Tanzania FY 2006 Country Operational Plan (COP)


TANZANIA

Project Title: Tanzania FY 2006 Country Operational Plan (COP)

Budget Summary:

 
Field Programs Funding by Account
Central Programs Funding by Account
 
 
Notified as of May 2006
Current Notification August 2006
Current Notification August 2006
 
Implementing Agency

GAP

GHAI

Subtotal:
Field Programs Funding by Account

GHAI

GAP

New Subtotal: Field Programs Funding by Account

GHAI Central Programs

Total Dollars Allocated: Field & Central Funding

DOD

0

8,200,000

8,200,000

600,000

0

8,800,000

0

8,800,000

DOL

0

0

0

0

0

0

0

0

HHS

3,883,000

26,186,134

30,069,134

2,950,000

0

33,019,134

20,861,447

53,880,581

Peace Corps

0

476,000

476,000

0

0

476,000

0

476,000

State

0

655,000

655,000

0

0

655,000

0

655,000

USAID

0

60,394,866

60,394,866

850,000

0

61,244,866

4,911,478

6,156,344

TOTAL Approved

3,883,000

95,912,000

99,795,000

4,400,000

0

104,195,000

25,772,925

129,967,925

HIV/AIDS Epidemic in Tanzania:

Adult HIV Prevalence Rate: 6.5% [5.8-7.2%] (UNAIDS 2006)
Estimated Number of HIV-infected People: 1.4 million [1,300,000-1,600,000] (UNAIDS 2006)
Estimated Number of AIDS Orphans: 1.1 million [910,000-1,200,000] (UNAIDS 2006)

Country Results and Projections to Achieve 2-7-10 Goals:

Tanzania Total # Individuals Receiving Care and Support Total # Individuals Receiving ART
End of FY 2004* 25,600 1,500
End of FY 2005** 413,000 14,700
End of FY 2006*** 1,770,354 45,000
End of FY 2007*** 563,822 85,000

*Results. "Engendering Bold Leadership: The President's Emergency Plan for AIDS Relief." First Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, March 2005
**Results. "Action Today, a Foundation for Tomorrow: The President's Emergency Plan for AIDS Relief." Second Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, February, 2006
***Projections from FY 2006 Country Operational Plan

Program Description:

The USG in Tanzania supports an integrated program covering prevention, treatment and care. The program supports existing as well as new activities in Tanzania, and allows for a rapid expansion which is both unprecedented and would not be possible were it not for the Emergency Plan. This expansion takes into account expected inputs from the Global Fund, World Bank, bi- and multi-lateral donors and the Government of Tanzania itself.

The population of Tanzania is predominantly rural based with approximately 23% of Tanzanians living in urban environments and 77% in rural areas. The islands of Zanzibar; Unguja and Pemba are slightly more urbanized; approximately 35% live in urban areas and 65% in rural areas. Almost two-thirds (62%) of the population resides on Unguja and 38% on Pemba. Females make up 51% of the population and males, 49%. Life expectancy in Tanzania is 54 years for males and 56 years for females.

Tanzania�s mainland faces a generalized HIV/AIDS epidemic, with a 6.5% [5.8-7.2%] prevalence rate in the adult population (UNAIDS 2006). Close to 85% of HIV transmission in Tanzania occurs through heterosexual contact, less than 6% through mother-to-child transmission and less than 1% through blood transfusion. HIV is firmly established in Tanzania�s urban and rural areas, particularly in high transmission trading centers, border towns, and along transport routes. According to these results, there continues to be a significant difference in the prevalence among women (7.7%) as compared to men (6.3%) and in urban (10.9%) as compared to rural (5.3%) areas of the country. Males and females are differentially affected with peak prevalence among women occurring in the 30-34 year age group (12.9%) while for males the peak is between 40-44 (12.3%).

The epidemic in Zanzibar is very different from the mainland. HIV prevalence on Unguja and Pemba is estimated at 0.6% for the general population. Although prevalence is low in Zanzibar, the islands remain at risk. HIV prevalence among pregnant women on the islands doubled from 0.3% in 1987 to 0.6% in 1997, with subsequent prevalence holding steady at less than one percent in 2000. Among blood donors, the rate increased from 0.5% in 1987 to 1.5% in 1998. Health indicators in Zanzibar show a high proportion of sexually transmitted infections (STIs), with 60% of STIs occurring among married couples.

