Five-Year Partnership Framework in Support of the Tanzanian National Response to HIV and AIDS, 2009-2013 between The Government of the United Republic of Tanzania and the Government of the United States of America (March 2010)


   

Guide to Acronyms

ABC-T              AIDS Business Coalition - Tanzania

AIDS                 Acquired-Immune Deficiency Syndrome

ART                  Anti-Retroviral Therapy

ARVs                Anti-Retrovirals

CIDA                Canadian International Development Agency

CMO                Chief Minister’s Office (Revolutionary Government of Zanzibar)

CSO                 Civil Society Organization

DANIDA           Danish International Development Agency

GF                    Global Fund to Fight AIDS, Tuberculosis and Malaria

GIPA                Greater Involvement of People Living with HIV and AIDS

GTZ                 Deutsche Gesellschaft für Technische Zusammenarbeit

HIV                  Human Immunodeficiency Virus

HMIS               Health Management Information System

HRH                 Human Resources for Health

HRMIS             Human Resources Management Information System

HSSP                Health Sector Strategic Plan

IDUs                Injecting Drug Users

JICA                 Japan International Cooperation Agency

LGAs                Local Government Authorities

MARPs            Most at Risk Populations

M&E                Monitoring and Evaluation

MDA                Ministries, Departments, and Agencies

MOFEA            Ministry of Finance and Economic Affairs

MOHSW          Ministry of Health and Social Welfare

MOU               Memorandum of Understanding

MSD                Medical Stores Department

MTEF               Medium-Term Expenditure Framework

NACP               National AIDS Control Program

NMSF               National Multi-sectoral Strategic Framework on HIV/AIDS

OGAC              Office of the U.S. Global AIDS Coordinator

OIs                   Opportunistic Infections

OPRAS             Open Performance Review Appraisal System

OVCs               Orphans and Vulnerable Children

PEPFAR            U.S. President’s Emergency Plan for AIDS Relief

PETS                Public Expenditure Tracking Systems

PF                    Partnership Framework

PFIP                 Partnership Framework Implementation Plan

PLHIV               People living with HIV

PMO                Prime Minister’s Office

PMO-RALG      Prime Minister’s Office – Regional Administration and Local Government

PMTCT             Prevention of Mother to Child Transmission

PMU                Procurement Management Unit of MOHSW

PO-PSM           President’s Office – Public Service Management

PPRA                Public Procurement Regulatory Authority

PR                    Principal Recipient

PSI                   Population Services International

RCC                 Rolling Continuation Channel

STI                   Sexually Transmitted Infection

TACAIDS          Tanzania Commission for AIDS

TB                    Tuberculosis

TBS                  Tanzania Bureau of Standards

TDHS               Tanzania Demographic and Health Survey

TFDA                Tanzania Food and Drug Administration

THMIS             Tanzania HIV and Malaria Indicator Survey

TNCM              Tanzania National Coordinating Mechanism

TOMSHA         Tanzania Output Monitoring System for non-medical HIV and AIDS interventions

UNJP                United Nations Joint Program

URT                 Government of the United Republic of Tanzania

VCT                  Voluntary Counseling and Testing for HIV

WB                  World Bank

ZHAPMos        Zanzibar HIV and AIDS Programme Monitoring System

 

I. Purpose and Principles

This Partnership Framework articulates the expected contributions of the Government of the United Republic of Tanzania (URT) and the Government of the United States of America (U.S. Government) (together, the two Governments) to a durable and effective response to the HIV and AIDS crisis in Tanzania over a five-year period. The Framework is consistent with Tanzania's National Multi-sectoral Strategic Framework on HIV/AIDS (NMSF 2008-2012) and the Health Sector Strategic Plan III (HSSP 2009-2015), and is intended to align the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) with Tanzania's national priorities. The Partnership Framework also strives to ensure that U.S. Government contributions to the national HIV and AIDS response complement and leverage those of other stakeholders.

