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: Strengthening the National and Regional Use of the Wide Area Network (WAN)
NEED and COMPARATIVE ADVANTAGE: The fight against pandemic diseases such as HIV/AIDS can be
made more effective when complete, accurate and timely data and information is available. Information and
Communication Technologies (ICTs), particularly Wide Area Network (WAN), can be used as a tool to
enhance the collection, processing, dissemination and availability of such information. This could be through
e-mails, file sharing, access to the World Wide Web, publishing information on the web and speedy delivery
of data via web-enabled data collection tools from upcountry to the ministry headquarters. This project is
therefore a timely initiative to modernize how health workers and policy makers collect, process,
communicate, disseminate and share information.
ACCOMPLISHMENTS: Implemented Local Area Networks (LAN) in seven regional medical
offices/hospitals and 1 referral hospital namely: Mbeya, Iringa, Lindi, Mtwara, Dodoma, Arusha, Mwanza
and Mbeya Referral Hospital; provided Internet connectivity for the above regional medical offices; recruited
two system administrators to manage the WAN and provide end user support; provided LAN and WAN for
two NIMR sites (Mwanza and Tabora); provided training to end users on e-mail use and internet surfing;
maintained all LAN and WAN equipment in 6 Dar es salaam sites and seven regional sites in good working
ACTIVITIES: Maintain and strengthen the existing LANs and WAN including connectivity, hardware, and
software updates through continued technical support to the 16 sites in seven regions
1. Conduct quarterly supportive supervisory visits to the existing 16 sites in seven regions
2. Train Health workers in seven regions on computer applications and training them about email and
internet use at the sub-national levels to ensure proper use of the technologies and timely data transfer.
3. Perform maintenance of the WAN system to the existing 16 sites in seven regions to ensure systems are
operating and address any issues. The sites under maintenance will include: Headquarters of the Ministry of
Health and Social Welfare (MOHSW), National AIDS Control Program (NACP), Prevention of Mother to
Child Transmission (PMTCT), Mbeya Referral Hospital, Regional Medical Offices/Regional Hospitals of
Mtwara, Lindi, Mbeya, Iringa, Arusha, Mwanza, Dodoma, NIMR Headquarters, Tukuyu, Muhimbili, Mwanza
4. Maintain Annual Internet subscription fee for shared bandwidth for all 16 sites
5. Awareness and dissemination through websites and electronic newsletters
LINKAGES: NIMR collaborates closely with MOHSW and particularly with HMIS unit and NACP in
implementation and management of LAN/WAN at Dar-es-salaam and upcountry sites. In FY 2005 the
assessment of ICT needs for regional connectivities was carried out from July to September 2005. The
assessment team was composed of three officials from the MOHSW's Policy and Planning Department, two
from CDC, one from NIMR and two from a private company, AFSAT. The MOHSW team was headed by the
Head of HMIS Unit. Planning meetings involved stakeholders from CDC, NIMR, MOHSW HQ and NACP
who formed a task force that implemented LAN/WAN to Dar-es-salaam and regional sites. The senior
ministry officials (Permanent Secretary and Director of Policy and Planning) launched the MOHSW
LAN/WAN and website that was developed.
Regionally, the project involved the Regional HMIS Focal persons in implementing and managing the
LAN/WAN. This collaboration has always been done when LAN was implemented and VSAT based-
Internet was provided for the following regional hospitals (Regional Medical Offices) of Mtwara, Lindi,
Mbeya, Iringa, Arusha, Mwanza, Dodoma and Mbeya Referral Hospital. Also, upcountry NIMR's IT officers
were also involved during connecting NIMR sites of Mwanza and Tabora which also received LAN and
CHECK BOXES: Conduct In-service training to health workers in seven regions on computer applications
and train them on email and internet use at the sub-national levels to ensure proper use of the technologies
and timely data transfer.
M&E: 1. Conduct quarterly supportive supervisory visits to all 16 sites to ensure that the systems are
operating and address any issues.
2. Review the usage of official e-mails on MOH.GO.TZ, NACPTZ.ORG and NIMR.OR.TZ domains. Review
will answer question about how many users are properly using the system, what are the gaps/limitations
and recommendation on improvements will be outlined.
