TITLE: Strengthen PMTCT Scale-up and Sustainability Through Capacity Development.

NEED AND COMPARATIVE ADVANTAGE: The activities address the need to strengthen supervisory and

management capacity at the national, regional, and district levels to support scale-up of quality PMTCT

services that will meet national targets. A training-of-trainers (TOT) model will be instrumental in the

successful rollout of the updated PMTCT guidelines and PMTCT Supervisor's Guide, which includes topics

such as documentation of skills expected after PMTCT training, barriers to quality service delivery, and

problem-solving strategies. This will be undertaken concurrently with technical assistance to support

national leadership to maintain up-to-date guidelines and strengthen the coordination of PMTCT and

pediatric HIV services. The activities build on Francois-Xavier Bagnoud's (FXB's) previous

accomplishments in Tanzania and Zanzibar, and provide continuity of technical assistance and training

development to facilitate PMTCT program sustainability and enhance quality standardization of PMTCT

service delivery. FXB has extensive global experience in providing technical assistance and developing

training for implementation and scale-up of PMTCT and pediatric HIV services.

ACCOMPLISHMENTS: FXB worked with the PMTCT Technical Working Group (TWG) to 1) revise

Tanzania and Zanzibar PMTCT guidelines; 2) develop the National and Zanzibar PMTCT training packages

including manuals, slides, and wall charts; 3) and develop a preliminary version of a computer program and

user guide for monitoring PMTCT training to support decision-making in human resource management; 4)

initiate revision of the PMTCT Supervisor's Guide; and 5) develop clinical mentorship materials for Zanzibar.

ACTIVITIES: FXB was previously funded under the University Technical Assistance Program (UTAP)

mechanism which is expiring. To prevent a gap in activity implementation, I-Tech will serve as the funding

mechanism until an Federal Opportunity Agreement (FOA) can be developed and competed. Activities are

the same as Activity ID # 140 but only cover the first half of the FY 2008 funding period. As soon as funds

arrive an FOA will be distributed and competed to cover the second-half of the funding period.

1) Develop and implement training on program management and supervision for national PMTCT Unit and

PMTCT staff at district level, reaching 120 district managers, 15 trainers and 40 national and regional

PMTCT staff. Training will support development of management capacity needed for scale-up of PMTCT

services in accord with the National Strategic Plan. FXB will directly implement training for regional PMTCT

staff, focusing on program management tools and skills and advancing content introduced in FY 2007

workshops. To reach district level staff, a series of three model workshops using a TOT approach will

support future rollout through regional workshops to reach all PMTCT district managers. 1a) Conduct follow-

up evaluation of FY 2007 manager training for regional PMTCT staff to assess outcomes/effectiveness and

use results to inform training for FY 2008 1b) Develop and conduct a five-day workshop for national/regional

PMTCT staff in consultation with the Ministry of Health and Social Welfare (MOHSW). 1c) Develop a plan

for district managers' workshop and TOT, including identification of specific topics, exercises, and logistics

in consultation with MOHSW. 1d) Develop TOT model workshop materials. 1e) Implement three 3-day TOT

model workshops (one in each of three regions) 1f) Develop and conduct process evaluations of each

workshop.

2) Provide technical assistance to the PMTCT TWG for periodic review and revision of Tanzania's PMTCT

guidelines and training materials. This activity supports the delivery of high quality, up-to-date PMTCT

services. 2a) Work with TWG to identify relevant changes in national and international care guidelines. 2b)

Develop written report outlining areas to be revised or added to guidelines and updated in training materials.

3) Provide technical assistance to and collaborate with the PMTCT and Pediatric TWGs to facilitate the

development of a Joint PMTCT/Pediatric Operational Plan, harmonizing and aligning clinical guidelines,

curricula, and training materials with the National PMTCT/Pediatric Strategic Plans. A coordinated approach

assures that scale-up plans and activities provide for a continuum of PMTCT and pediatric HIV services,

reduces loss to follow-up, and promotes early HIV diagnosis and access to HIV treatment. 3a) Review

existing guidelines and curricula for the care of HIV-exposed and HIV-infected children and develop a report

about modifications and updates needed to meet the goals and objectives of the National Strategic Plan.

3b) Assess and identify training needs among PMTCT staff to assure the coordinated care and treatment of

HIV-exposed and HIV-infected children. 3c) Collaborate with the PMTCT and Pediatric HIV TWGs to plan

and implement a meeting to review findings of sub-activities 3a and 3b and to develop a draft Joint

Operational Plan. 3d) Provide technical assistance to support review and finalization of Joint Operational

Plan.

LINKAGES: FXB is committed to ensuring that our work is integrated into existing infrastructure to ensure

buy-in from stakeholders as well as sustainability. 1) Training on program management and supervision will

be planned in collaboration with the MOHSW and national and district PMTCT staff; plans for the TOT will

be developed in partnership with MOHSW, who will ensure that it meets staff needs and prepares staff to

meet the needs of the program. FXB will work with I-TECH to implement these trainings through the Zonal

Training Centers. 2 & 3) FXB will work with the PMTCT TWG on periodic review and revision of the PMTCT

guidelines and training materials. FXB will work with both the PMTCT and Pediatric TWGs to develop the

Joint Operational Plan. These groups represent a wide range of organizations including major regional

hospitals, the Centers for Disease Control and Prevention, World Health Organization, Elizabeth Glaser

Pediatric AIDS Foundation, MOHSW and the National AIDS Control Program (NACP). Working with the

TWGs ensures that the periodic review of the guidelines and training materials as well as the development

of the Operational Plan are undertaken in consultation with a range of stakeholders.