Both Governments share a desire, through this Framework, to strengthen their relationship and increase the efficiency, effectiveness, and sustainability of their joint efforts on HIV and AIDS. In considering how best to achieve these aims, the U.S. Government and URT have dedicated themselves to these principles:

  • Country leadership. The Framework supports national plans and priorities and emphasizes capacity building to strengthen the ability of Tanzanian stakeholders to plan, manage, and continuously improve a sustainable national response to HIV and AIDS. All goal statements in the Framework have correlates in the Tanzania NMSF 2008-2012.
  • Accountability. The Partnership assumes that the two Governments should strive to meet all Framework objectives and be answerable to interested constituencies. The Framework includes objectives to further empower stakeholders to track progress on the national response to HIV and AIDS. Furthermore, the Implementation Plan is expected to elaborate additional accountability mechanisms in its monitoring and evaluation plans.
  • Evidence-based and strategic decision making. The two Governments value a rational, data-driven approach to the elaboration of the Framework informed by national management information systems.
  • Equitable, universally-accessible, quality care. The Framework is guided by the vision that systems and services related to HIV and AIDS should be equitable, universally-accessible, and of high quality. Attention to these three facets of care has been at the heart of Framework development and should continue to inform implementation efforts.
  • Cooperation and consultation. The U.S. Government and URT value joint decision making under the Partnership Framework and recognize the need to move the URT toward increased management responsibility for the national HIV and AIDS response. Successful implementation of Framework objectives hinges on continued involvement of government and non-state actors from all sectors, as well as people living with HIV.

In addition to the principles above, the two Governments affirm the importance of the following financial principles:

  • Transparency in resource allocation and expenditures.
  • Managing resources to achieve Partnership Framework results while reducing Tanzania's reliance on foreign aid over time.
  • Recognition that, as U.S. Government and URT resources are limited, prioritization is necessary to achieve the most durable public health impact, and planned investments are subject to the availability of funds.1
  • Recognition that achievement of national HIV and AIDS goals requires resource flows beyond the ability of any one partner, and that constraints on availability of funding from either Government or from other key partners could lead to a review and revision of goals.2
  • Where U.S. assistance is provided directly to the URT under this Partnership Framework, URT contributions are expected to meet host country cost sharing requirements under U.S. foreign assistance programs. Details regarding the URT's financial and/or in-kind contributions to programs under this Partnership Framework are to be provided in the Partnership Framework Implementation Plan.3
  • While the U.S. Government's main modality for delivering development assistance is project support, U.S. Government investments in Tanzania should be on plan, transparent, and support the principles of the "Three Ones".

II. Background/Context

The United Republic of Tanzania faces many economic and social development challenges, including those posed by a generalized AIDS epidemic and other communicable diseases. Adult HIV prevalence in the country is estimated at six percent (seven percent of adult women and five percent of adult men) and an estimated 1,400,000 Tanzanians are living with HIV/AIDS (THMIS 2007/08). Critical impediments to strengthening health outcomes in Tanzania include the inadequacy of trained human resources, inadequate infrastructure, and overburdened logistics systems and supply chains.

The URT has taken an active role in responding to the country's health challenges, as is borne out in several financial indicators. According to the World Health Organization's National Health Accounts Series, the estimated total expenditure on health grew fourfold between 1999 and 2006. During the same period, the government share of those expenditures rose from 43% to 58%, and government expenditure on health rose from an estimated US $ 4 per capita in 2000 to US $ 11 per capita in 2007. Although the URT has yet to meet the Abuja target of allocating 15% of total Government spending on health, the new Health Sector Strategic Plan establishes a target date of 2015. The URT also has steadily increased its budgetary allocations for HIV/AIDS activities, which are expected to stabilize at US $20 million annually.

In addition to financial commitments, the URT has made strides in policy and planning for the HIV response. The Tanzania Commission for AIDS (TACAIDS) recently elaborated the second generation NMSF (2008-2012), and the Ministry of Health and Social Welfare (MOHSW) and other partners have effectively articulated strategic policy frameworks in several focal areas. A key challenge, however, lies on the implementation end, where leadership at all levels is critical.

Grants to Tanzania from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund or GF) and contributions from PEPFAR together accounted for 86% of donor support to HIV/AIDS in the 2007/08 fiscal year. The UN Joint Program provides capacity building to national planning bodies and targeted technical interventions (i.e. PMTCT, IDU, workplace programs). With major funding through JICA, UNITAID, and the World Bank's Multi-Country AIDS Program (T-MAP) coming to a close in the near term, Global Fund and PEPFAR funding, including potential increases related to the Partnership Framework, is expected to constitute a greater proportion (more than 90%) of external financing for HIV/AIDS and other health sector priorities in out years. This changing donor landscape highlights the importance of additional contributions to the national HIV/AIDS response; continued, close collaboration between the U.S. Government, the Global Fund, and the URT; and new partnerships and increased civil society participation to expand the funding base and leverage existing investments.