SUSTAINABILITY: 1. The program staff will collaborate with the Ministry's HMIS staff to conduct basic
computer training, including basic troubleshooting of the systems to HMIS Focal person of the seven
regions where the regional and/or referral hospitals are connected.
2. Conduct end-users training and follow up for all sites. This will specifically involve conducting training to
end-users about email and internet use at the sub-national levels to ensure proper use of the technologies
TITLE: National Institute of Medical Research (NIMR), Build Capacity and Implement Health Workforce
Research and Evaluation for Policy Change in Tanzania
NEED AND COMPARATIVE ADVANTAGE
A strong workforce in the health sector is a critical component in meeting the challenges of the HIV/AID
crisis. In Tanzania there is a need to urgently increase health manpower as well as the performance and
productivity of health workers. Improvements in human resources for health (HRH) require policies that are
informed by evidence based research about Tanzania's unique problems and issues. There is the need to
build the capacity for this research, perform the evaluations and use the results to inform and improve the
system and policies relating to human resources for health.
National Institute of Medical Research (NIMR) has played a critical role in supporting the Ministry of Health
and Social Welfare (MOHSW) to address human resource crisis through operational research and
evaluations related to HRH. NIMR has experience in research in the fields of epidemiology, biomedical,
and general public health and began work on the HRH issue in 2004. The presence of NIMR offices
throughout the country and the availability of a network of researchers are added advantages. NIMR, which
is part of the MOHSW under the Policy and Planning Department, is in a key position to advocate for major
policy decisions based on the results of their evaluations. In addition NIMR as a member of the HRH
Working Group of the MOHSW is strategically placed to give input, advocate and advise MOHSW on
changes in HRH policies and systems.
Since 2004 NIMR has made strides in performing evaluations and assessments in the area of HRH,
advocating for policy changes in HRH and building capacity through support of Tanzanians in the Field
Epidemiology and Laboratory Training Program (FELTP) in Kenya. More specifically, operational research
centered on workload and productivity was conducted. These studies were important in informing policy
makers and local/district leaders on productivity and the means to improving it. After analysis, triangulation
of data, and through discussions with health care workers root causes and possible solutions that could be
applied were identified. As a result, at the national level the MOHSW and NIMR are redefining staffing for
health facilities and are developing activity standards and workload indicators. A major finding from the
workload study was that retaining health workers in rural areas is a major challenge. Therefore a retention
study was undertaken. Analysis and dissemination is ongoing and is expected to inform policy decisions on
which cost-effective retention schemes to embark on at the national and district levels.
Another component of NIMR work involves capacity development. In FY 2006-07, through the Kenyan Field
Epidemiology and Laboratory Training Program (FELTEP) program, two graduates completed masters'
degrees. These two graduates will strengthen both communicable and non-communicable units of the
MOHSW. Additional residents have been recruited, one for strengthening the Zanzibar AIDS Control
Program of Zanzibar and the other for Laboratory Diagnostic Unit of the MOHSW on Mainland. The FELTP
graduates and students are beginning to play a major role in outbreak investigation (measles, rift valley
fever and malaria), in studying the epidemiology of HIV/AIDS and have prepared epidemiological bulletins
and materials for short course for laboratory workers. One current student is conducting a study on
antiretroviral (ARV) drug resistance in patients starting ARV treatment.
Major activities for NIMR for COP 2008 include: continued work on HRH related issues; strengthening the
capacity of Tanzanians to undertake public health evaluations (PHEs); building capacity for GIS; and
continued support for Tanzanians in the FELTP program.
1) Operational research will continue, with a greater emphasis on capacity building at NIMR zonal/district
levels to decentralize the research. As a follow up to previous work, a job description assessment will be
completed to measure the effect of providing clear job descriptions and job aides on improving performance
of health workers. In addition NIMR, with additional funds for one PHE, will conduct an evaluation of the
feasibility of task shifting of health workers in health facilities and its acceptability among consumers and
communities. Results from these two activities will be translated into policy changes for improving HRH in
Tanzania. In addition, NIMR will continue to disseminate information and build health worker capacity
through production of the quarterly NIMR HRH newsletter and through membership of the MOHSW HRH
working group. Lastly, in collaboration with the Capacity Project, a retention scheme intervention at district
level will be implemented and evaluated.
