
NEED AND COMPARATIVE ADVANTAGE: The Prevention of Mother to Child Transmission of HIV
(PMTCT) unit is under the National AIDS Control program (NACP) of the Ministry of Health and Social
Welfare (MOHSW). To date, the unit has received technical and financial support from the Government of
Tanzania's development partners and multilateral organizations to support, implement and coordinate
PMTCT services in the country. PEPFAR support has enabled the unit to implement PMTCT services and
coordinate activities conducted by PMTCT partners.
The PMTCT Unit is leading the regionalization of PMTCT services and partners in-line with the recent ART
regionalization in order to improve linkages to HIV care and treatment programs and rapidly increase
coverage of PMTCT services. The national PMTCT Unit will focus on its role of program coordination and
management and transition primary PMTCT service implementation and support to PMTCT and ART
partners by March 2008. With FY 2008 funds the MOHSW, through the PMTCT program, will improve the
national PMTCT policy environment and strengthen national coordination to scale-up quality PMTCT
services nationwide. Increased emphasis will also be placed on monitoring and evaluation of the national
PMTCT program in order to use data for decision-making and program improvement, improve the quality of
services, and monitor progress towards achievement of national PMTCT targets.
ACCOMPLISHMENTS: In FY 2007, the MOHSW revised the national PMTCT guidelines to include the
WHO tiered-approach for PMTCT ARVs, implementation of provider-initiated testing and counseling in
antenatal (ANC), labor and delivery (L&D) and postnatal wards, and provision of single dose Nevirapine as
per national guideline so as to ensure all HIV-positive pregnant women receive at least the minimum
PMTCT prophylaxis regimen. National PMTCT indicators and monitoring and evaluation tools (M&E),
including monthly summary forms and ANC and L&D registers, are being revised to reflect the new regimen
options and ensure referrals and linkages with other continuum of care services. The national PMTCT
training curriculum was revised to reflect the updated guidelines, indicators, and M&E tools, and ensure
implementation of revised policies and strategies. Supportive supervision visits were conducted in all
regions and districts implementing PMTCT, and 203 trainers and 2758 service providers were trained in
PMTCT service provision. Workshops were conducted for 24 district teams from four regions to include
PMTCT in district planning and budget documents. Information, education and communication (IEC)
materials are in development to address challenging issues in PMTCT implementation. The MOHSW also
contributed to national PMTCT commodities and drug forecasting.
ACTIVITIES: 1) Strengthen national coordination and integration of PMTCT into reproductive and child
health services (RCHS), integrated management of childhood illness (IMCI) programs, and HIV care and
treatment services; 1a) Coordinate the expansion of early infant diagnosis programs; 1b) Ensure infant-
diagnosis and infant-feeding preferences are captured in data forms and used for decision-making; 1c)
Ensure linkages with immunization services and that mother's PMTCT information is transferred to the child
immunization card; 1d) Work with partners to ensure provision of maternal and pediatric cotrimoxazole; 1e)
Work with implementing partners to devise innovative approaches to rapidly increase the percentage of HIV
-positive pregnant women that receive ARV prophylaxis or ART as eligible, initiate mothers to mothers
programs to promote adherence, follow-up care and psychosocial support.
2) Strengthen monitoring and evaluation of the national PMTCT program and use data for decision-making;
2a) Coordinate piloting and finalization of revised PMTCT M&E tools; 2b) Operationalize revised M&E tools
by coordinating roll-out and partner implementation; 2c) Lead the integration of PMTCT data with HIV care
and treatment systems and ensure HIV care and treatment systems track services provided to pregnant
women and their children; 2d) Use and disseminate data (via regular reports and stakeholders meetings) to
continuously review policies and strategies and make updates when needed; 2e) Coordinate expansion
plans to ensure national PMTCT targets are met; 2f) Oversee and manage the decentralization of
supportive supervision activities from regional to district levels in order to increase efficiency and promote
ownership of the program by the Council Health Management Team (CHMT). Supervision tools will be
disseminated and trainings on the importance of data use will be conducted; 2g) Train regional health
management teams (RHMT) on PMTCT service provision and data use for decision-making;
3) Strengthen commodity and test kit quantification, procurement, distribution and coordinate LMIS roll-out;
4) Coordinate updates to PMTCT training curricula and guidelines;
5) Increase male involvement in PMTCT; 5a) Collaborate with RCHS to add PMTCT to existing outreach
activities targeting men; 5b) Coordinate national IEC and advocacy work pertaining to PMTCT, and ensure
PMTCT messages are incorporated into existing IEC campaigns;
6) Coordinate a demonstration project with the national IMCI Community Own Resource Persons (CORP)
program to raise awareness of PMTCT in the community, and assist with the follow-up of HIV positive
women and their children. This will be done by sub-granting this community initiative to Health Focus
network, a NGO with vast experience in community outreach services in Tanzania;
7) Strengthen linkages with family planning; 7a) Participate in the development of demonstration projects for
providing counseling and testing services at family planning clinics, and providing family planning services
and methods at ART sites. Activities will be implemented with the aim of preventing unintended
pregnancies in HIV+ women of childbearing age. Family planning plays several roles in helping to maintain
the health of individuals, families, and communities, and can be utilized as an entry point to counseling and
testing services; 7b) Work with partners to ensure integration of HIV and PMTCT messages into existing
family planning training curricula and service implementation;
8) Build capacity of district and regional supervisors and the national PMTCT coordinating unit; 8a) Maintain
equipment and staff for national PMTCT coordinating unit; 8b) Provide PMTCT related program
management training and relevant short-courses to PMTCT staff at district, regional, and national levels; 8c)
Coordinate quarterly national secretariat and subcommittee meetings, and advise the National Care and
Treatment Advisory Committee on PMTCT related policy decisions;
9) Coordinate an annual program review workshop involving stakeholders; successes, challenges, and
Activity Narrative: progress towards achievement of national targets will be discussed. Innovative approaches to ensure
increased coverage and quality of PMTCT services will be discussed and way forward will be decided.
