TITLE: Scaling-up Palliative Care Services in Tanzania through the Tanzania Palliative Care Association

(TPCA)

NEED and COMPARATIVE ADVANTAGE:Palliative care in Tanzania has need for updating of guidelines,

enhancement of services, and strengthening of providers, The Tanzanian Palliative Care Association

(TPCA) is a national organization for all palliative care providers and will be strategically placed to

spearhead palliative care development in Tanzania. However, TPCA is a relatively new organization; thus,

it is important that they collaborate with the African Palliative Care Association (APCA) to support their

organizational development and to leverage APCA's expertise. APCA is a multi-national and well

established organization that has a wealth of experience from which they can provide technical assistance

to TPCA and the National AIDS Control Programme (NACP) to build their capacity and expand the

provision of high-quality palliative care in Tanzania.

ACCOMPLISHMENTS: APCA has completed the establishment of the TPCA secretariat; a review of

existing palliative care and home-based care (HBC) standards with recommendations on how these can be

strengthened; development of a national framework for palliative care standards across the care continuum;

and the development of care standards and guidelines that address the needs of children for discussion

with NACP.

ACTIVITIES: The major activities for FY 2008 will include updating and implementation of the national

Palliative Care Guidelines. This will involve stakeholders' meetings with the NACP at the Ministry of Health

and Social Welfare (MOHSW), the National Aids Council, and other key stakeholders in Tanzania. APCA

will also work to develop pediatric palliative care programs. APCA will work with NACP to implement the

TPCA national palliative care strategic plan. The strategic plan, developed in FY 2006/07, is based on the

WHO palliative care core foundation measures: education development, drug availability, public policy and

pubic awareness, and implementation. The strategic plan will also review and refine existing basic care

packages (including prevention care packages, access to clean water, cotrimaxazole prophylaxis, basic

hygiene and insecticide treated nets). APCA will work closely with TPCA to develop a program of work

under the key areas of education and training and public policy. APCA will train a core group of trainers

(approximately 35 people) to build on the achievements of FY 2007. This will involve clinical placements

both across and outside Tanzania to ensure that the trainers have clinical experience. APCA will support

TPCA to continue to develop the action plans developed at Entebbe, Uganda by the country drug

availability team. Specifically, APCA will provide technical assistance to TPCA to develop opioid guidelines

and advocacy skills to influence government-level policy changes that favor drug availability. There will also

be series of national workshops and a national palliative care conference to increase public awareness of

palliative care.

APCA will help NACP develop palliative care standards based on the APCA African Palliative Outcome

Scale (APCA POS). They will also draft national guidelines for monitoring and evaluation, including a public

health evaluation of palliative care in Tanzania. Materials will be translated into local languages for

dissemination. APCA will work with the NACP to integrate palliative care into existing HBC networks though

a pilot project. APCA will draw lessons from its current work in Namibia to develop a protocol for integrating

palliative care into HBC across the country and to develop tool kits to facilitate this process. APCA will work

with training institutions to integrate palliative care into the curriculum of nurses and doctors across

Tanzania to increase the skills base for palliative care. They will develop a national task force for palliative

care to ensure local support for TPCA and long-term sustainability after APCA has departed.

LINKAGES: Key linkages will include TPCA, MOHSW, and NACP, to support integration of palliative into

the national HBC guidelines. With Family Health International and Pathfinder International, the project will

link to and integrate palliative care with the home-based care networks. APCA will also link with the

Foundation for Hospices in Sub-Saharan Africa's New Partner Initiative program working with the

Evangelical Lutheran Church of Tanzania in Arusha, Tanzania, so that lessons learned can be shared

widely and the project can utilize the trainers trained under this program to increase the delivery of training

of trainers (TOT) services.

CHECK BOXES: APCA will work at the national level in collaboration with TPCA, a national body

representing palliative care providers in Tanzania. APCA will target mainly people living with HIV/AIDS

(PLWHA) across both gender and age categories. However, given that children are routinely neglected in

palliative care, APCA will work with NACP to develop appropriate programs for children based on pediatric

palliative care guidelines.

M&E: APCA will work with TPCA to develop national M&E frameworks and protocols for palliative care

service development. APCA/TPCA will participate with other palliative care providers and NACP in the

development of a national monitoring system for palliative care. These protocols and the national

monitoring system will be linked to existing national guidelines and PEPFAR indicator protocols, and will

build on the work achieved in FY 2007. The program will also develop minimum data sets for data

collection from partners. APCA will support TPCA in developing data analysis procedures, storage and

retrieval systems, and reporting templates for disseminating M&E information. Further development of the

M&E frameworks will also include information acquired from the public health evaluation, anticipated to take

place in FY 2008. The M&E work will also incorporate feedback mechanisms for stakeholders so that

collected data can be used as a quality improvement tool for services.

SUSTAINAIBLITY: APCA will build the human and organizational capacity of TPCA through an

organizational development program. This will help strengthen TPCA into an effective organization which is

able to attract donor funding and has the capacity to deliver palliative care expertise within Tanzania. To

achieve this, APCA will support TPCA in developing organizational policies, providing a board development

program, and hosting a fundraising/donor relations skills development program. More importantly, APCA

will link TPCA with international partners, so as to ensure continuous support for their work.