CHECK BOXES: Training on program management and supervision, and the revision of tools for PMTCT

care such as the guidelines, address the in-service management training needs of National PMTCT Unit

staff and district PMTCT staff, as well as the needs of healthcare workers, and supports the standardization

and scale-up of quality PMTCT services. Increased capacity will support scale-up of PMTCT services,

which target pregnant or recently-delivered women, women with HIV and their infants.

M&E: Monitoring and evaluation is an integral component of each activity. FXB will develop evaluation

forms for each training and workshop using standard templates. The scope and time frame require a focus

on process evaluations; perceived change in knowledge/skill in target areas will also be assessed as an

indicator of effectiveness. Follow up evaluation of FY 2007 managers' workshop with regional PMTCT staff

will be used to evaluate the effectiveness of training for management capacity. These results will inform

Activity Narrative: development of FY 2008 training. FXB has systems in place for monitoring work plan activities and timely

deliverables; progress is reviewed, summarized and reported quarterly with MOHSW, I-TECH and other

partners as indicated. Approximately 5% of budget is used for overall M&E purposes.

SUSTAINABILITY: By focusing on program management capacity development at multiple levels and

developing a model workshop to be rolled out using a TOT approach, the activities are designed to develop

sustainable training and capacity development. Such capacity supports implementation and scale-up of

PMTCT services at facilities in all districts in accord with the National Strategic Plan for PMTCT in Tanzania.

MOHSW collaboration in the development and implementation of these trainings will facilitate effective

linkages with other training efforts. The process of national level technical assistance for periodic review of

the PMTCT guidelines and training materials is designed to increase sustainable capacity for program

direction and leadership.

TITLE: Strengthen the National PMTCT Program and linkages between PMTCT and pediatric care.

NEED and COMPARATIVE ADVANTAGE: Following the development of the national PMTCT/Pediatric

scale-up plan for Tanzania, activities are needed to build upon the strategic plan and aid in the

implementation of targets and achievement of the plan's goals. Activities are also needed to ensure

implementation of the revised PMTCT guidelines and corresponding monitoring and evaluation (M&E) tools.

ACTIVITIES: These activities were previously implemented by FXB who was funded under the UTAP

mechanism which is expiring. An FOA for these activities will be developed and competed. Activities are the

same as Activity ID # 144 but cover the second half of the FY 2008 funding period.

1) Hold district-level workshops to orient district health teams to new scale-up/strategic plan. Facilitate the

Ministry of Health and Social Welfare's (MOHSW) PMTCT unit's work in developing the Council Health

Management Team's capacity in program planning, management, and programming quality assurance; 1a)

Organize and facilitate the training of district managers in PMTCT, with specific emphasis on target setting,

drug forecasting and M&E.

2) Strengthen linkages between PMTCT and pediatric care while building the capacity of staff with maternal

and child health (MCH) and pediatric clinical care responsibilities to detect HIV infection and HIV exposure

and deliver the minimum package of care for the HIV-exposed infant;. 2a) Work with the PMTCT/Pediatric

HIV care technical working group (following strategic plan development) in developing a joint operational

plan (PMTCT and pediatric HIV) and ensuring the technical accuracy, alignment and harmonization of all

the various technical guidelines and strategies for PMTCT and pediatrics. 2b) Review existing curricula for

the care of HIV-exposed and HIV-infected children and modify to meet the goals and objectives of the

Tanzania scale-up plan for pediatric HIV care. Assess training needs and develop introductory and

refresher training materials as indicated. 2c) Develop clinician support tools for the identification and

management of HIV-exposed and HIV-infected infants and children. 2d) Develop patient information

materials that focus on linkages between PMTCT, pediatric HIV care and treatment, and basic child health

services. 2e) Develop a clinical mentorship/preceptorship program to support health care workers delivering

pediatric HIV care.

3) Strengthen program management and coordination and ensure accountability for PMTCT scale up by all

stakeholders; 3a) Improve the capacity of the national PMTCT team with expertise in the areas of

forecasting and district planning. Set up resource sites at regional offices or at zonal training centers.

Provide access to online journals at computer stations; 4) Assist the National AIDS Control Program

(NACP) with implementation of the new PMTCT Guidelines, including the more efficacious drug regimens,

key policy changes, and linkages to paediatric care and treatment;. 5) Assist NACP with implementation of

revised M&E tools and their use for program planning.

LINKAGES: Linkages between PMTCT and Pediatric services, as well as, other services included in the

continuum of care will be strengthened. Linkages to care and treatment clinics for HIV-positive pregnant

women who are eligible for ART will be strengthened to ensure the new PMTCT guidelines are

implemented.

CHECK BOXES: Activities will focus on training of health care workers and building human capacity at

various levels of government.

M&E: The National M&E tools will be incorporated into trainings and used to report to NACP the number of

health care workers trained and progress towards strengthening linkages between continuum of care

services. Will work with NACP on implementation and use of the M&E tools for program planning and

decision making.

SUSTAINABILITY: Activities are all focused around sustainable capacity building of district managers and

health care staff at all levels of the health system.