The URT has achieved several milestones in the HIV/AIDS response. Efforts to increase public awareness have resulted in high levels of HIV prevention knowledge. The impressive uptake of voluntary counselling and testing (VCT) and national scale-up of antiretroviral therapy (ART), which has resulted in nearly a seven-fold increase in the number of patients enrolled in treatment since 2005, demonstrates strong momentum in expanding treatment services to all those in need. The URT has increasingly recognized the role of policy reform in the development of a sustainable national response to HIV/AIDS, as demonstrated by the passing of the national HIV/AIDS bill into law and the development of comprehensive strategic plans, such as the National Costed Plan of Action for Most Vulnerable Children. Nonetheless, these successes are counterbalanced by the scale and scope of continued need. Though public awareness is high, prevention efforts have not necessarily resulted in sustained behaviour change. Persistent, gender-based behaviors and norms in Tanzania increase risk of HIV transmission and diminish ability to cope with HIV/AIDS. There is also unmet and growing demand for broader and deepened HIV/AIDS services such as treatment, care, support, prevention, testing, and national coordination. Expansion has highlighted vulnerabilities in management as well as service delivery systems that must be addressed if further scale-up is to be achieved.

In sum, there is still much to be done to solidify key interventions and systems so that they will have a sustainable impact, as well as to ensure they remain effective and of high quality.

III. Five-year Strategic Overview

Overall, the Framework aims to reduce new HIV infections and morbidity and mortality due to HIV and AIDS, as well as to improve the quality of life for those affected by HIV and AIDS. These outcomes are anticipated through delivery of high-quality services and evidence-based interventions as well as improvements in structures, systems, and leadership capacity. The Framework emphasizes capacity building at all levels, with the expectation that at the end of five years, the URT should be better equipped to manage a sustainable response to the HIV and AIDS epidemic, with concomitant benefits to the broader health and social service system. Similarly, the Partnership Framework prioritizes capacity building with local indigenous organizations so that Tanzanian civil society is further engaged in and accountable for the national response to HIV and AIDS.

More than a year of careful planning and deliberation among representatives of the URT, U.S. Government, and non-government stakeholders was invested in the development of this Partnership Framework. The Framework design committee was motivated by a desire to be comprehensive; to balance investments in systems, structures, and services; to ensure a coordinated program with mutually reinforcing goals; to maximize ripple effects and linkages with other health and development activities; and, to integrate cross-cutting issues of gender, human rights, and involvement of PLHIV. The platform of six goals and associated objectives and contributions identified in the Framework reflect these considerations. The goals address these areas:

  1. Service Maintenance and Scale up: As a result of their investments in care, treatment, and support services, the two Governments expect to reduce morbidity and mortality due to HIV and AIDS and improve the quality of life for PLHIV and those affected by HIV and AIDS. Care, treatment, and support services include services for OVC, community and home-based care, and facility-based care (ART, PMTCT, and TB/HIV). Supporting quality improvements is an integral part of this goal.
  2. Prevention: The U.S. Government plans to support the URT to reduce new HIV infections in the country. The Partnership Framework describes a three-pronged approach: increase the efficacy of prevention programming; bring to scale prioritized prevention interventions; and, enhance the enabling environment though sustained leadership, policy change, and attention to structural factors affecting HIV transmission.
  3. Leadership, Management, Accountability, and Governance: Partnership Framework investments are intended to provide well-coordinated, effective, transparent, accountable, and sustainable leadership and management for the HIV and AIDS response. The two Governments plan to build the capacity of state and non-state actors at national and local levels for these oversight functions. Progress in this goal area is necessary for the success of all other Partnership Framework goals.
  4. Sustainable and Secure Drug and Commodity Supply: The U.S. Government plans to support the URT to strengthen a functional, prioritized, transparent, and timely logistics and supplies procurement system, including planned preventive maintenance of essential equipment.
  5. Human Resources: With U.S. government assistance, the URT intends to ensure the human resources capacity necessary for the achievement of quality health and social welfare service at all levels. Expected inputs to achieve this goal include training of new personnel, improved retention, and improved management of existing and future personnel.
  6. Evidence-based and Strategic Decision Making: The two Governments plan to improve the use of relevant and comprehensive evidence, provided in a timely manner, in HIV-related planning and decision making. Key approaches include improving management and coordination of relevant data systems, increasing national capacity to implement surveys and studies, improving incidence measures, and adopting best practices.

