Project Title: Tanzania Fiscal Year 2007 Country Operational Plan (COP)
|Field Programs Funding by Account||Central Programs Funding by Account|
|Notified as of March 2007||Notified as of June 2007||Notified as of November 2006|
|Implementing Agency||GAP||GHAI||Subtotal: Field Programs Funding||GAP||GHAI||New Subtotal: Field Programs Funding||GHAI Central Programs||Total Dollars Allocated: Field & Central Funding|
HIV/AIDS Epidemic in Tanzania:
Estimated Population: 38,329,000*
HIV Prevalence rate: 6.5%*�
# of HIV infected: 1,400,000*
Estimated # of OVCs: 1,100,000*�
*Figures are from the 2006 Report on the Global AIDS Epidemic, UNAIDS
�Prevalence is in adults only (15-49 years)
�Orphans aged 0-17 due to AIDS
Country Results and Projections to Achieve 2-7-10 Goals
Total # Individuals Receiving Care and Support
Total # Individuals Receiving ART
End of Fiscal Year 2004*
End of Fiscal Year 2005**
End of Fiscal Year 2006***
End of Fiscal Year 2007****
End of Fiscal Year 2008****
* 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.
*** Results. �Power of Partnerships: The President�s Emergency Plan for AIDS Relief.� Third Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, February, 2007.
**** FY 2007 Country Operational Plan targets
Tanzania is facing its most critical health and development crisis to date. The mainland faces a generalized HIV/AIDS epidemic, with an estimated 6.5% of the mainland population infected with HIV (7.7% of adult women and 6.3% of adult men). Zanzibar is considered a concentrated HIV epidemic, with an estimated 0.6% of the general population infected with HIV (Ministry of Health and Social Welfare [MOHSW] validation survey, 2002), with a prevalence rate of 26% among injecting drug users (IDU) (Dahoma et al 2006).
Overall, 1.4 million Tanzanians (1,300,000 adults and 110,000 children) are living with HIV/AIDS, in a total population of 35 million. The social, economic, and environmental impact of the pandemic is sorely felt as an estimated 140,000 Tanzanians have perished, leaving behind as estimated 2.5 million orphans and vulnerable children, representing approximately 10-12% of all Tanzanian children.
As elsewhere in sub-Saharan African, the underlying factors of poverty, migration, marginalization, lack of information and skills, disempowerment, and poor access to services raise the risk of HIV and have an impact on the course and spread of the pandemic. 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. There continues to be a significant difference in the prevalence among urban (10.9%) and rural (5.3%) areas of the country.
There are clearly identifiable high-risk groups that warrant more aggressive targeting, including: military and uniformed services, people in prostitution, truckers and communities along the transport corridors, and a growing urban population of injecting drug users. Finally, social and behavioral norms such as multiple and concurrent partners and cross-generational sex are fundamental to the ongoing spread of HIV in the general population. Approximately 27% of sexually active men report having two or more sexual partners in the past year, and almost 10% of sexually active 15- to 19-year-old females had sex in the past year with a male partner who was 10 or more years older.
Additional Funding: In June 2007, an additional $32,262,126 was allocated to expand critical PMTCT, HIV/TB, and palliative care services. Additional funding will also support an increased emphasis on linking with malaria prevention activities as part of palliative care, and on addressing issues related to gender-based violence.
Emergency Plan funding will be focused on the following programmatic areas to achieve the 2-7-10 targets:
Prevention: $37,567,685 ($31,068,240 Field and $6,499,445 Central) (20.7% of prevention, care, and treatment budget)
Prevention activities in Tanzania include prevention of mother-to-child transmission (PMTCT), abstinence and faithfulness (AB) programs, blood and injection safety, and other behavioral prevention initiatives focused on high prevalence urban areas, transportation corridors, and most at-risk populations (MARPs).
The USG will continue to partner with Government of Tanzania (GOT) in fiscal year 2007, expanding PMTCT services to new sites, including support to HIV-positive women and their children. The program also will focus on improved quality of services and strengthened PMTCT-antiretroviral treatment (ART) linkages. At the national level, a standard training curriculum will be implemented, monitoring systems will be strengthened, PMTCT guidelines will be revised to introduce a more effective prophylaxis regimen, and job aids will be developed to promote infant feeding counseling.
Blood and injection safety activities in fiscal year 2007 will increase the scale of programs to provide national level coverage through the National Blood Transfusion Services (NBTS) as an executive agency and a blood transfusion advisory board. Coverage will be extended to hard-to-reach areas by renovating regional and municipal hospital-based facilities. The USG will continue to support expansion of the Infection Prevention and Control-Injection Safety Program.
The USG will maintain its support of high-quality AB programs, including life skills training for youth, community outreach, and support for standardized messaging in accordance with the recently finalized National HIV/AIDS Communications and Advocacy Strategy. In fiscal year 2007, the USG will strengthen programming for B messaging with the adult male population, to address high-risk social norms and discourage multiple partnering and cross-generational sexual practices.