LINKAGES: Linkages with implementing partners will be maintained and strengthened in order to increase
the coverage and uptake of PMTCT services. Linkages with ART services will be strengthened to ensure
HIV positive pregnant women are enrolled in care, assessed for ART, and provided ART if eligible.
Linkages with ART will also ensure HIV-exposed infants are receiving appropriate care and are tested for
HIV as soon as possible. In order to strengthen M&E of the national program, the PMTCT Unit will, in
collaboration with the NACP M&E Unit, HMIS and partners, update and rollout a revised national PMTCT
Monitoring system, support sub-national M&E efforts, provide PMTCT progress reports, and improve
PMTCT data quality and timely reporting. Linkages with RCHS will be strengthened to increase coverage
and uptake of PMTCT services and integrate PMTCT services within the expanded program of
immunizations (EPI). PMTCT will also be included in existing RCHS outreach activities. Linkages with
family planning will be strengthened to prevent unwanted pregnancies among HIV-positive women. To
ensure HIV-exposed infats receive home- and community-based care and support, linkages with OVC
programs will be developed.
CHECK BOXES: In-service training to health care workers at reproductive and child health clinics is a
capacity building activity. IEC materials and media to increase male involvement in PMTCT is a gender
M&E: MOHSW will decentralize supportive supervision from regional to district levels and build sub-national
-level capacity. M&E activities will also involve managing and implementing a national PMTCT system that
reflects the national guidelines; improving data quality and reporting; training and supporting sub-national
levels on data use; and disseminating PMTCT program data and data quality reports.
SUSTAINABILITY: MOHSW will work with District Councils to include PMTCT activities in Comprehensive
Council Health Plans and support resource mobilization from Global Fund and other sources. Full
integration of PMTCT into RCH services will help to ensure sustainability. Capacity building of the regional
and council health management teams in program specific training, supportive supervision, and mentoring
skills will be included to ensure continuity of their supervisory roles and program ownership. Capacity
building at the national level will help to ensure continuity of program monitoring and evaluation for decision-
TITLE: Advocacy and Social Mobilization for Behavior Change Communication
NEED and COMPARATIVE ADVANTAGE: NACP coordinates the Health Sector HIV/AIDS response in
Tanzania through planning and implementation of health related HIV/AIDS interventions in collaboration
with other partners. Social mobilization is crucial for community support and uptake of services being
provided through the various program areas of prevention, care, treatment, and support. These
interventions are implemented by five other units within NACP and are all linked for advocacy and behavior
change communication through the Information, Education and Communication (IEC) unit. The HSS
recommended incorporation of Behavior Change Communication (BCC) in addition to IEC. Evaluation of
whether these IEC activities lead to behavioral change towards safer sexual practices, abstaining, and
faithfulness has not yet occurred. In addition to creation of conditions that influence behavior, practices and
socio-cultural norms, IEC/BCC strategies must address gender and economic dimensions which influence
ACCOMPLISHMENTS: NACP has supported the regions in the identification and selection of the Regional
AIDS Coordination Committees (RACCs), District AIDS Coordination Committees (DACCs) and Council
Multi-sectoral AIDS Committees (CMACs), including 14 regional facilitating agencies to implement IEC/BCC
strategies. NACP plans to implement the program in five regions including Dar es Salaam, Shinyanga,
Mwanza, Tabora and Singida.