The scope of the Framework is necessarily broad given Tanzania's demographic and epidemiologic profile and the multiple challenges facing management and service delivery systems in the country. Goals 1 and 2 address the provision of services and interventions related to HIV and AIDS prevention, care, treatment, and support. The concept is that services supported by the U.S. Government at the initiation of the Framework should be maintained (whether by the U.S. Government, URT, or another partner), meet quality standards, and be scaled up where resources allow. In the realm of prevention (Goal 2), the Framework emphasizes effective and strategic targeting and appropriate scaling of behavioral, biomedical, and structural approaches as well as key changes in the enabling environment. Goals 1 and 2 are consonant with national goals and contribute to PEPFAR II's global targets for service delivery.

The Framework goals related to HIV and AIDS services and interventions are indivisible from those focused on host country leadership and systems strengthening. These structural elements, which are crucial to ensure the sustainability of existing and future investments by the two Governments, as well as other development partners, are iterated in goals 3, 4, 5, and 6. They are also reflected in contributions within each of the first two goals. Goal 3 provides for the reinforcement of Tanzanian leadership, management, accountability, and governance. Effective, multi-sectoral leadership at all levels is necessary for the realization of each Framework goal and can be regarded as a "foundational element" for the sustainability of the Framework.

Goals 4, 5, and 6 propose investments in systems and structures related to drugs and commodities, human resources, and data for decision making to ensure more effective management and the long-term viability of the HIV and AIDS response. These inputs are also mutually reinforcing. Structural improvements are not only essential to achieve sustainable outcomes, but can also be expected to have positive spill over effects to other health and development efforts, both directly and indirectly.

Finally, gender, human rights, and the greater involvement of people living with HIV and AIDS (GIPA) are cross-cutting issues with relevance throughout the Framework. Each of these issues is reflected in at least one goal (gender and human rights in the context of prevention and GIPA as a part of leadership); however, the two Governments recognize that consistent and concerted attention to these areas is essential to achievement of all of the goals. Through the Partnership Framework Implementation Plan, the URT and U.S. Government intend to reaffirm their support for gender, human rights, and greater involvement of PLHIV by specifying relevant activities and pertinent indicators to ensure full attention to these issues.

The diagram below highlights the interrelationships among the six goals and cross-cutting issues.

Date: 04/02/2010 Description: Interrelationship among Tanzania Partnership Framework goals and cross-cutting issues © PEPFAR Tanzania Team

IV. Partners: Roles and Contributions

The table below presents, in detail, each of the six Partnership Framework Goals. The adopted language is the outcome of several rounds of negotiation and has been carefully chosen to reflect the consensus of the two Governments on desired roles and contributions. The goal statements are aligned with and, in several cases, excerpted directly from the NMSF (2008-2012). Each goal is associated with several objectives that support its achievement, and these objectives are in turn associated with expected contributions from each Government. The "Other Contributions" column details contributions from other entities that complement those of the two Governments to support an integrated national response. Lastly, the column titled, "Considerations for Development of a Partnership Framework Implementation Plan" lists precursors to Implementation Plan development, as well as substantive issues recommended for discussion during the development process. Future development of the Implementation Plan is expected to focus chiefly on prioritization among these goals and objectives; strategies for operationalizing them, including policy changes; quantification of expected inputs and outcomes; and articulation of plans to monitor progress on mutually identified targets.

 

Five-Year Goal (1)

Service Maintenance and Scale Up: Reduce morbidity and mortality due to HIV & AIDS and improve the quality of life for PLHIV and those affected by HIV & AIDS

Under this goal, the U.S. Government plans to work in concert with the URT to ensure continued provision of quality HIV and AIDS care, treatment, and support services, including services for OVC, community and home-based care, and facility-based care (ART, PMTCT, TB/HIV, and Laboratory).  The focus of this goal is to maintain existing services; support some degree of growth in the national program as new clients are identified through ART feeder systems, such as PMTCT, TB/HIV, PITC, and VCT; and begin the transition to indigenous partners for program implementation.