Prevention: $27,871,626 as of August 2006 ($20,315,000 Field and $7,556,626 Central) (24.6% of prevention, care, and treatment budget)

In August 2004, Tanzanian President Mkapa addressed the need for a wide range of HIV/AIDS prevention interventions in Tanzania. His public endorsement clearly supports Tanzania�s National Multisectoral Strategic Framework on HIV/AIDS, embracing comprehensive prevention approaches and strategies to address the pandemic. The newly elected President Kikwete has also come out very strongly in his early speeches regarding the importance of a strong HIV prevention. Prevention is viewed as a fundamental link to care and treatment and vice versa in a full spectrum of support. Given the level of stigma and discrimination that exists throughout Tanzania, strong emphasis is needed to change negative provider, community, and social norms.

The USG program is well positioned to expand prevention activities in Tanzania and promote strong collaboration among existing activities. While specifically targeted groups were a focus of prevention activities in Tanzania throughout the 1980s, prevention activities in recent years have focused largely on the general population. There is recognition that a focus on targeted high risk groups will be needed to spearhead more effective prevention efforts in the future. High risk groups in Tanzania include those traditionally defined such as prostitutes, miners, and truck drivers. In addition it is important to recognize the high risk introduced through the endemic nature of multiple partner behavior and trans-generational relationships in Tanzanian society. This widespread practice widens the high-risk definition to include discordant couples, married, and non-married men.

Specific activities will include continuing to scale up coverage of prevention of mother-to-child transmission (PMTCT) services across all regions of the country, and expanding abstinence programs to reach the growing number of youth who are both in and out of school. FY 2006 funds will continue the blood and injection safety activities initiated with prior year Emergency Plan funds while increasing the scale of these programs to provide national level coverage of blood safety programs, and integrating injection safety into pre and in-service training. Prevention activities will also include a newly designed national level behavior change program linked to the social marketing of services and commodities, as appropriate. There is no change in the amount of funding allocated for prevention as of this operational plan.

Principal partners include: Mbeya, Rukwa, and Ruvuma Regional Medical Offices, the Elizabeth Glaser Pediatric AIDS Foundation, African Medical and Research Foundation (AMREF), the Ministries of Health and Social Welfare (Mainland and Zanzibar), KIHUMBE, the Jane Goodall Institute/TACARE, YouthNet, T-MARC, Ministry of Health/NACP, PharmAccess, the United States Peace Corps, and Deloitte.

Care: $28,977,192 as of August 2006 ($27,830,900 Field and $1,146,292 Central) (25.6% of prevention, care, and treatment budget)

USG support will build further on existing relationships with faith based and community organizations, expanding services to reach over 24,000 clients through 47 home-based care (HBC) service organizations. A total of 2,300 HBC providers will be trained in basic palliative services to support this expansion. FY 2006 funds will help ensure that USG HBC partners are providing basic care packages, including cotrimoxazole prophylaxis, support for pain relief, end of life care, and counseling in healthy living choices/prevention for positives.

With FY 2006 funding, the USG will also implement a network of services targeting orphans and vulnerable children (OVC), with the goal of reaching 60,000 children by the end of the year. In the target districts, services will cover children�s needs for shelter, food, education, health care, economic opportunity, psychosocial support, HIV education, and social and legal protection.

Tanzania is also one of the three target countries for the new USG malaria initiative and linkages with this new initiative will be used to enhance HBC services through provision of treated bed nets for people living with HIV/AIDS (PLWHA). Innovative programs will also include the development of community agricultural plots for PLWHA. Some will serve as small income generating opportunities for PLWHA while in some programs, food from these plots will be used to supplement dietary needs for HBC clients and patients initiating antiretroviral therapy (ART).