ACTIVITIES: The National AIDS Control Program (MOHSW/NACP) has responsibility for coordinating the
mainland Tanzania health sector response to HIV/AIDS. One component of the national response is to
encourage healthy behaviors that prevent HIV infection through the promotion of abstinence and
faithfulness. NACP, through its IEC/BCC unit, aims to enhance communication abilities of health care
service providers through behavior change communication and social mobilization trainings with a focus on
promoting abstinence among young people and encouraging faithfulness and stable sexual relationships
among adults. NACP's IEC/BCC unit maintains and supplies a range of innovative materials such as
booklets, leaflets and other audiovisual materials for low-literacy and rural populations and the general
public. In FY 2008, NACP plans to implement the following:
1) Continue to further promote the use of IEC/BCC materials and build the capacity skills of staff to address
AB HIV prevention effectively: This will be achieved by: 1a) conducting an inventory of existing information
resources; 1b) identifying information gaps and thereafter developing appropriate IEC/BCC materials
focusing on AB; 1c) training 2500 health care providers and media personnel on the appropriate use of
2). Promote adequate production and distribution of culturally appropriate IEC/BCC materials that support
BCC and AB: 2a) produce and distribute 300,000 posters, 600,000 brochures, and 300,000 booklets
covering different aspects HIV/AIDS/STI in the context of AB; 2b) distribute the materials to all referral,
regional, district and ward level facilities and NGOs.
2 d) develop and disseminate reference materials for the Regional and District AIDS Control Coordinators
(RACCs and DACCs) and other partners to assist them in their IEC/BCC intervention activities.
3). Produce & print training materials and train CMACs, RACCs, & DACCs:
3a) develop training materials for service providers, conduct training of trainers (TOT) in communication
strategies for behavior change, and involve CMACs, RACCs and DACCs in IEC/BCC activities in the project
area. NACP expects to reach 121 DACCs and 21 RACCs;
3b) collaborate with zonal training centers (ZTCs) to train master trainers for the zones;
3c) conduct seminars with partners and media personnel for the promotion of partner reduction and
abstinence campaigns; 3d) conduct sensitization meetings with local leaders, local government authorities
(LGAs) and private stakeholders implementing abstinence and faithfulness interventions in the regions.
4). Collaborate with partners to develop and train partners on a BCC strategy to link with the planned
STRADCOM radio program: 4 a) Use Modeling and Reinforcement to Combat HIV/AIDS (MARCH), a BCC
strategy that integrates modeling through radio dramas and various reinforcement activities such as small
group discussions to target change at the interpersonal and community levels. 4b) Technical assistance will
be sought for developing and producing films and talk shows on different areas with emphasis on AB.
5). Assess level of behavioral change and communication:
5a) Promote culturally appropriate AB messages and strategies for the general public; 5b) Increase the age
of sexual debut; promote HIV testing through IEC/BCC strategies; 5 c) NACP IEC/BCC unit will conduct
routine process monitoring during the funding period. Indicators will focus on trainings delivered,
intervention quantities related to proposed activities, and IEC/BCC materials and programs produced
through various channels as a result of these efforts.
LINKAGES: NACP will work closely with the local government authorities in regions and districts (mainly
CMACs, RACCs and DACCs in Dodoma, Tanga, Morogoro, Coast & Lindi). The linkages will be continued
with other USG AB implementing partners including TAYOA, Ministry of Education and Vocational Training,
STRADCOM, TANESA, track 1 ABY partners, NGOs, and Media Institutions/Houses. 1) STRADCOM will
provide technical assistance and produce and air radio programs on different issues on HIV/AIDS/STIs in
the context of AB in collaboration with NACP. 2). TANESA is committed to working with RACCs, DACCs
and CMACs in community outreach campaigns and sensitization workshops. 3) NACP will work closely with
the track 1 ABY and MOEVT-TIE partners to disseminate the youth AB curriculum to adapt a standard
approach for AB life planning skills (LPS) training.
CHECK BOXES: The program will focus on IEC/BCC in the context of AB in different settings. NACP will
focus on building the capacity of local organizations in the respective regions. Training of key implementers
of HIV programs focusing on health workers at district level and community mobilization. The general
population will be targeted through community outreach activities on AB implemented by existing partners in
M&E: AB will be integrated into the health management information systems (HMIS). There will be training
on the use of M&E tools and support provided in the use of the tools in day to day operations. All supported
sites will use MOHSW daily registers and monthly summary forms. This will harmonize recording and
reporting of AB community outreach activities.
SUSTAINABILITY: This project will utilize existing knowledge on major obstacles to an effective HIV/AIDS
response, such as issues on stigma and discrimination against people living with HIV/AIDS, and gender
inequalities, particularly in the area of information access and utilization. Through the existing systems at
Activity Narrative: the regional and district levels NACP will build capacity of the CMACs, RACCs, DACCs and other local
leaders in the area of AB. In turn the trained CMACs, RACCs, DACCs and LGAs authorities will continue
educating and advocating for the correct AB interventions in their respective communities. NACP will work
with district authorities to include part of the programming in AB into the CMACs plans at the district level.
