The goal of the Applying Science to Strengthen and Improve Systems (ASSIST) project in Tanzania is to support the Ministry of Health and Social Welfare (MOHSW) and Implementing Partners to achieve and sustain delivery of quality HIVAIDS care, through capacity building on applying and adapting modern quality improvement (QI) approaches to care delivery practices. In addition to scaling up QI to new regions, the technical scope of the interventions in the FY2013 COP will be enhanced to test applications of modern QI methods to new program areas, including pediatrics and PMTCT Option B+, to produce additional improvements. These will include testing the application of QI approaches to enhance provider performance in Mtwara, HBC SOPs in Tanga and Morogoro, feasibility of Patient Self Management in ART in Morogoro, and modalities of improving management capacities of CHMTs through application of QI techniques to strengthen district health management performances. Furthermore, ASSIST will assist the MOHSW to roll out, benchmark and improve the quality of OVC services, and assess the quality and impact of integrated PMTCT and RCH services. Throughout the plan period, ASSIST will mainstream gender into all its activities, and partner and leverage resources from other stakeholders to harmonize work and maximize outcomes. ASSIST will capacitate the MOHSW structures to ensure sustainability and strengthen the MOHSW knowledge management system, in order to monitor progress and results of the work plan.

"University Research Corporation, in collaboration with the MOHSW and HBC implementing partners (IP), has completed the process of developing Standard Operating Procedures (SOP) for HBC services. As part of SOP development, prototyping of the SOP in Morogoro and Tanga regions is ongoing, to demonstrate and model how its application improves practice and to document associated effectiveness using routine M&E tools. The completion of this endeavor will be followed by introduction and application of the SOP in routine service delivery.

In the FY2013 COP, ASSIST will continue to support the MOHSW and IPs to introduce SOP in service delivery and document resulting care outcomes. This support will provide a formal and standardized mechanism for linking existing non-HIV community-based programs such as family planning, community IMCI, immunization and nutrition. Furthermore, in strengthening the M&E system, ASSIST will continue to support the NACP, IPs and council staff on using the HBC/UWANYU database, as well as on linking routine M&E indicators with client-level program performance measures. The HBC SOP provides detailed descriptions of steps and procedures for providers in performing specific tasks including referrals management, adherence to treatment, and linkages for clients to PLHIV support groups, IGA, family planning and TB clinics to mention a few. It follows that appropriate use of SOP is expected to result in harmonized HBC practices across councils and IPs, improved coordination, and efficient program monitoring and evaluation as well as better health and social outcomes for PLHIV and their families.

In this endeavor ASSIST will collaborate with the NACPs M&E department, HBC IPs and the University of Dar Es Salaam computing centre to train all regional and district HBC coordinators on how to use the HBC/UWANYU database. A total of 155 staff will be trained on HBC/UWANYU database, across 25 regions and around 130 districts in Mainland Tanzania.

The SOP for HBC is based on eight priority programmatic areas which are directly linked with HBC M&E indicators. Since adherence to standards of care delivery is associated with better care outcomes, ASSIST will build the capacity of MOHSW, councils and IPs to be able to measure key HBC outcomes using routine M&E tools.

ASSIST will also support SOP training to national and regional HBC coordinators and trainers from the government and IPs from the remaining 13 regions, using a cascade model in which a national team will train regional teams which in turn train district teams and, subsequently, HBC service providers and supervisors. This approach creates ownership and sustainability of the program across levels of care, and allows for transition of responsibilities from the central government to local authorities. A total of 406 staff will be trained on SOP usage."

"The goal of this project is to strengthen the capacity of the MOHSW, Implementing Partners (IP) and local structures in providing quality care, support and protection of OVC in Tanzania.

ASSIST will continue to provide national level TA to support scaling up and utilizing QI job aides by local structures. Efforts will be directed to skills building for social welfare officers, parasocial workers and other key staff at LGA s, to facilitate effective implementation of national QI guidelines at the service delivery level and to improve data collection and use from MVC registers for planning and decision making.

Support to local multisectoral structures, e.g. MVCC, child protection teams, local CBOs, is key for sustainability, ensuring these structures are capable of mobilizing resources to provide direct social services, and identifying and addressing various issues related to child protection, including violence, abuse, exploitation and neglect; all of which underpin the growth and development of OVC. ASSIST will support teams to identify, plan and implement different changes in accordance to standards, and norms and structures which are to the best interest of OVC.