Objectives

Expected Contributions

Other Contributions

Considerations for Development  of Partnership Framework Implementation Plan

 

United Republic of Tanzania intends to…

U.S. Government

intends to…

Maintain care, treatment, and support servicesexisting at initiation of Framework

 

• Ensure adequate financial resources from MTEF, GF, and other development partners to maintain existing care, treatment, and support services

• Ensure maintenance of USG-funded care, treatment, and support  services at initiation of Framework5

·         • MoFEA (Global Fund Principal Recipient (GF PR) Rounds 3, 4 and 8) is procuring ART and related commodities and supporting components of service delivery, including supportive supervision  

·          

• Pact (GF PR Round 4 and RCC) is maintaining and expanding services to OVCs

 

 • GTZ is continuing to support services in four regions and concentrating on health financing and social health insurance; sexual and reproductive health; support for decentralized health services, including public private partnerships; and human resources development and management

 

• CIDA and DANIDA are supporting the HIV Fund to increase access to HIV and AIDS services through LGAs

 

• WB is in discussion with MOHSW regarding high priority investments (e.g., essential medical equipment; diagnostic services; HRH; and introduction of a food fortification program  

 

The UNJP is supporting the MOHSW and other key institutions to support quality services for HIV and AIDS care, treatment and support, including training of service providers on Early Infant Diagnosis and on the use of regimens for PMTCT.

 

 

Expand prioritized care, treatment, and support services, dependent on available resources6

 

• Mobilize and allocate adequate financial resources from MTEF, GF, and other development partners for scaled-up, universal access to care, treatment, and support services

 

• Fund/support introduction of innovations/new care, treatment, and support services, as well as mutually identified priority requests

•Evaluate data from ART costing study that is underway and the results of NMSF costing exercise, which includes HSSP III

Ensure existing and additional care, treatment, and support services adhere to a minimum quality standard and package of services

 

•Implement costed and funded quality improvement frameworks for all relevant sectors that build capacity at all levels

• Provide financial and technical assistance for the implementation of quality improvement frameworks for all relevant sectors

 

• Ensure any USG-supported care, treatment, and support services adhere to national standards

•Assess existence of quality improvement frameworks in all relevant sectors; cost and fund frameworks

 


Five-Year Goal (2)

Prevention:  Reduce new HIV infections in the United Republic of Tanzania

Under this goal, the U.S. Government plans to support the URT to realize the number one priority of the national response: to reduce the number of new HIV infections.  The strategy is to focus on structural and behavioral drivers of the epidemic as well as biomedical interventions.  The two Governments plan to scale up prevention interventions throughout the life of the Partnership Framework based on priorities identified in URT prevention strategies.  The U.S. Government expects to bring injection and blood safety to a sustainable scale and capacity such that a transition of these health system components to URT would be possible within the period of the Partnership Framework. 

Objectives

Expected Contributions

Other Contributions

Considerations for Development  of Partnership Framework Implementation Plan

 

United Republic of Tanzania intends to…

U.S. Government

intends to…

Increase access to prioritized and evidence-based HIV prevention interventions that focus on behavioral and biomedical drivers of the epidemic and on underlying structural factors that influence HIV transmission and vulnerability

 

 

 

 

 

 

 

• Engage a range of state and non-state actors, including the private sector, to develop and implement a national multi-sectoral prevention strategy and costed work plans in order to expand and bring to scale HIV prevention efforts

 

· Ensure adequate financial resources from MTEF, GF and other development partners to support accelerated expansion of multi-sectoral HIV prevention efforts as outlined in URT prevention strategies

 

• Continuously strengthen prevention strategies by adapting  innovative  approaches that are informed by data, represent best practices, and adequately target and prioritize local drivers

 

· Continue to support the URT to expand and bring to scale HIV prevention efforts

 

• Fund/support mutually identified priority interventions defined through URT’s prevention strategies as well as innovations/new services as prioritized by URT

 

· Assist the URT in identifying, adopting, and targeting the implementation of innovative and best-practice approaches

 

 

 

• PSI (GF R4 PR and RCC) are continuing to purchase male and female condoms for public and private sector distribution

 

• JICA is continuing to procure test kits, commodities and STI drugs

 

• Open Society and UNJP are supporting targeted IDU activities.

 

ABC-T is working with the private sector on workplace policies, strategies and interventions

 

The UNJP is supporting:   the development of workplace programs in Health and Education sectors but also in the private sectors; finalization of the National Prevention Strategy; and providing financial and technical support to the National BCC/SCC campaigns.