TITLE: Scaling-up Community Home-based Care/ Palliative Care in Tanzania
NEED and COMPARATIVE ADVANTAGE: The Tanzania Health Sector Strategy on HIV/AIDS includes
community home-based care (HBC) as one of the interventions under care, treatment, and support. HBC
refers to a broad spectrum of palliative care and has been recognized as one of the most effective ways of
mitigating the physical, mental, emotional, spiritual, and economic difficulties for people living with HIV/AIDS
(PLWHA) and their families. These services are provided by both healthcare workers and trained
volunteers, both within facilities and in the community. The Ministry of Health and Social Welfare (MOHSW)
established HBC services in nine districts in 1996. As of December 2006, the services reached 70 out of
127 districts across Tanzania. With expansion of care and treatment, the need for facility-based palliative
care increases as well.
While there are guidelines and standard training materials, implementation of palliative care is still
fragmented and uncoordinated. MOHSW, through the National AIDS Control Programme (NACP), is
responsible for coordinating services as well as ensuring that the services are accessible and of high
quality. NACP's Counseling and Social Support Unit (CSSU) sets standards, oversees and coordinates
implementation of the training of community HBC workers, and monitors and evaluates the implementation
of palliative care services provided to PLWHA.
ACCOMPLISHMENTS: FY 2007 was the first year that the USG requested Emergency Plan funding for the
CSSU of NACP. Those funds have only just been awarded; though NACP is proceeding with many
important aspects of coordinating palliative care services, strengthening the preventive care package,
improving quality of services and initiating an accreditation system for programs, and revising palliative care
guidelines. This upcoming support will also be very important for the initiation of work on a national
monitoring system of palliative care services that can be used as a management tool at both the national
and local level, and thereby proceeding with stronger coordination and quality efforts.
ACTIVITIES:FY 2008 will be an important year for exerting stronger leadership and significant expansion in
the area of palliative care. The CSSU has organized a care and support sub-committee of the National
Care and Treatment Task Force. This formal body will foster better partner coordination and
implementation under NACP's leadership. This initiative will focus on the quality and comprehensiveness of
palliative care. Several organizations will collaborate with NACP: Family Health International (FHI) for
organizational strengthening, the African and Tanzanian Palliative Care Associations, Mildmay, the
Foundations for Hospice in Sub-Saharan Africa, Columbia University/Ocean Road Cancer Institute, and a
twinning partnership with the Iowa Synod. Each of these organizations has expertise and innovative ideas
to help facilitate the expansion and improvement of standards of care, guidelines, and training curriculum.
The CSSU will ensure that providers of palliative care, especially HBC, convene regularly to discuss quality
issues, approaches, program content, and supervision. Attention will be paid to ensuring that implementers
create, in collaboration with NACP, a standard service package including nutrition counseling and
assistance, psychosocial/spiritual support, opportunistic infection (OI) and pain management,
cotrimoxizole/malaria prevention, referrals for malaria and TB diagnosis and treatment, access to safer
water, ART adherence counseling, and referrals to services in the community, such as income generating
activities (IGA), legal and human rights education, etc. Nutritional assessments will also be included as
appropriate. In addition, a prevention with positives package will be considered to reduce risky behavior,
provide access to family planning and condoms, and support disclosure. To ensure compliance with
quality standards, and verification that coordination reaches the community level, the CSSU will organize
biannual national level meetings and zonal biannual meetings. In addition, the CSSU will conduct
supportive supervision visits throughout the year.
In FY 2008, the MOHSW CSSU Unit and the Monitoring and Evaluation Unit at NACP will work with FHI
also develop and implement a national monitoring system for palliative care. The system will be developed
under the direction of NACP with input from stakeholders. The rollout of the system in FY 2008 will involve
training of HBC providers in the new system, and implementation will be accomplished with a project
management team. Supportive supervision will be built into the training to ensure quality data is collected
and that district level personnel understand how to use data for program planning, budgeted, managing,
A key role that the CSSU of NACP plays is to coordinate the trainings and allocate trainers, while the
council health management teams (CHMT) will identify the facilities from which the health facility HBC
providers will be trained. This is particularly important where there is no USG partner working at this time.
These trained health workers will sensitize their respective communities to select additional resource people
(using the criteria set in the national guidelines) to be trained as HBC volunteers. Key components of the
training include community sensitization on HIV prevention, nursing care of PLWHA and other chronically ill
patients, management of OIs including pain management, basic counseling skills, adherence support,
referral, networking, and recording and reporting data. Trainings will be conducted in the districts with
support from national and district HBC trainers.
Funds will support copies of "Integrated Management of Adolescent and Adult Illnesses" caregiver booklets
and patients' flipcharts, to be provided as references and working tools for the HBC providers. In FY 2008,
the CSSU of NACP will be involved with USG partners in the review of publications to identify a collection
that are usable by all partners and other small organizations that provide HBC. These will be printed and
made available to all partners.
In order to address the service and coordination gap, NACP, in collaboration with the CHMT, will undertake
several additional activities. Approximately 160 district HBC trainers will be re-trained on palliative home-
based care, community directly observed therapy-short course (DOTS) for TB, monitoring and evaluation,
and preventive care. Fifteen new health center and dispensary level HBC providers will be trained in each
of the proposed districts. Thirty lay volunteers will be trained in each of the proposed districts.
