Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012

Details for Mechanism ID: 7239
Country/Region: Tanzania
Year: 2012
Main Partner: Mbeya Referral Hospital
Main Partner Program: NA
Organizational Type: Host Country Government Agency
Funding Agency: USDOD
Total Funding: $2,550,908

Mbeya Referral Hospital (MRH) is a tertiary care facility in the Southern Highlands of Tanzania that serves as a referral centre for Iringa, Mbeya, Ruvuma & Rukwa regions. The referral catchment population approximates six million people. The centre is also tasked with coordinating and overseeing HIV/AIDS care and treatment services in the zone, including pediatric andlLab management services, VMMC, and Maternal, Neonatal and Child Health. Specifically for VMMC, MRH trains MC providers and coordinates MC programming in both Mbeya and Rukwa regions.

As a government institution, MRH receives central URT government funding for its daily clinical and supervisory plans. USG funding leverages on this support. Increased efficiency and quality of services will enable the hospital to generate more revenue to improve quality of services.

MRH will continue improving the M&E system to ensure quality data collection, analysis and reporting using harmonized and standardised USG/URT tools. MRH will produce monthly reports and hold quarterly implementers meetings to share information and evaluate ongoing program performance. To achieve maximum performance, MRH will continue coordinating HIV/AIDS interventions among relevant stakeholders in the zone (partners, MoHSW, donors, NGOs and LGAs).

To improve the HCW skills in the four regions of the Southern Highlands of Tanzania, MRH will continue to provide timely and strategic training, on-job mentorship and support supervision. To become more cost effective, the hospital will implement various strategies such as hospital data management systems, fostering quality at the hospital through accreditation, improving the work environment, and continually looking at areas for quality improvement.

Funding for Care: Adult Care and Support (HBHC): $90,645

Mbeya Referral Hospital (MRH) is a referral hospital for the Southern Highland regions of Tanzania that include Mbeya, Ruvuma, Rukwa and Iringa regions and a population of over six million people. Its functions include direct clinical service, training, coordination and overseeing quality of care and treatment.

For COP 2012, activities will include a standard DOD package of care activities:

1) Provide integrated adult care and support services that are linked to other services such as ART, ANC, PNC, PMTCT, TB/HIV and HTC2) Strengthen nutritional assessment, counseling and support (NACS) to PLHA at all CTCs3) Strengthen community mobilization activities in collaboration with home/community based adult care and support provider, through individual, small groups and community sensitization messages to improve local support for efforts that address GBV and stigma and discrimination services4) Conduct strategic in-service training and on-the-job mentorship to HCW to improve adult care and support services at the hospital5) Improve M&E system through utilization of harmonized data collection, analysis and reporting tools and participate in quarterly zonal program performance meeting to discuss and share program performance6) Integrate HTC services. including promotion of PITC and couple counseling into other services such as ART, family planning, PMTCT, ANC and PNC7) Provide individual and group psychological, spiritual support as well as bereavement services to PLHA and their families, in collaboration with outreach partners and religious organizations8) Provide STI diagnosis and treatment services integrated with other services such as family planning, ANC, PNC, ART, VMMC and PMTCT9) Improve retention and adherence to care and treatment by strengthening PHDP counseling among all CTC staff10) Link PLHAs with available support mechanisms including home/community -based HBC services

These activities will be implemented in collaboration with Baylor International Pediatric AIDS Initiative (BIPAI). MRH is a government institution that receives central funding through the MOHSW budget, basket funding, and cost sharing mechanisms. Such resources will be used to leverage USG support.

Funding for Care: TB/HIV (HVTB): $94,677

MRH is one of five zonal hospitals in Tanzania. Its functions include direct clinical service, training, coordination and oversight of the quality of care and treatment in the Southern Highlands zone. MRH also establishes health service referral systems for a population of over six million people in four regions (Mbeya, Iringa, Rukwa, and Ruvuma). MRH is also the government institution receiving financial and technical support from DOD to increase and strengthen local capacity to provide quality TB/HIV services.

