Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012

Details for Mechanism ID: 9453
Country/Region: Tanzania
Year: 2010
Main Partner: Johns Hopkins University
Main Partner Program: JHPIEGO
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $2,516,990

JHPIEGO's MAISHA (Kiswahili for "Life") Program works with the Ministry of Health and Social Welfare (MOHSW) to build capacity throughout the country to: 1) reduce maternal and newborn morbidity and mortality; 2) strengthen the platform for prevention of mother-to-child transmission (PMTCT) of HIV/AIDS by fostering integrated maternal and neonatal health (MNH) services for HIV-positive women and children; 3) develop the foundation for a national cervical cancer prevention program; 4) provide infection prevention guidance and technical assistance to ensure safe health care delivery and minimize transmission of HIV/AIDS, and 5) strengthen pre-service training of health professionals.

In addition to assisting the MOHSW strengthen the platform of basic emergency obstetric care, essential newborn care, postnatal care, and postpartum family planning, JHPIEGO supports development of national and district resources (guidelines, training packages, trainers, and supervision tools). JHPIEGO also coordinates with District Health Management Teams, donors, and other key district stakeholders to ensure funding is allocated for quality service delivery. JHPIEGO's MAISHA is funded primarily from USAID's health office, complemented by PEPFAR HIV/AIDS funding.

To address the human resource shortage, JHPIEGO works with the MOHSW to strengthen pre-service education (PSE) programs and systems focuses on nursing/midwifery education and the HIV/AIDS component in medical school curricula. In partnership with AIHA, JHPIEGO will strengthen training materials and teaching methods, and will improve practicum experiences in their assigned schools. In those same schools, JHPIEGO will continue to support development of skills labs at their assigned nursing/midwifery schools, as well as apply a quality improvement approach for pre-service nursing/midwifery education. In addition, JHPIEGO is also training Community Health Workers to strengthen linkages between the community and health facilities to improve the uptake of services. To assist with the effective deployment of new graduates, JHPIEGO will continue their work on a graduate tracking system that can be linked with the pre-service database being developed by the MOHSW.

JHPIEGO aims to support a sustainable system for PSE that will ensure a steady supply of technically competent providers and ultimately lead to improved quality of health care (i.e., more skills integrated into PSE, less reliance on costly in-service training for basic skills). Also, for sustainability, JHPIEGO encourages the inclusion of programs they support into the Council health plan budgets.

To assist with enhancing the professionalism and quality standards in the medical field, JHPIEGO will provide capacity building to the Tanzanian Medical Association and will work with the Medical Council of Tanzania, as well, particularly to link continuing medical education with licensure.

Cost-efficiency: JHPIEGO provides a cost-effective, integrated approach for a broad array of maternal and newborn health programs, including malaria in pregnancy, and HIV/AIDS services. Through MAISHA, PEPFAR supports an initiative in Morogoro that builds on MNH health achievements to strengthen availability and quality of prenatal and family planning services, as well as cervical cancer prevention, for HIV- positive mothers. This latter program addresses both facility- and community-level interventions to ensure that HIV-positive mothers have access to a more comprehensive, integrated spectrum of MNH services.

Cross-cutting: A variety of resources are being developed under MAISHA to support capacity building and performance improvement of providers in integrated MNH and HIV/AIDS service delivery. JHPIEGO will orient regionalized PMTCT partners to these resources to further dissemination and to strengthen providers in integrated services. It will also coordinate with AIHA and ITECH under the direction of the MOHSW to standardize PSE approaches.

Geographic coverage: Coverage for MNH programs is or will be national in the next two years. Coverage of pre-service institutions will be determined by the US Government, dividing in half the responsibility for the regions between JHPIEGO and AIHA, with whom JHPIEGO shares responsibility for nursing/midwifery pre-service training coverage.

Target groups: Women of reproductive years and newborns; for PSE, nurses/midwives, CHWs, and doctors.

Link to Partnership Framework: JHPIEGO will support two of the six Partnership Framework pillars: by supporting service provision in a quality continuum of care for HIV-positive mothers, and exposed newborns and children through community, facility, and outreach programs; and the human resources goal in terms of pre-service training and optimizing the workforce through strengthened linkages with CHWs.