The FY 2008 funding will support two direct-hired HBC program officers at NACP to address the workload
described above. One only needs to envision an hourglass to understand the impact of too few staff to
significantly scale up services.
LINKAGES: As the coordinating body for all HBC services, NACP will play a key role in facilitating linkages
Activity Narrative: with other services such as care and treatment. NACP will develop and implement referral systems that will
be used to link counseling and testing patients to HBC and will include this in the monitoring system. Since
comprehensive care and support requires networking and referrals to link services and needs of PLWHA
and their families, linkages with care and treatment clinics (CTCs), reproductive health clinics, TB, and other
community-based services will be established. HBC providers will be oriented to these services during
training, as appropriate. In addition, this activity will have a critical linkage with all the palliative care
programs: those involved in systems strengthening, those developing innovations, and those on the ground
with significant caseloads.
CHECK BOXES: NACP's work will develop human capacity through in-service training of the clinical nurses
who will supervise the community HBC volunteers in the community. NACP will also promote task shifting
of HBC from trained nurses to non-medical personnel in the community.
M&E: NACP CSSU will work in collaboration with the NACP M&E unit, as well as with Family Health
International and all implementing partners, to develop and implement a database and related tools to
provide NACP with information to monitor, plan, and share results on progress of HBC in Tanzania.
Reports will be channeled monthly from the dispensaries and health centers to the districts and compiled to
be submitted quarterly to MOHSW. NACP will use data from the new system for program planning and
feedback to partners and the government on the progress and challenges of HBC in Tanzania. The data
will also be made available to local government authorities and the relevant NGOs so that data can be used
for planning, management, budgeting, and decision-making. In order to improve supervision, NACP will
develop a standardize tool (in collaboration with HBC partners) to use for data quality and for feedback to
HBC organizations on the progress and quality of their work. They will also work to build their capacity so
that the unit is able to manage data from the new system.
SUSTAINAIBLITY:It is critical for HBC to be integrated into the district comprehensive plans as a core
service. During establishment of the services in the districts, sensitization is conducted to emphasize that
the services are included in the district comprehensive plans. At the central level, the services have been
included in the HIV/AIDS Health Sector Strategic plan. However, it is well understood that there is lack of
resources and inadequate allocation of resources in the health sector budget. Training, capacity building,
and advocacy will ensure sustainability.
TITLE: Strengthening HIV Counseling and Testing Services for Mainland Tanzania
NEED and COMPARATIVE ADVANTAGE: The Ministry of Health and Social Welfare, through the National
AIDS Control Program (NACP), has the responsibility of coordinating the health sector response to
HIV/AIDS. The Counseling and Social Support Unit (CSSU) at NACP coordinates the Counseling and
Testing (CT) program through development of policies and guidelines, training protocols and manuals,
standard operating procedures and job aides. NACP also provides supervision and technical guidance to
implementing partners, strengthens training of counselors to secure the required quantity and quality of
services, and monitors the progress of implementation of CT activities through reports from district councils,
NGOs, and other stakeholders.
ACCOMPLISHMENTS: Recent NACP achievements include providing CT services and indirect support to a
combined total of approximately 681,000 clients and training of 23 health care workers in CT services. In
addition, CSSU worked with the Epidemiology Unit at NACP to revise the M&E tools for CT.
FY 2008 funds will be used to:
1. Strengthen VCT services at 56 USG-supported sites within 10 regions;
2. Establish provider initiated testing and counseling (PITC) services at 25 health facilities within 16
3. Train 100 health care workers from 25 sites and retrain 50 counselors from 28 health facilities;
4. Procure HIV test kits and related commodities;
5. Provide mentoring and facilitative supervision to hospitals and health centers providing CT services;
6. Mobilize and sensitize communities for the uptake of CT services;
7. Design, develop and pretest IEC messages in collaboration with the IEC/BCC Unit;
8. Monitor the progress of CT activities through supportive supervision, monitoring and reporting;
9. Standardize the CT monitoring system, to capture both VCT and PITC data; and
10. Strengthen the managerial capacity of the Unit to coordinate CT services in Tanzania.
LINKAGES: For individuals testing HIV-positive, linkages will be made with various programs including
palliative care/home based care and HIV treatment. HIV-negative persons will be linked with resources
(e.g., post-test clubs) to help them maintain their negative status). Work will be completed in collaboration
with various implementing partners including JICA, GTZ, GFATM, and SIDA.
CHECK BOXES: Coordination of CT services, training of health care workers, service provision for VCT and
PITC and supporting the Council Health Management Teams (CHMTs) in the roll out of CT services.
Disseminate the CT guidelines and training materials to all partners implementing CT services.
M&E: NACP will continue to support integration of HIV CT in HMIS and training for M&E tools. NACP will
also provide support in the use of the tools in day to day operations. All supported sites will use MOHSW
daily registers and monthly summary forms, which will harmonize recording and reporting of CT services.