In FY 2006, a regional focus for USG funded treatment partners will be operationalized under the Government of Tanzania�s National AIDS Control Program (NACP) guidance, as will the expansion of community based, orphans and palliative care services. Organizations serving communities surrounding current and anticipated treatment facilities will be targeted for development or expansion with FY 2006 funds. Programs providing services to communities without access to quality facility based care and treatment will continue to be expanded in preparation for national ART coverage. FY 2006 USG funding will also include treatment adherence counseling for ART patients in some sites as a means to enhance patient follow up at their homes. In this fashion, the USG program expects to fully utilize a continuum of care approach where all necessary services can be provided within one geographic area.

Principal Partners: Henry M. Jackson Foundation Medical Research International, KIHUMBE, Family Health International, CARE/Tumaini, Jane Goodall Institute/TACARE, Deloitte, Africare, Pathfinder International, Mbeya, Rukwa, and Ruvuma Regional Hospitals, PATH, Pact, AMREF, and the Ministry of Health/NACP.

In the May 2006 notification, an additional $25,327,192 was allocated for care activities. The additional funds will provide HIV-related palliative care training for 4,100 individuals and HIV palliative care training for 50 individuals. These additional funds will also result in two additional service outlets that will provide HIV-related palliative care. The number of OVC served by OVC programs will increase by 9,150 and the number of providers/caretakers trained in caring for OVC will increase by 135. The number of individuals who will receive counseling and testing for HIV (and will receive their test results) will increase by 12,000 and the number of service outlets providing counseling and testing (according to national and international standards) will increase by 4. There is no change in the amount of funding allocated for care as of this operational plan.

Treatment: $56,313,973 as of August 2006 ($39,243,966 Field and $17,070,007 Central) (49.8% of the prevention, care, and treatment budget)

Activities to support general access, patient follow-up and the targeting of specific populations for ART by USG efforts initiated in the early years of the Emergency Plan will be continued with FY 2006 funding. These include services for HIV positive pregnant women and their family members and the specific improvement of pediatric care.

The primary focus of the treatment activities will be the scaling up of clinical treatment services for people living with AIDS. The initiation of these activities, though slower than expected, is poised to roll out to 200 sites by the end of 2006, through both downstream and upstream USG partner support. With FY 2006 funds, USG support for training, accreditation, service provision, and commodity procurement, including antiretrovirals, treatment services will continue their rapid expansion by year end and beyond. It is envisioned that treatment, prevention, and care will all be linked and that activities will provide an opportunity for patients to access a range of services at each point of the continuum as appropriate.

USG efforts in improving pediatric care will be continued both at the national and local care provider level. This will include strengthening the pediatric components of the National HIV/AIDS Care and Treatment Guidelines and facilitating the training of medical personnel in provision of quality pediatric services. Additionally, experienced providers from outside and within Tanzania will be utilized to mentor and provide supportive supervision for sites initiating treatment.

Additional USG efforts will support the integration of HBC providers and dispensary personnel as part of the network of ART, linking them to ART facilities for training and support as a means of providing patient follow up and assistance in treatment adherence.

Principal partners include: John Snow International, Medical Stores Department, Mbeya, Rukwa, Ruvuma Regional Hospitals, Mbeya Referral Hospital, PharmAccess, University Research Corporation, Deloitte, Family Health International, Management Sciences for Health, Muhimbili National Hospital, Harvard University, Elizabeth Glaser Pediatric AIDS Foundation, Catholic Relief Services/AIDSRelief consortium, Columbia University, and the Ministry of Health: Diagnostics.

In May 2006, an additional $400,000 was allocated for treatment activities. These additional funds will provide for antiretroviral therapy for an additional 500 people. Three service outlets providing antiretroviral therapy will be available and twelve health workers will be trained to deliver ART services (according to national and/or international standards) as a result of the increased funding.

In August 2006, an additional $4,400,000 was allocated for treatment activities. The additional funding will be used to purchase ARVs to put additional people on treatment and to strengthen laboratory services through the procurement of critical commodities and supplies. Please note that pediatric AIDS funding that is attributed to OVC programs is included in the care program area total and is deducted from the treatment program area total.