Monitoring and evaluation: JHPIEGO conducts quarterly reviews of service delivery through sentinel site surveillance visits, in addition to annual Quality Improvement (QI) facility assessments. For pre-service training institutions, MAISHA has annual QI PSE institution assessments planned, as well as assessments of provider knowledge and skills during training in the schools in which they will work. In addition, JHPIEGO will explore cellphone-based tools to assist providers in delivering high quality care and storing information to track HIV-positive mothers and infants during pregnancy and beyond, minimizing loss to follow-up.

Funding for Care: Adult Care and Support (HBHC): $50,000

Working in close collaboration with Ministry of Health and Social Welfare (MOHSW) and Ocean Road Cancer Institute, JHPIEGO wil print cervical cancer screening guidelines and initiate supervision of cervical cancer services in Morogoro (2 sites), Lindi (3 sites) and Mtwara (3 sites); JHPEIGO will support the MOHSW in carrying out quarterly cervical cancer Technical Working Group meetings and host one annual meeting event to review cervical cancer prevention program progress and discuss next steps.

Funding for Health Systems Strengthening (OHSS): $600,000

JHPIEGO will work with the Ministry of Health and Social Welfare to address several training needs: Preservice medical ($150,000): follow-up of PSE QI initiatives; development of e-learning modules; training of additional 100 faculty members. In addition, JHPIEGO will carry out training and support to 200 CHW ($200,000) so that they can implement the community/facility service linkages. JHPIEGO will provide technical assistance to ITECH ($50,000) to review/revise AMO curriculum and related teaching aids. JHPIEGO will also work in the Nursing and Midwifery ($200,000) pre-service education (PSE), training an additional 100 faculty members, carrying out follow-up of PSE initiative in 30 schools.

Funding for Biomedical Prevention: Injection Safety (HMIN): $332,669

Continuation of support for integration and implementation of IPC (Infection Prevention and Control) in Reproductive Health Services in regional and district hospitals.

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $1,534,321

Working with the MOHSW and Ocean Road Cancer Institute, the program will develop and finalize Tanzania specific Visual Inspection/Cryo-therapy training package and initiate and expand cervical cancer screening service to regional hospitals of Lindi, Mtwara, Iringa, Arusha, Kilimanjaro, and Kigoma. The program will train trainers and carry out training to health care providers. The program will procure cryo equipment for six sites (250,000). JHPEIGO will work with 30 pre-service nurse/midwifery schools and equip their skills labs ($354,321). The program will carry out integrated facility/community PMTCT activities. This will include the scale up of the Morogoro pilot to 4 additional regions; carry out facility needs assessments in two districts of each each region covering a total of 20 sites; carry out training of providers in prenatal care and post-partum family planning from 20 facilities; carry out sensitization work to the community leaders/elders to program plans (3 villages per 20 health facilities); training of 40 Community Health Worker (CHW) trainers/supervisors and 600 CHWs in CHW package. The program will also carry out supervision of facility and community work; procure and distribute equipment, supplies and IEC materials and support coordination meetings in each region to review program progress and plan for subsequent year activities. Working with the MOHSW, JHPIEGO will provide technical assistance to PMTCT implementing partners to complement and scale up the provision of Focused Antenatal care (FANC), Basic Emergency Obstertric and Newborn Care (BEmONC), Postnatal and postpartum family planning (PNC/PP FP), cervical cancer screening through capacity building. JHPEIGO will work with the MOHSW and partners to develop of continuum of care model in one region (Morogoro), using an electronic job aid/tracking tool to be developed with ACCESS/FP funds; The program will also provide technical assistance to partners for training of providers in BEmONC, FANC, PNC/PP FP and cervical cancer in Morogoro, Lindi, Mtwara, Arusha, Iringa, Kilimanjaro and Kigoma The program will coordnate with these paartners to ensure that appropriate equipment/supplies to support service delivery following training is carried out using PF funds allocated to these partners.

Cross Cutting Budget Categories and Known Amounts Total: $700,000
Human Resources for Health $700,000
Key Issues Identified in Mechanism
Safe Motherhood