SUSTAINAIBILITY: To ensure sustainability of CT services, NACP will support the training of CHMTs on
mentoring and supportive supervision of CT services (VCT and PITC) and in directly supports the overall
HIV Care and Treatment Plan. This activity will also strengthen the CHMTs to manage and supervise the
implementation of quality CT services at the council level through monthly/quarterly coordinating meetings.
It will also strengthen the referrals and linkages to care, as well as treatment and prevention activities in all
sites and the integration of CT services into other services.
TITLE: Coordination of ARV services and HIV care in Tanzania
NEED and COMPARATIVE ADVANTAGE:
The Care and Treatment Unit (CTU) is the National AIDS Control Program (NACP) focal point for
coordination, management and implementation of the National HIV/AIDS Care and Treatment activities in
Tanzania. The CTU works with other units of the NACP and partner organizations within and outside the
health sector to develop and implement comprehensive care strategies in public, private and community
The Care and Treatment program in Tanzania was initiated in 2004 with 32 health facilities and by the
beginning of FY 2007, there were 204 operational CTCs (all located in referral, regional and district
The NACP/CTU coordinated regionalization of all care and treatment services where each region was
assigned one supporting partner. This resulted in PEPFAR partners providing support to 19 out of 21 (90%)
regions in mainland Tanzania as well as to Unguja and Pemba Islands of Zanzibar. Regionalizing partner
support has enabled the NACP to rapidly decentralize support to regions and districts. The partners in turn
have been able to integrate with regional medical offices (RMO) thereby providing assistance in planning
and implementation of services.
In FY 2007, the NACP/CTU started to develop human and physical infrastructure needed to expand the
services to Primary Health Centers (PHC) to provide HIV care and treatment as initiation, refill or outreach
(satellite) centers. The plan was to have four PHCs per district to a total of 500 PHCs providing treatment
services in Tanzania. USG treatment partners have begun to implement these plans in the regions that they
support. By Sept 2008, approximately 274 (55%) PHCs will be support by USG partners.
Using existing funds from USG as well as funds from the Royal Netherlands Embassy (RNE) through
PharmAccess International (PAI), the NACP M&E Unit revised the Care and Treatment Centre (CTC)
monitoring and reporting system to include a facility-based monitoring & reporting component. This included
adapting the World Health Organization (WHO) facility-based chronic HIV/AIDS care registers to the
Tanzania situation and revising the paper-based longitudinal management patient record. In the CTC 2
form, it will function as the data source for the registers. Cross sectional and cohort reports were also
adapted for Tanzania. By March 31, 2007, the NACP M&E Unit in collaboration with PAI and USG treatment
partners had trained 261 regional, district and CTC staff in 11/21 regions on the use of these tools. The
revised CTC 2 forms have been distributed to all existing CTCs while the registers and reporting tools are
being distributed after completion of the training.
NACP M&E unit also contracted the University Computing Centre (UCC) through the Global Fund to
develop an electronic database based on the CTC 2 form. The CTC 2 database, which is capable of
generating national and PEPFAR reports for treatment services, is currently in use at 35 of the 204 existing
CTCs. UCC also developed for NACP, a central-level database (CTC 3) which has de-identified patient
level data on a subset of CTC 2 data elements. The CTC 3 database is electronically linked to other partner
-supported databases such as the Harvard system in Dar es Salaam (4 CTCs) and the DoD system in
Mbeya, Rukwa and Ruvuma regions with 15 CTCs.
Finally, by March 31, 2007, Tanzania had 71,584 patients actively on ART (96% supported by USG) and
1,457 HCWs trained on management of HIV including focused training on Pediatric HIV.
In FY 2008, the NACP CTU will coordinate the following activities in order to come up with quality
unduplicated ART services;
a) Coordination of partners implementing ART services in Tanzania including conducting regular meetings
with partners to discuss various issues including provision of policy and technical guidance, sharing best
practices and sharing M&E data to track progress against national goals and to improve program
b) Coordinate the expansion of care & treatment services to PHCs.
c) Review training materials in collaboration with I-TECH and disseminate the revised training guidelines.
Since management of HIV/AIDS is very dynamic with progressive and frequent changes, the CTU plans to
review and finalize the national clinical guidelines, national training materials, and standard operating
procedures (SOPs) used at tertiary and secondary levels and the IMAI documents to be used at primary
health care levels.
d) For the sites to provide quality ART services, supportive supervision needs to be conducted frequently. In
a bid to decentralize supportive supervision, the NACP/CTU in collaboration with treatment partners will
empower Regional Health Management Teams (RHMTs) to conduct supportive supervision to districts and
facilities in their regions.
e) Ensure that on TB/HIV collaborative activities are well coordinate and linked between HIV and TB Clinics.
f) NACP/CTU will work with the NACP M&E Unit to coordinate the rollout of the revised M&E tools for care
and treatment and the expansion of electronic databases at facility level and central level. All USG
treatment partners have been funded to support the NACP implement these activities. The USG will assist
the NACP to build in-country capacity to regularly evaluate the impact of ART in Tanzania.
g) Continue maintaining the CTU unit at NACP including remuneration of program hired CTU staff and
procurement of stationary and other office supplies to ensure smooth running of the program.
h) Attend international conferences. To enable CTU coordinate ART activities, personnel need
strengthening/capacity building by attending relevant courses, workshops and conferences within and
outside the country.