Further, the USG will emphasize a comprehensive ABC (abstain, be faithful, and correct and consistent use of condoms) approach to reduce transmission in MARPs, including specific workplace interventions and prevention messages to persons living with HIV/AIDS (PLWHA). Focused behavior change communication will include peer education programs, interpersonal communications, and other activities that directly interface with MARP target groups in high HIV transmission areas. USG partners will increase the variety of �edutainment� methods used, and increase the social marketing of condoms and associated behavior change. Interventions will target the military and uniformed services, agricultural workers, people in prostitution, communities along the transport corridors, and a growing urban population of intravenous drug users, in order to reduce HIV transmission and link prevention services to the continuum of care.
Principal partners: Academy for Educational Development, American Association of Blood Banks, Balm in Gilead, Elizabeth Glaser Pediatric AIDS Foundation, Family Health International, Harvard University School of Public Health, International Rescue Committee, Kikundi Huduma Majumbani, National AIDS Control Program, Rukwa and Ruvuma Regional Medical Offices, Selian Lutheran Hospital, University of Medicine and Dentistry, New Jersey, University Research Corporation, World Vision International, and Zanzibar AIDS Control Program.
Care: $52,449,415 ($51,147,922 Field and $1,301,493 Central) (28.9% of prevention, care, and treatment budget)
Care activities in Tanzania include the provision of basic palliative care, support for integrating tuberculosis (TB) and HIV programs, support for orphans and vulnerable children (OVC), and counseling and testing (CT). In fiscal year 2007, the USG will emphasize scaling up services, with a focus on improved quality, comprehensiveness and consistency. To strengthen the continuum of care at the regional, district, and community levels, the regionalization that occurred among USG treatment partners in fiscal year 2006 will be mirrored in palliative care and, to the extent possible, with OVC programs.
In fiscal year 2007, the USG will reach additional HIV positive patients with HIV-related palliative care. The basic package of services will meet national standards, including the use of cotrimoxazole prophylaxis, insecticide-treated bed nets, and access to safe water.
The USG will continue to assist and advise the Government of Tanzania in the screening, diagnosis, and treatment of TB disease among PLWHA, including strengthening laboratory infrastructure, and supporting TB infection control in HIV palliative care settings and antiretroviral (ARV) programs. The USG will support expansion of HIV diagnostic counseling and testing for HIV in TB clinics, direct service delivery in HIV Care and Treatment Center sites, and training of clinicians in case management. All USG partners will work in collaboration with National TB and Leprosy Programme and National AIDS Control Programme efforts, to strengthen systems to screen all HIV patients for TB and set up referral monitoring systems.
With fiscal year 2007 funds, the USG will focus on expanding and improving the quality of services for OVC, who represent 10�12% of all Tanzanian children. In collaboration with the Presidential Malaria Initiative, OVC under 5 years of age will be provided with insecticide treated nets for malaria prevention. USG partners will increase efforts to identify HIV-positive OVC, in order to link them with ARV programs. Activities initiated in fiscal year 2006 for developing community agricultural plots for nutritional support and income generation will be expanded. Finally, the USG will support the review of laws and policies that affect OVC, and will continue to sit on the National Steering Committee for OVC and support the National Implementing Partner Group.
The USG will focus on increasing utilization and improving quality of counseling and testing services. A cornerstone of providing counseling and testing in Tanzania will be the integration of provider-initiated testing into clinical services. The USG will assist the GOT with developing policies, guidelines, protocols, and a standard curriculum. An anticipated change in the national HIV testing algorithm, which will no longer be cold-chain dependent, will allow testing to be conducted in more remote settings and in homes. In addition, the USG will focus on the promotion of services, with an emphasis on addressing stigma and discrimination as barriers to testing. Promotion of testing to adult men will be a critical element, as testing uptake among men remains low. Services will be expanded in high prevalence, high density locations such as border crossings. Quality improvement will be achieved through support for government efforts to strengthen supervision and improve coordination.
Principal partners: Africare, Deloitte Touche Tohmatsu, IntraHealth International, Kilombero Community Trust, Mennonite Economic Development Associates, Mildmay International, National AIDS Control Program, National Tuberculosis and Leprosy Control Program, Pact, Inc., Partnership for Supply Chain Management, Pastoral Activities & Services for People with AIDS, Pathfinder International, Program for Appropriate Technology in Health, and Salvation Army.
Treatment: $91,293,837 ($74,037,758 Field and $17,256,079 Central) (50.4% of prevention, care, and treatment budget)
Treatment activities in Tanzania include the provision of free ARV drug and service programs as well as laboratory support. An estimated 400,000 Tanzanians have advanced HIV infection and would benefit from HIV treatment.
In fiscal year 2007, the USG will focus on sustainability, increasing pediatric treatment, and enhancing linkages to care and support services. The USG will build the capacity of local authorities in both managing and providing supportive supervision of treatment services. USG programs will include improved identification of pediatric cases and referrals for services; raising health care worker awareness of pediatric care and improving clinical skills in ART therapy; promoting provider-initiated testing among children; and linking mothers� HIV status to the child health card for follow-up. Finally, the USG will strengthen linkages with other programs to ensure and enhance a continuum of care and quality of both adult and pediatric services.