 

 

• GTZ is supporting services in four regions and concentrating on health financing and social health insurance; sexual and reproductive health; support for decentralized health services, including public-private partnerships; and human resources development and management

 

• CIDA and DANIDA are supporting the HIV Fund in order to increase access to HIV and AIDS services through LGAs

 

• If approved, URT GF R9 plans to support biomedical, behavioral, and structural interventions

 

• Establish baseline to ensure goal is measurable

 

• Ensure that innovative and/or new approaches such as male circumcision,  prevention with positives, interventions targeting higher risk populations such as MARPs are adequately addressed in the implementation plan

 

• Ensure that support is appropriately targeted in scope and scale to maintain prior gains and focus on reducing new HIV infections

 

 

Increase the efficacy of prevention programming through appropriate alignment of resources and prioritized interventions targeting key drivers of the HIV epidemic

 

 

 

 

 

 

 

 

 

 

 

· Continue to ensure that HIV prevention programs are grounded in gender/human rights and GIPA principles

 

· Introduce strategies to identify key risk behaviors and drivers of the Mainland and Zanzibar epidemics and strengthen the capacity of both state and non-state actors to implement locally relevant and prioritized prevention strategies and interventions

 

· Mobilize and allocate adequate financial resources from MTEF, GF and other development partners to support interventions as prioritized through URT prevention plans

 

· Lead and coordinate situation assessments, operations research, program monitoring/ evaluation and other HIV research to ensure continuous quality improvement

 

· Ensure rational and efficient implementation of URT prevention plans through a strong oversight and coordination mechanism. 

 

·  Support the URT in ensuring that HIV prevention programs are grounded in gender/human rights and GIPA principles

 

·   Continue to provide technical assistance to the URT in identifying key risk behaviors and drivers of the country’s diverse HIV epidemics and support the URT to build the capacity of both state and non-state actors to implement locally relevant and prioritized prevention strategies and interventions

 

·   Ensure that U.S. Government financial support is aligned with and supportive of mutually agreed upon priority interventions

 

·   Support URT in the identification and execution of prioritized programmatic and epidemiologic HIV prevention research

 

·   Support the URT in strengthening of its HIV prevention oversight and coordination mechanism

 

·   Continue to actively participate in HIV prevention coordination and planning fora as requested by URT

 

 

Develop/create an enabling environment for effective and sustainable prevention programming  

 

 

 • Maintain and enhance high-level political commitment, leadership, and visibility for HIV prevention

 

·  Ensure that adequate technical and financial resources are targeted at underlying gender, socio-cultural, socio-economic, and other structural factors that influence HIV transmission and vulnerability

 

·      Facilitate the expedient  adoption of regulatory and legal frameworks that increase access to comprehensive prevention interventions

·   Provide technical assistance to the URT to increase high-level political commitment, leadership, and visibility for HIV prevention

 

·   Ensure that HIV prevention initiatives supported through PEPFAR appropriately focus on gender and socio-cultural normative transformation to decrease HIV transmission and vulnerability

 

·   Support the URT in the identification of potential regulatory and legal hurdles and provide assistance in the development of facilitative frameworks

• Conduct studies that help to identify policy barriers that impede effective prevention programming

 

 

 



Five-Year Goal (3)

Leadership, Management, Accountability, and Governance:  Provide well-coordinated, effective, transparent, accountable, and sustainable leadership and management for the HIV & AIDS response

Under this goal, the U.S. Government plans to facilitate the strengthening of Tanzanian leadership for the national response through Government and non-state actors at local, regional, and national levels.  Facilitating policy changes over five years is a critical aspect of this goal, as is adopting mutually determined accountability measures and strengthening civil society and local government to enable decentralized demand for and management of HIV and AIDS responses.

Objectives

Expected Contributions

Other Contributions

Considerations for Development  of Partnership Framework Implementation Plan

 

United Republic of Tanzania intends to…

U.S. Government

intends to…

Ensure the implementation of prioritized, costed HIV & AIDS plans based on the NMSF and HSSP III

 

• PMO/CMO7 intend to lead implementation of a prioritized and costed NMSF, including the involvement of stakeholders (e.g. Ministries, Departments, and Agencies (MDA) focal points and non-state actors) across sectors in planning, budgeting, and implementation of HIV & AIDS programs

 

• PMO/CMO plan to ensure that MDAs and Local government authorities (LGAs)develop and implement sectoral HIV & AIDS strategic plans as mandated

 

Lead the implementation of  workplace programs for public and private sector

 

• Ensure Districts/Councils adapt the national HIV & AIDS strategy into their comprehensive District/Council Health Plans and other relevant planning documents

 

• Engage civil society in planning, and support civil society to implement HIV & AIDS responses at all levels