With multiple donor support including PEPFAR, the Center for Infectious Disease (CID) was established in 2004. Presently, the Center accommodates an infectious disease clinic and a training facility with a referral level laboratory capacity. The CID supports a continued expansion of HIV/AIDS services including viral and TB resistance testing.

COP 2012 will be used to:

1) Scale-up TB/HIV services in the region through screening PLWHAs for TB and improving referral and integration of TB/HIV services into other programs such as ART, HTC and PMTCT.;2) Strengthen laboratory services including sputum smear microscopy and quality assurance to ensure quality TB care services;3) Strengthen quality TB/HIV services through technical support to districts and high-volume and satellite clinics, in-service training and on-job mentorship to HCWs on TB control practices and implementation of the three Is as well as establishment of TB/HIV coordinating bodies at district level;4) Improve program coordination and M&E system through improved availability and use of standard National TB/HIV tools such as screening tools and clinical assessment forms as well as sharing and discussion of results to inform the program. MRH will support establishment of coordination bodies in regions and districts.

Funding for Care: Pediatric Care and Support (PDCS): $29,353

MRH is a referral hospital serving the sub-populations that are currently being serviced by Mbeya RMO. The referral catchment area includes Mbeya, Iringa, Rukwa, and Ruvuma regions, with a population of six million. MRH also offers specialized laboratory services such as viral load testing, PCR, and viral resistance testing.

Activites funded through COP 2012 will include:

1) Strengthening involvement of adolescents and children in PHPD services and support groups for better retention and adherence to treatment.2) Community mobilization through individual, small groups and community sensitization messages to improve local support and increase child enrollment into care.3) Improved data collection, analysis and reporting using harmonized tools, discussion of targets, and use results to inform program implementation.4) Capacity building to improve skills of HCWs and CHWs through strategic in-service training, on-job mentorship and support supervision; improve facility infrastructure to improve care for children.5) Integrated pediatric care and support services that are linked to other services such as ART, EID, OVC, HBC, TB/HIV, PMTCT and HTC.

These activities will be implemented in collaboration with Baylor International Pediatric AIDS Initiative (BIPAI). MRH is a government institution that also receives central funding through MOHSW budget, basket funding, and cost sharing mechanisms. Such resources will be used to leverage on USG support.

Funding for Laboratory Infrastructure (HLAB): $374,771

Mbeya Referral Hospital (MRH) is one of five zonal hospitals in Tanzania. Its functions include direct clinical service, training, coordination and overseeing quality of care and treatment in the Southern Highlands zone, and establishing health service referral systems for a population of over six million people among the four regions of Mbeya, Iringa, Rukwa, and Ruvuma.

Under PEPFAR funding and multi-donor support, the Center for Infectious Disease (CID) was initiated and provides a forum for practical training for medical and laboratory staff to improve adult and pediatric HIV/AIDS care and treatment service. MRH has the following objectives:

1) Improve testing capability - The ability of the MRH laboratory to provide a range of diagnostic tests has been developed and is being further expanded. In TB diagnosis, the MRH TB lab has just been completed, thus establishing a reference center in the Southern Highlands that provides liquid culture and drug susceptibility testing. A microbiology lab where both aerobic, anaerobic culture, and blood culture will be performed has also been established; basic culture work is ongoing but this will be expanded. A molecular biology laboratory which has a capacity to do HIV viral load and early infant diagnosis by using PCR systems is now running. Future plans are to extend these services and to further offer HIV resistance testing using Siemens TruGene sequencing. In addition, the histopathology laboratory, which was unable to run due to defunct equipment, has now been newly equipped for diagnosis of HIV associated cancers.

2) Improving Quality Assurance - MRH has introduced daily Quality Assurance routines, running QC samples and procedures, servicing and maintaining equipment and external proficiency testing programs from reputable schemes. In addition, it is now planned to Introduce quality indicators and quality indicator monitoring for all laboratories, such as ensuring turnaround times are adhered to and results are reported accurately and timely.

3) Accreditation Process - In FY 2009, MRH lab invited the College of American Pathology (CAP) accreditation system assessors for the first assessment toward accreditation. The overall quality was good, however the lab staff still needs to be certified on analyzers and all lab technicians need to have GCLP certification. To progress towards accreditation, there are now plans to enroll in CAP external quality assurance systems, which will help to ensure that all instruments, such as centrifuges, thermometers fridges, and freezers, are calibrated and validated and that all staff receives GLP training. The accreditation process is ongoing, though none of the labs in the Southern Highlands has yet to be accredited.