The USG collaborates with the MOHSW and its partners to strengthen laboratory infrastructure and capacity for HIV diagnosis, disease staging, and therapeutic monitoring. In fiscal year 2007, the USG will implement a national quality assurance program for HIV-related laboratory services, facilitate capacity building, and strengthen the national program for infant diagnosis of HIV among children for recruitment into care and treatment.
The Partnership for Supply Chain Management (PFSCMS) will undertake procurement on behalf of the USG in Tanzania in fiscal year 2007. PFSCMS will focus on capacity building and monitoring of supply chains, emergency and buffer stock procurements, and quantification. Logistical activities in fiscal year 2007 will ensure that drugs procured by all parties arrive at their final destination�the patient�and provide both central level and zonal/regional support. The GOT will continue to procure first-line regimens utilizing Global Fund resources, and USG ARV procurements will be limited to alternate first line, second line, and pediatric formulations. USG funds also will assist in the procurement of medications necessary for the treatment of opportunistic infections, test kits, and laboratory reagents.
Principal Partners: Bugando Medical Centre, Catholic Relief Services, Columbia University, Deloitte Touche Tohmatsu, Elizabeth Glaser Pediatric AIDS Foundation, EngenderHealth, Harvard University School of Public Health, Mbeya Referral Hospital, Mbeya, Rukwa, and Ruvuma Regional Medical Offices, Partnership for Supply Chain Management, Pastoral Activities & Services for People with AIDS, PharmAccess, Regional Procurement Support Office, University of Washington, and University Research Corporation.
Other Costs: $24,171,390
In fiscal year 2007, the USG will support the GOT�s efforts to monitor the extent of the HIV epidemic through direct funding and technical assistance to conduct population- and clinic-based surveys, as well as special surveys among at-risk groups. The USG also will provide support to strengthen national monitoring and evaluation activities and health management information systems. The USG strategic information focus in fiscal year 2007 will be on decentralized data management at the district level and improving the flow of data from the facility to the national level, with appropriate aggregation and use of data at all levels for program planning and monitoring. To avoid duplication of information flow, the USG will support MOHSW to develop an electronic system for data entry for multiple program areas using a single portal. The USG will also help build national capacity and sustainability by supporting staff in the Epidemiology Unit of NACP and the Zanzibar AIDS Control Program.
The success and sustainability of Emergency Plan activities in Tanzania depend largely on crosscutting programs that encompass systems strengthening, policy, and stigma reduction. The USG has worked with the GOT, civil society and faith-based organizations, PLWHA groups, parliamentarians, the private sector, media, and other institutions to strengthen advocacy for policy change for improved implementation and access to services. To address the critical shortage in human resources for health, other policy and system strengthening activities will accelerate the implementation of an emergency hiring plan supported by the Global Fund, and also will improve the quality of pre-service HIV training in schools of allied health. The USG will continue to strengthen the policy environment for HIV/AIDS by improving the capacity of district and national leaders to advocate for HIV services and the passage of the AIDS bill. Stigma and discrimination reduction will be addressed broadly, through scaling up of best practices identified through an assessment of partners� work in stigma interventions.
Principal Partners: American International Health Alliance, Family Health International, Macro International, Management Sciences for Health, Mbeya Referral Hospital, Ministry of Health, National AIDS Control Program Tanzania, National Institute for Medical Research, Pathfinder International, Policy Project, State University of New York, University of North Carolina, World Health Organization, and Zanzibar AIDS Control Program.
Management and staffing funds will support the in-country personnel needed for USAID, HHS/OS, HHS/CDC, State, DOD and the Peace Corps. Working cooperatively, these agencies have developed innovative approaches and management structures that ensure program monitoring and accountability, capture the programming advantages of partner agencies, and ensure USG policy and technical leadership within the Tanzanian national response.
Other Donors, Global Fund Activities, Coordination Mechanisms
The United States is the largest bilateral donor to HIV/AIDS activities in Tanzania. In addition to the Global Fund, other major donors include: Royal Netherlands Embassy, German Development Corporation (GTZ), Japan International Cooperation Agency, and the World Bank. The total amount of the Global Fund awards for both the mainland and Zanzibar is $510 million, approximately $325 million of which is for HIV/AIDS.
The primary coordinating bodies for HIV/AIDS are the Tanzania Commission on AIDS on the Tanzania mainland and the Zanzibar AIDS Commission on the island of Zanzibar. In addition to working with NACP, the USG meets regularly with key officials of individual Ministries to ensure that USG assistance supports the GOT goals within each program area. Internally, the USG meets on a weekly basis with agency heads of the Interagency HIV/AIDS Coordinating Committee (IHCC). This body, chaired by the Deputy Chief of Mission, oversees all USG activities and is the arbitrating body for internal matters. Together, both externally and internally, the USG continues to build a well-respected relationship across agencies, other donors, and the GOT.
Program Contact: Emergency Plan Coordinator, Tracy Carson
Time Frame: Fiscal year 2007 � fiscal year 2008
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