FY2013 COP funds will go toward enhancing the utilization of available resources for integrating and linking OVC services with other HIV programs such as PMTCT, care and treatment, and HBC, to improve retention but also explore opportunities in other sectors to strengthen the economic capacity of families in caring and supporting OVC and as well as meeting other household basic needs.

Lastly, ASSIST will support gathering evidence and documentation of QI processes on the impact and efficiency of QI models as well as on best practices through mentoring and coaching to local partners and LGA in leveraging resources to avoid duplication of efforts and scaling up in other areas applicable to the context. This will enable local structures to harmonize and utilize tools to document implementation of OVC standards at the service delivery level. Exchange visits will be conducted across local stakeholders to facilitate in sharing best practices and challenges in implementing service standards."

"In the FY2013 COP, ASSIST will support the MOHSW and IPs to sustainably scale up PMTCT quality improvement services, with a specific focus on Option B+. ASSIST will carry out the process in phases in conjunction with the planned rollout of Option B+ across the country. In the new regions, baseline assessment of the quality of HIV services will be determined to provide initial learning on quality gaps. This will be followed by identification of QI teams in each facility providing PMTCT/ART in all districts. The team will then prioritize initial challenges from the quality gap analysis they will like to address, and agree on indicators to benchmark progress and outcomes in line with MOHSW and PF priorities.

ASSIST will train the teams on the use of QI techniques to test changes that provide optimal improvement of PMTCT services. The guiding principles are that good PMTCT services will ensure that all patients in need of ART receive services, that they are retained in services and that they experience good outcomes from the treatment. A modular course of three learning sessions alternating with coaching and mentoring sessions is planned for all teams. During the learning sessions, each facility will share observations of their QI efforts. RHMTs and CHMTs in each region will be trained as program mentors and coaches, and they will facilitate sessions and coaching visits in preparation for transition. It is envisaged that their involvement will increase QI program sustainability while also helping improvement in other programs under their jurisdiction.

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"In the FY2011 COP, University Research Corporation supported the MOHSW to finalize the National QI Guidelines for HIV/AIDS Services and corresponding training curricula to harmonize training and practice procedures. Currently, HCI is working with MOHSW and other partners in training of national Trainers of Trainers (TOT) in QI, covering so far 12 regions.

In the FY2013 COP, ASSIST will support the MOHSW and IPs to sustainably scale up QI of ART services to new regions. In the new regions, baseline assessments of the quality of HIV services will be determined to provide initial learning on quality gaps to be addressed. This will be followed by identification of QI teams in each facility providing ART in all districts. The team will then prioritize initial challenges from the quality gap analysis they will like to address. and agree on indicators to benchmark progress and outcomes in line with MOHSW and PF priorities.

ASSIST will train the teams on the use of QI techniques to test changes that provide optimal improvement of ART services. The guiding principles are that good ART services will ensure that all patients in need of ART receive services, that they are retained in services and that they experience good outcomes from the treatment. A modular course of three learning sessions alternating with coaching and mentoring sessions is planned for all teams. During the learning sessions, each facility will share observations of their QI efforts. RHMTs and CHMTs in each region will be trained as program mentors and coaches, and they will facilitate sessions and coaching visits in preparation for transition. It is envisaged that their involvement will increase QI program sustainability while also helping improvement in other programs under their jurisdiction."

"In the FY2013 COP, ASSIST will support the MOHSW and IPs to sustainably scale up pediatric quality improvement services. They will build on adult ART QI interventions, and baseline assessments of the quality of HIV services will be determined to provide initial learning on quality gaps in pediatric ART. This will be followed by identification of QI teams in each facility providing pediatric ART in all districts. The team will then prioritize initial challenges from the quality gap analysis they will like to address, and agree on indicators to benchmark progress and outcomes in line with MOHSW and PF priorities.

ASSIST will train the teams on the use of QI techniques to test changes that provide optimal improvement of PMTCT services. The guiding principles are that good pediatric ART services will ensure that all patients in need of ART receive services, that they are retained in services and that they experience good outcomes from the treatment. A modular course of three learning sessions alternating with coaching and mentoring sessions is planned for all teams. During the learning sessions, each facility will share observations of their QI efforts. RHMTs and CHMTs in each region will be trained as program mentors and coaches, and they will facilitate sessions and coaching visits in preparation for transition. It is envisaged that their involvement will increase QI program sustainability while also helping improvement in other programs under their jurisdiction."