Activity Narrative: LINKAGES:
In Tanzania, the NACP/CTU provides technical guidance on referals and linkages and collaborates with all
ART partners implement Care and Treatment program. CTU ensures that there are linkages between ART
program and Home based care, TB and PMTCT programs. Linkages with the National TB and Leprosy
Control Program (NTLP) will be strengthened in order to track referals and ensure continuum of care.
The general population benefits the quality and accessible ART Services.
Tanzania has a national standardized care & treatment M&E paper-based tools that are used at almost all
facilities. The system consist of; CTC 1 - a patient appointment card; CTC 2 - a patient management record;
CTC 3 - a monthly identifier-stripped patient-level report (soon to be discontinued); Pre-ART and ART
registers which are manual longitudinal patient record transcribed from CTC 2 forms; monthly cross
sectional and quarterly cohort reports. The CTC 2 and CTC 3 databases are electronic formats of CTC 2
and CTC 3 forms respectively capable of generating all the NACP and OGAC reports. The Harvard and
DoD are partner developed systems with links to the national systems for report generation.
With financial and/or technical support from RNE/PAI, USG, Global Fund and UCC, the NACP M&E Unit on
behalf of the NACP/CTU will continue to coordinate the implementation, scale-up and maintenance of these
systems. The NACP will also provide leadership in promoting data use culture at facility, district and
regional; coordinate regular outcome evaluation to track the impact of ART in Tanzania and conduct
regular data sharing workshops to disseminate findings
NACP/CTU is committed to sustainability and plans to: work with authorities from regional and district level,
to implement the program to empower local authorities and create ownership, putting the responsibility of
sustainability into their hands; Involvement of RHMT and CHMT to conduct supportive supervisors and plan
and budget for the gapes identified; Integrate ART activities in to the Districts Comprehensive Health Plans.
TITLE: Support for SI capacity, surveillance and program area monitoring systems within NACP
NEED AND COMPARATIVE ADVANTAGE: The National AIDS Control Program (NACP) in Tanzania
coordinates the Health Sector response to HIV/AIDS Epidemic. The Unit has primary responsibility for all
strategic information for NACP, including: a) surveillance and surveys including Ante-Natal Clinic (ANC)
based sentinel surveillance for HIV, HIV drug resistance threshold surveys and participation in national
population-based surveys such as the Tanzania HIV Indicator Survey (THIS); b) monitoring HIV/AIDS
interventions, including the development/adaptation and maintenance of electronic data-collection-tools
systems; training on paper-based tools and synthesis to move from data collection to reports; supportive
supervision to ensure data quality and timeliness of reports and data and report flow, c) capacity-building on
M&E to other units within NACP and d) compiling health sector response data for HIV/AIDS and reporting
these to the Tanzania Commission for AIDS (TACAIDS). This unit also links with TACAIDS to provide
information on the "Third One" for the Health Sector Response to the HIV/AIDS epidemic in Tanzania.
ACCOMPLISHMENTS: In the five years of collaboration between the NACP and the USG, there has been
substantial progress in the implementation of national HIV surveillance activities. Coverage for antenatal
clinic (ANC) surveillance has grown from 24 sites in six regions (2001/2002) to 128 sites in all 21 regions
(2007/2008) of mainland. The methodology of ANC surveillance has also improved substantially. For
instance, the use of dried blood spots (DBS), which are easily transportable, has enabled coverage to
remote sites with no lab capacity. During FY 2006, NACP piloted HIVDR threshold survey in six sites in Dar
es Salaam region, and in FY 2007, NACP carried out HIVDR threshold survey in Mwanza and Mbeya
ACTIVITIES: FY 2008 funding will support surveillance activities and capacity building for strategic
1. Surveillance: ANC, HIVDR Monitoring
a. ANC Sentinel Surveillance
For the 2008-2009 round of ANC surveillance, NACP will maintain full coverage of all 21 regions in
mainland Tanzania, covering six sites per region. A total of 128 ANCs will participate in data collection for a
period of three consecutive months according to the standard protocol. ANC surveillance activities will
include maintenance of the surveillance workgroup; training of ANC and lab staff on protocols, procedures
and quality assurance; distribution of supplies; data collection; periodic supportive supervisory visits; HIV
testing of collected dried blood spots (DBS); data management, analyses, report preparation and
dissemination. During supportive supervisory visits, sites will be provided with funds for shipping of DBS
and data forms to the testing laboratory. Surveillance staff will be given a token during the three months of
data and specimen collection.