2) FY 2008 funding will also support strengthening Tanzanian capacity to undertake public health
evaluations. By strengthening this capacity NIMR will be a strong local partner to serve as co-investigator in
public health evaluations. They will be able to offer services such as protocol and tools development, field
data collectors, data entrants/analysts and report writers. Databases will be established of research
assistants who would assist in fieldwork and data entry. Funds will also be used to purchase equipment to
assist in easy data collection and transfer such as PDAs. In addition NIMR will provide assistance in data
analysis and validation of the SAVI (social assets and vulnerabilities indicators) database.
3) With FY 2008 funds, NIMR will support two students to complete their studies in the Kenyan Field
Epidemiology and Laboratory Training Program (FELTP) which will build capacity in Tanzania to address
the current shortages in these fields. As part of the MOHSW Epidemiology Unit activity plans are
underway to establish a Tanzania FELTP program and these two students who will graduate in 2008 will
play a key role in this future program.
4) NIMR will use FY 2008 funds to build its capacity to complete GIS mapping through close collaboration
with the MEASURE project. As part of this activity GIS experts will work closely with NIMR to build in-
country capacity and use. Although GIS mapping is widely applied in health data, efforts have not been
coordinated resulting in duplication. Given, the existence of GIS experts in NIMR and NIMR's position as a
national research institute, coordination also falls under its mandate. In addition, NIMR will coordinate the
GIS group, through; routine meetings and updates, sharing of information among the group, organizing and
offering coordinated support to PEPFAR activities and linking GIS data sets.
In order to achieve the FY 2008 objective NIMR will link with a number of other key partners. NIMR will
Activity Narrative: work with the Capacity Project and the Health Policy Initiative for research and advocacy on HRH. Kenyan
FELTP students and graduates program will be linked with PMI, AFENET, Muhumbili University and the
new Tanzania FELTP program. NIMR will collaborate with institutions that have research experience for
implementation of the PHE component. For the GIS activities linkages will be developed MEASURE
Evaluation, University College of Lands and Architectural Studies and the National Bureau of Statistics.
NIMR has a strong focus on M&E and will employ the following M&E strategies: feedback from readers;
quality assurance plans for data collection; and visits to districts and respective zones to review use and
implementation of operational research after training. NIMR will strictly adhere to the PEPFAR reporting
and planning requirements.
All NIMR activities will be initiated in a participatory manner from both national and local level. Key
stakeholders will be involved through a bottom up approach to get their input into specific activities. Such
stakeholders include: ministries; NGOs; district leaders; and community representatives. Where possible,
additional funds will be leveraged to create a wider ownership and to ensure sustainability. Most of the
NIMR activities will include a capacity building component to build the necessary skills to sustain activities in
Title of Study: Evaluation of the feasibility of existing task shifting of health workers at health facility levels
and its acceptability among consumers and communities in Tanzania.
Expected Timeframe of Study: Phase One of the study is expected to take a total of 12 months. The
April-May: protocol and tools development
June-July: Pilot study, analysis of pilot data and tools rectification
August-October: Data collection
November-March 2009: Data entry, cleaning and processing, report writing and dissemination.
The Phase Two timetable will be developed during Phase One for implementation in year two.
Local Co-investigators: National Institute for Medical Research (NIMR); Tanzania Ministry of Health and
Social Welfare; Policy Analysis partner to be identified during phase one.
Project Description: A strong workforce in the health sector is a critical component in meeting the
challenges of the HIV/AID crisis. In Tanzania there is a need to urgently increase health manpower as well
as the performance and productivity of health workers. This proposal builds on existing evaluations that
investigated workload, productivity and retention schemes. The first phase evaluates the feasibility and
acceptability of task shifting among health workers based on both current informal task-shifting and within
sites where limited formal task-shifting has begun. Phase two will involve a pilot of new formal task-shifting
approaches within government facilities. Evaluation includes triangulating methods of cross-sectional
survey, discreet choice analysis and qualitative methods. Policy analysis for both phase one and two will
assess barriers to implementation of task-shifting and identify mechanisms to change policy. NIMR will be
working closely with MOHSW particularly in Phase Two to identify which task shifting to evaluate and refine
Evaluation Question: Phase One
The primary question is: What is the feasibility of task shifting (informal and limited formal) by health
workers at health facility level and its acceptability among health workers, consumers, communities and
policymakers in Tanzania?