 

• Fund capacity building for planning, budgeting, management, accountability, and technical oversight by MDAs, LGAs, and civil society

 

•Program USG resources to reflect priorities identified in the costed NMSF

• UNJP and WB are providing technical support for costing of the NMSF

 

•DANIDA is providing support for capacity strengthening of TACAIDS

 

•UNJP is providing ongoing technical assistance for national and MDA capacity strengthening

 

• GTZ/UNJP are supporting the NMSF milestone on HIV focal points in MDAs

 

•JICA is supporting capacity strengthening for Regional Health Management Teams and the MOHSW/NACP in STI/VCT

 

•Public Financial Management Reform Program Basket Donors are providing resources to strengthen the Public Procurement Regulatory Authority

 

• Costed NMSF and donor assessments should enable URT to specify actors to be engaged in and accountable for implementing HIV & AIDS interventions and specify where resources should be allocated (national, regional, district, and community levels) for effective implementation

 

• Define terms of engagement between URT and civil society and relationship to coordination

 

 

• Engage the Ministry of Finance and Economic Affairs (MoFEA) to ensure adequate financing for the HIV & AIDS response.

 

Improve governance systems responsible for HIV & AIDS programs  (accountability, transparency, and information flow)

• Improve accountability for financial management through expenditure and performance-based reporting

 

• Convene joint reviews in order to monitor and ensure effective implementation of HIV & AIDS programs at all levels

 

• PMO, through the Tanzania National Coordinating Mechanism, intends to assume responsibility for monitoring implementation of the contributions specified  in the Framework

 

• Through Prime Minister’s Office – Regional Administration & Local Governments (PMO-RALG), ensure information flow and transparency in its relationship with civil society

 

• Ensure effective operationalization of the GIPA principle

 

• Through PMO/CMO, ensure improved coordination between PEPFAR and the Global Fund

• Support the roll-out of Public Expenditure Tracking Systems (PETS) at all levels

 

• Along with URT, identify and adapt best practices in governance and leadership

 

• Ensure USG-funded partners coordinate and share information with LGAs

 

• Participate fully in efforts led by PMO/CMO to improve coordination between PEPFAR and the Global Fund

 

• Item for further discussion:  mainstreaming of accountability and governance issues

 

• Refer to URT Institutions/ processes for improving accountability of financial management: Public Procurement Regulatory Authority auditing, National Audit office, Public Accounts Committee of Parliament, PETS

 

• Follow up with civil society for transparent information sharing (corresponding to URT activity 4)

Support a decentralization by devolution strategy for HIV & AIDS-related issues

 

•Implement a decentralization by devolution strategy and the PMO-RALG 5-year Partnership Plan (including funding, program oversight, and site-specific prioritization) in support of decentralization by devolution to ensure maintenance of existing multi-sectoral care, treatment, and support services and expansion to those in need, including OVC

• Provide financial and technical assistance for implementation of URT Framework-related activities to promote a multi-sectoral HIV & AIDS response

 

 

Five-Year Goal (4)

Sustainable and Secure Drug and Commodity Supply: Strengthen procurement and supply management systems of HIV & AIDS-related commodities8

Under this goal, the U.S. Government intends to collaborate with the URT to strengthen infrastructure and capacity in the supply chain management system to respond to the increased volume and complexity of the national procurement environment and ensure transparency and accountability in forecasting, procurement, and financing.

Objectives

Expected Contributions

Other Contributions

Considerations for Development  of Partnership Framework Implementation Plan

 

United Republic of Tanzania intends to…

U.S. Government

intends to…

Strengthen logistic management systems to provide drugs, supplies, and commodities for the management of HIV & AIDS patients through the supply chain

 

• Plan proactively and undertake timely procurements using domestic and other resources, through regular reviews of a National Procurement Plan and associated schedule that consider lead time, the status of buffer stocks, and evolving utilization projections

 

• Establish a drugs, supplies, and commodities monitoring panel comprised of a range of stakeholders that monitors procurement plans, analyzes root causes of procurement challenges, and eliminates stock outs

 

• Establish and implement a monitoring and early warning system for stock management

 

• Support technical assistance for strengthening the procurement, logistics, and distribution systems for drugs, supplies, and commodities to promote timely and appropriate procurement

 

• Support the upgrade of the Medical Stores Department physical plant and systems for effective management of increased volumes of drugs, supplies, and commodities

 