HIV testing of the collected ANC samples will be done in four referral hospital labs namely, Muhimbili
University College of Health Sciences-HIV Reference laboratory, Bugando Referral Hospital, Mbeya
Referral Hospital and Kilimanjaro Christian Medical Center (KCMC). For quality assurance, 10% of all
specimens will be retested at the National Quality assurance laboratory in Dar es Salaam. The surveillance
advisory group will analyze data, and prepare and disseminate reports.
b. HIV drug resistance monitoring
With the rapid scale-up of the National Care and Treatment program and increased access to ARVs, the
prevalence of acquired resistance should be examined. The emergence of some degree of HIV drug
resistance in ART programs is inevitable, but can be exacerbated by failure to optimize support for
continuing access, adherence, and continuous drug supply, by inadequate prescribing practices, and by
baseline (pre-ART) drug resistance. Routine ART program evaluation to monitor these factors and their
relationship with drug resistance should be instituted early in ART roll-out, utilizing standard minimum-
With FY 2008 funding, NACP expects to pilot HIVDR monitoring in four sites (private, faith-based/NGO
referral, regional) in four regions: Mtwara, Mbeya, Iringa, and Kilimanjaro. A cohort of 400 treatment-naïve
individuals (100 persons per site) will be monitored for a 12 to 15-month period to assess development of
acquired (primary) drug resistance. A national protocol for HIVDR monitoring will be developed and site
assessment will be conducted, to determine readiness and identify any gaps to be strengthened prior to
data collection. Data collection forms will be developed and will be revised based on pre-testing of tools.
Data will be evaluated for important lessons which can be generalized to other clinical sites, as HIVDR
monitoring is expanded to other ART sites.
2. Strengthening SI Capacity at NACP
a) Strengthening capacity in the M&E Unit
In FY 2008, the USG will provide funding and technical assistance to strengthen the infrastructural and
human capacity required to enable the Epidemiology and M&E Unit to carry out surveillance activities, build
M&E capacity, and provide information to TACAIDS on HIV interventions.
Funds will cover maintenance and/or recruitment of new staff and logistical support to enable personnel to
perform their duties as required. For staffing in the unit, six cadres of staff have been identified: 1) an
epidemiologist in charge of the unit; 2) an M&E officer to oversee activity planning, monitoring and
reporting, as well as capacity-building, data use and program evaluation activities; 3) a surveillance officer
to coordinate all surveillance activities; 4) three program monitoring officers in charge of all sub-national
level program monitoring activities including data quality assurance, training and supportive supervision; 5)
two data managers to maintain all central-level databases; 6) three data clerks to enter data as required.
The Unit currently has staff who are full-time MoHSW employees as well as contract staff supported by
donors, including the USG. FY 2008 funding will be used to maintain the existing USG-supported personnel,
as well as to fill vacant positions (officers in charge of M&E, surveillance, and counseling and testing
b) Revision of the Health Sector M&E framework and coordination of reporting to TACAIDS
The USG will continue to support NACP in revising the health sector M&E framework to monitor and
evaluate the health sector's response to the HIV/AIDS epidemic. This framework plans to develop and/or
strengthen existing linkages between the different interventions, provide a comprehensive set of indicators,
Activity Narrative: standardize the reporting health information up to TACAIDS, and provide guidelines for developing work
plans, monitoring programs, and reporting all HIV/AIDS intervention activities. The M&E Officer will provide
oversight for the development of the framework including collaborating with the World Health Organization
(WHO) Resident M&E Advisor in the development and implementation the framework. The NACP and WHO
M&E Advisors will coordinate packaging, dissemination, and training on the framework. The M&E officer will
also coordinate the health sector information reporting to TACAIDS.
c) Building capacity of use of Personal Digital Assistants (PDAs) for data collection
Supervision is one of the keys to the success of a quality program. Supportive supervision at the regional
and district levels to health facilities are one of the integral components of program monitoring within NACP.
Currently, most regional supervision programs keep paper management records. They report their findings
to the national level. The introduction of new data collection methodologies will assist in ensuring that
quality data are collected and used in real time. PDAs will be used for data collection and dissemination of
findings and feedback.
LINKAGES: NACP works with other government organizations in the implementation of M&E activities,
including Tanzania Commission on AIDS (TACAIDS), National Bureau of Statistics (NBS), National Institute
for Medical Research (NIMR) and other Ministry of Health and Social Welfare departments. NACP also
works with Japan International Cooperation Agency (JICA), PharmAccess International (PAI), Global Fund
to Fight AIDS, Tuberculosis and Malaria (GFATM) and WHO.
SUSTAINABILITY: This activity builds capacity of national, regional, district and facility-level staff. It
supports the NACP M&E unit, programmatic units of NACP, local organizations, and laboratories. Supports
of SI capacity of the M&E unit will strengthen capacity of activity monitoring within program areas in NACP
including Counseling and Testing, Home Based Care, ART.