1. What are tasks of the various cadres of health workers in different types of health facilities?
2. How dissimilar are the tasks of the health workers compared to their training and capacity?
3. What kind of task shifting, given current pre-service and in service training in Tanzania, can be done in
the various cadres of health workers in the health facilities?
4. What is the perception and acceptance of task shifting among health workers, patients, the community at
large and policy makers?
5. How do these findings differ in facilities where limited formal task-shifting is already ongoing?
6. What are the barriers within policy preventing formal task shifting initiatives and how can these be
Phase 2 (To be further refined depending on policy analysis and progress and in consultation with MOHSW)
The primary question is as follows: in selected health services and in selected health cadres where formal
task shifting, approved by MOHSW, is being piloted, what is the success as measured in ability to perform
tasks and feasibility and acceptability among health care workers, consumers and policy makers in
Methods: Phase one
The study will employ both qualitative and quantitative methods:
1. Quantitative methods will involve; a questionnaire surveying healthcare workers from health facilities that
are practicing task shifting either informally or formally. Informal task shifting is when health workers are
performing tasks they were not formally trained for and/or tasks not in their job descriptions. Formal task-
shifting is where a health worker has been formally trained to perform an additional task and where the
Ministry has sanctioned the particular task shifting to that cadre. Currently only limited formal task shifting is
occurring involving lay counselors performing HIV pre-counseling but not being able to perform the HIV
tests. In phase two it is hoped the MOHSW will authorize piloting of more comprehensive task shifting.
Variables of interest include performance, job satisfaction, and perceptions and acceptability of task-shifting.
In addition health workers will be asked to make choices of different groups of tasks that they would like to
be assigned using discrete choice experiment techniques
2. Qualitative methods will include: in-depth interviews and focus group discussions with health workers,
and other stakeholders including patients and communities.
Quantitative data will be double entered into a database and later analyzed using both Epi-info and Stata 8.
All qualitative data will be tape-recorded, transcribed and then using software, e.g. MAXQDA, grounded
theory analysis will be undertaken. Sub analysis will involve comparing the main variables of interest
between informal and limited formal task-shifting facilities. Further analysis will distinguish variables of
interest between the different cadres, areas, level of facility, and according to numbers of health workers in
the particular health facility.
Methodology for Policy Analysis will be developed early in the protocol development phase in conjunction
with a partner experienced in this area of research.
This phase is to be developed during phase one. The aim would be to pilot MOHSW approved models of
task-shifting. Since the task-shifting model is yet to be decided it is not possible to elucidate the outcome
measures or research methodology at this point.
Population of Interest: The population of interest will be: health workers and stakeholders such as Council
health Management Team (CHMTs), leaders, councilors, patients and communities.
Using the existing four geographical zones, at least one district per zone will be chosen randomly. In each
district-- all District hospitals, 50% of health facilities, and 10% of Dispensaries will be selected. Fifty percent
of all health workers will be recruited from the selected facilities for the survey. Exit interviews will be
carried out with patients in the same health facilities on the day of the survey. In each district at least three
Focused Group Discussions (FGDs) will be carried out with members of the community from catchments
area of the health facilities, making a total of 24 FGDs. These FGDs will involve women, men, leaders and
youths. All stakeholders will be identified through a snowball technique and will be involved in the in-depth
It is hoped that data will also be collected from sites purposively selected as examples of limited formal task
-shifting (e.g. where lay counselors are working).
In phase two, similar data approaches will be used but the study sites will be clinics implementing new
models of formal task-shifting developed in collaboration with MOHSW.
Information Dissemination Plan: A workshop will be organized prior to the study to solicit information from
important stakeholders such as the Director of Human Resources of MOHSW, Human Resources for Health
Working Group, private facilities, and civil societies on key issues to be considered in the study. Once the
study is finalized and report produced, it will be disseminated according to well-set dissemination plan
including workshops, conferences, newsletters, policy briefs and distribution of report.
Budget Justification: Salary/fringe benefits: $50,000
Participant Incentives: None
Laboratory testing: None