4) Number of testing Labs in Mbeya - In the Southern Highlands there are 38 testing labs in Rukwa and Ruvuma regions. Program personnel in these labs have been trained on quality assurance issues (forecasting, ordering, safety of personnel and buildings, documentation and reporting, planning, and budgeting). This has improved the performance of these labs as indicated by reduced stock-outs of reagent and turn-around time of test results.

5) Transitioning - MRH is the government institution receiving financial and technical support from DOD to increase and strengthen local capacity to provide quality HIV/AIDS laboratory services that will ensure sustainability of care and treatment.

Funding for Biomedical Prevention: Voluntary Medical Male Circumcision (CIRC): $677,115

Mbeya Referral Hospital (MRH) supports MC activities in the zone through on-site and campaign based approaches. Currently, there are eight sites providing routine MC on-site; during campaigns in Mbeya, all sites receive TA from MRH. A total of 51 MC clinicians have been trained ( 17 circumcision teams.

As the TA for MC in the Southern Highland regions of Tanzania, MRH will continue to train more MC clinicians in COP 2012 to increase the availability of MC services in Mbeya and Rukwa regions. In addition, linkages with other stakeholders in the regions involved in health education and promotion will be strengthened by improving peer education related to MC behavioral changes to increase MC acceptance.

To improve access and scale up of VMMC in remote areas, MRH will procure more reusable and/or disposable kits. To ensure quality and compliance with Infection Prevention and Control practices, autoclaving of reusable equipment will also be improved. MRH will also procure mobile MC units to improve availability of VMMC services in hard-to-reach locations.MC services are provided as a comprehensive prevention package that includes counseling and testing, behavioral intervention to prevent new infections, and PHDP. Encouragement of female partner participation in MC services will also continue to be promoted to encourage family centered HIV preventive approach. A high proportion of clients accept HTC during campaigns and in Mbeya it was reported to be over 90%.

Linkages to other programs such as care and treatment as well as PHDP care and support will be strengthened. Under the Swahili slogan, Menya Ganda (Remove the Hood), print and electronic media messages will be provided to communities in the region as well as improving community participation in MC services for demand creation. Special efforts will be made to promote MC services through peer education and media to ensure that men over 25 years accept the services, as currently less than 5% of all clients are from this age group.

MRH will continue to support all regions in the Southern Highlands (Mbeya, Ruvuma, and Rukwa) to implement quality MC services. Program performance and quality assurance will be achieved through regular support supervision and on-job mentorship, use of harmonized data collection and reporting tools and assessment of adverse events from the procedure. MC data will also be analyzed to document best practices and average procedure time in the region and for each health facility. Additionally, MRH will continue to support integration of MC services into routine health care in all facilities in the Southern Highlands. The IP has also adopted the web-based JHPIEGO MC reporting, which has also been adopted by other USG agencies to ensure quality data and efficient reporting.

Funding for Treatment: Adult Treatment (HTXS): $1,093,964

MRH is one of five zonal hospitals in Tanzania. Its functions include direct clinical service, training, coordination and oversight of the quality of care and treatment in the Southern Highlands zone. MRH also establishes health service referral systems for a population of over six million people in four regions (Mbeya, Iringa, Rukwa, and Ruvuma). MRH is also the government institution receiving financial and technical support from DOD to increase and strengthen local capacity to provide quality TB/HIV services.

With multiple donor support including PEPFAR, the Center for Infectious Disease (CID) was established in 2004. Presently, the Center accommodates an infectious disease clinic and a training facility with a referral level laboratory capacity. The CID supports continued expansion of ART and clinical care needs as well as provides a forum for practical training for medical and laboratory staff to improve adult and pediatric HIV/AIDS care and treatment service. CID also offers specialized laboratory services, such as viral load testing, PCR, and viral and TB resistance testing.