Other Costs: $16,805,134 as of August 2006

The USG supports a wide range of effort in Tanzania to ensure a sound foundation for all HIV/AIDS activities. These are part of Tanzania�s national response to HIV/AIDS, and include policy development, legislative review, stigma reduction, and capacity building of public, non-governmental, and private sector organizations involved in the response. These interventions provide necessary linkages between actors, programs, and government agencies. Recent achievements have included formulation of the National AIDS Policy, assessment of the impact of the AIDS Policy on laws as a means of safeguarding the rights of PLWHA. The USG has, and will continue to, support the development of faith-based consortia, regardless of denomination. Efforts to date have focused on both Christian and Muslim based groups. These groups in turn, working through their followers, provide messages and services to people infected and affected by HIV and AIDS.

The USG has long supported cross-cutting processes as a means to improve the policy/institutional environment in which USG HIV/AIDS activities are developed at national and local levels. Examples for government include policy development and implementation; capacity building to strengthen strategic leadership and coordination capacity of the Tanzania Commission for AIDS (TACAIDS) and The Zanzibar AIDS Commission (ZAC); technical assistance for Global Fund processes (partnership facilitation, proposal preparation and start up coordination). For the non-governmental and faith based organizations (NGO and FBO) sectors, this includes strategic leadership and coalition building around critical issues for civil society organizations (FBO, PLWHA organizations, and parliamentary networks).

USG is also actively involved with the Government of Tanzania on human resource issues; the dearth of staff has been called both �an emergency� and �a crisis�. Regardless of the title supplied, the reality is that there is simply not enough trained staff to carry out the increasingly complex clinical services which HIV care requires. At the community level, the ability to identify individuals who are willing to donate their time and skills to the rest of their neighbors is also becoming a challenge.

Utilizing FY 2006 funding, the USG will seek out innovative ways of alleviating these shortages including using the concept of twinning to bring experienced clinicians from the US and elsewhere to Tanzania, thus allowing the existing trained Tanzanians the ability to assist underserved areas of the country.

To support the overall achievements of the USG efforts in Tanzania requires a significant level of staffing across the different Departments and Agencies. While necessarily the level of staffing has been kept minimal, the burden of overseeing a program growing as rapidly the one in Tanzania can not be underestimated.

Principal Partners: Ministry of Health (NACP, ZACP, NTLP, NIMR), TACAIDS, Measure/Evaluation, ORC/MARCO, PharmAccess, Management Sciences for Health, The Futures Group/Policy Project, Pact, Family Health International, and IntraHealth.

Other Donors, Global Fund Activities, Coordination Mechanism:

The USG works closely with the Development Partners Group sub-group on HIV/AIDS. The Emergency Plan is a standing agenda item in the monthly meetings and updates, and all questions, concerns, etc. are attended to during that time. The monthly meetings, as well as other ad-hoc interactions, serve as opportunities to inform other donors on the areas that the USG seeks to support and identify opportunities to strengthen programs in a collaborative fashion.

The USG also works closely with the Global Fund and has a seat on the Tanzania National Coordinating Mechanism (the �Country Coordinating Mechanism�). The USG has been highly instrumental in the development of proposals for rounds 1-5 for both the mainland and Zanzibar and has a close working relationship with the Fund�s Country Manager. As both initiatives develop, the Team will continue to seek opportunities for synergizing programs and identify potential gaps where one or the other activity can provide assistance to the Government of Tanzania.

Coordinating of Emergency Plan activities in Tanzania is a multifaceted effort. Internally, the USG meets on a weekly basis with heads of Agency on the �Interagency HIV/AIDS Coordinating Committee� or IHCC. This body, chaired by the Deputy Chief of Mission, has oversight on all USG activities and is the arbitrating body for internal matters. Externally, under the auspices of the Embassy and the Ambassador himself, the USG liaises with the various ministries and offices in order to ensure a coherent program and tightly coordinated activities. Together, both externally and internally, the USG continues to build a well respected relationship across agencies, other donors, and the Government of Tanzania.

Program Contact: Ambassador Michael Retzer Sr. and Deputy Chief of Mission, Daniel Purnell Delly

Time Frame: FY 2006 � FY 2007

Approved Funding by Program Area: Tanzania

August 2006 Operational Plan Main Page

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