MRH began recruiting patients in January 2005. By the end of FY2011, MRH had a cumulative number of over 6,935 patients on ART. There are 5,671 patients currently on treatment and 841 new patients enrolled. Despite this achievement, loss to follow up has been a big challenge to the program, with a retention rate of 60.7% (APR 2011). Efforts to improve retention include linkages with CBOs to track patients in the community, use of support groups, and CHWs for adherence counseling and tracking of patients in their homes.

Activities:1) Support provision of quality ART services and enrolment of more patients into Care and Treatment at the main MRH CTC and at satellite centers by procurement of CD4 machines, drugs, reagents, and other lab supplies for better patient monitoring;2) Provide technical support, in coordination with Mbeya RMO, such as strategic in-service training to satellite clinics in order to decongest the MRH CTC;3) Provide ongoing mentorship and support supervision to satellite facilities to support strategic scale up of care and treatment services in the zone;4) Provide evaluation for malnutrition and nutritional counseling to all HIV positive clients;6) Provide support to zonal facilities to ensure quality services and improve patients' clinical outcomes and program performance. With the assistance from DOD, MRH will improve administrative and financial reporting capacity to ensure effective budgeting, timely expenditure and financial reporting. A contractor will be retained to build RMOs capacity in budgeting and financial reporting.7) Provide specialized technical support and guidance to the RMOs for identification and treatment of patients with treatment failure;8) Conduct monthly zonal ART meetings with the Mbeya, Rukwa, and Ruvuma RMOs to discuss treatment roll out, identify areas of need, determine solutions, and coordinate resolution;9) Function as the zonal training center in HIV related services for the Southern Highlands in support of NACP;10) Support linkages and referrals to feeder programs and services, such as MCH, TB, PITC, and EPI;11) Ensure strengthened integration of services focused on girls, women, and children into CTC;12) Ensure that gaps identified during quarterly performance appraisals are incorporated into MRH work plans and activities are implemented and monitored.

Funding for Treatment: Pediatric Treatment (PDTX): $190,383

MRH is a referral hospital that serves sub-populations that are currently being serviced by Mbeya RMO. Referral catchment area includes Mbeya, Iringa, Rukwa, and Ruvuma regions with a population of six million. It also offers specialized laboratory services such as viral load testing, PCR, and viral resistance testing.

MRH is tasked with coordinating and overseeing the quality of pediatric treatment services in the zone, but does not have pediatricians to undertake these specialized services, including HIV/AIDS treatment and care. In addressing the long-term need for specialists at the MRH and capacity within the zone, the hospital established partnership with Baylor International Pediatric AIDS Initiative (BIPAI). Currently, BIPAI serves as a treatment center and provides pediatric ART services and training for health workers in the zone. Additionally, pediatricians working with BIPAI conduct outreach services to mentor pediatric ART providers and provide specialized services where required.

MRH will provide quality integrated paediatric HIV care and treatment services through pediatric PITC, supply of pediatric drugs and commodities, diagnostics, adherence counseling, and strengthening linkages and referrals between pediatric care and treatment and other programs such as OVC and HBC. A continuum of care will be ensured through strengthened adherence counseling services by HCWs and CHWsA target of 143 children is set for FY 2012. Local manpower and systems will be strengthened to improve specialized pediatric care and treatment. Targets will be monitored and discussed during zonal technical meetings and national partner meetings. Linkages to other services such as HBC, OVC, PITC, EPI, PMTCT, TB/HIV, and RCH will ensure more child enrollment into care and treatment. Infrastructural improvement will be improved to specifically address pediatric treatment needs. to improve retention into treatment, adherence counseling and technical support will be provided to groups such as adolescent peer educators.

The integration of Pediatric care and treatment services at MRH leverages national referral system to ensure quality and sustainability. The USG/T supported activities will continue to be incorporated into the regional health plans through national funding such as central funding through MOHSW budget, basket funding, and cost sharing mechanisms.

Key Issues Identified in Mechanism
Addressing male norms and behaviors
Increasing gender equity in HIV/AIDS activities and services
Increasing women's legal rights and protection
enumerations.Malaria (PMI)
Child Survival Activities
Safe Motherhood
Tuberculosis
Family Planning