• MOFEA (GF PR R4 and R8) is supporting infrastructure development for MSD at all levels

 

•DANIDA is providing technical support for capacity strengthening of MSD

 

•JICA, Abbott Fund, WB, UNJP and other donors/foundations are providing HIV and AIDS related drugs and commodities for the national program

 

•Public Financial Management Reform Program Basket Donors are providing resources to strengthen the Public Procurement Regulatory Authority

 

• Engage NACP, TBS, PPRA, TFDA, and Public Health Laboratory Board in further discussions

Ensure the procurement of all quality drugs, supplies, and commodities based on the MOHSW Procurement Plan and associated schedule

• MOHSW intends to regularly update the Procurement Plan and adjust associated procurement schedules accordingly

 

 

• Provide technical assistance to strengthen the capacity of the URT to procure quality drugs, supplies, and commodities based on the MOHSW Procurement Plan and associated schedule

 

· Procure quality drugs, supplies, and commodities in line with procurement agreement with URT and the MOHSW Procurement Plan

 

 

Reduce proportion of equipment that is out of service

 

• Establish a national plan for preventive maintenance and the training of biomedical engineers for each region

 

• Support and provide technical assistance for a national plan for scheduled preventive maintenance and the training of biomedical engineers for each region

 

 

Strengthen logistic management systems to support the procurement of non-medical supplies and commodities, and medical supplies used outside of clinical services

·   Review all commodity procurement systems which address non-clinical/non-patient needs (e.g., surveillance, vehicles, nutritional supplements, etc.) in order to identify more specific contributions related to this objective

•Provide technical assistance to assist URT to review all commodity procurement systems which address non-clinical/non-patient needs (e.g., surveillance, vehicles, nutritional supplements, etc.)

 in order to identify more specific contributions related to this objective

 

 

Five-Year Goal (5)

Human Resources:  Ensure human resources capacity necessary for the achievement of  quality  health  and social welfare  service at all levels

Under this goal, the U.S. Government plans to collaborate with the URT and other donors to implement the National HRH Strategic Plan and, specifically, train new personnel, improve health sector employee retention, and improve personnel management.  Key aspects of this goal include investments in pre-service training and infrastructure, policy reform, and performance-based management.

Objectives

Expected Contributions

Other Contributions

Considerations for Development  of Partnership Framework Implementation Plan

 

United Republic of Tanzania intends to…

U.S. Government

intends to…

Increase production of health, social workers, and personnel in allied health services from training institutions

 

• Implement the current Human Resources for Health Strategic Plans for Mainland and Zanzibar

 

•Continue to develop and implement manpower training plan to project needs for deployment of health workers

 

• Assist URT to implement the Human Resources for Health Strategic Plan by supporting mutually identified components

 

•Contribute funding to the support of pre-service institutions and scholarship funds

•Multi-donor funded Workforce Initiative to achieve HRH Strategic Plan (participating donors include CIDA, JICA, USG, WB, GTZ) 

 

•UNJP supports several trainings of Health staff around Tanzania on use of more efficacious regimens for PMTCT and Early infant Diagnosis.

 

 

•Describe in PFIP the role of the multiple stakeholders responsible for implementation, including public, private, and other stakeholders

Increase number of qualified human resources strategically posted and retained; reduce vacancy rates

• Implement the current Human Resources for Health Strategic Plans for Mainland and Zanzibar

 

• MOHSW, the President’s Office – Public Services Management (PO-PSM), and PMO-RALG plan to determine the appropriate number of human resource requirements and establish annual measurable milestones regarding the placement of a minimum number of health and social workers for each fiscal year

 

• Resource and implement effective remuneration and innovative retention strategies

 

• Continue to implement URT’s phased plan of sustainable development and maintenance of infrastructure

• Assist URT to implement the Human Resources for Health Strategic Plan by supporting mutually identified components

 

• Support approaches for improved recruitment, placement, productivity, and retention

 

• Identify and assist the URT in adapting (if appropriate and desired by URT) best practices in human resources

 

•Advocate for and support interventions for effective remuneration and innovative retention strategies

 

•Support targeted infrastructure projects pursuant to arrangements with URT to provide long-term maintenance and support

• Develop models and scenarios to analyze the effectiveness of various health sector and non-health sector cadres

• Undertake health sector workforce analysis

• Undertake task shifting evaluation

• Develop dialogue structure around implementation of URT infrastructure development plan

Optimize manpower to address health and HIV & AIDS needs

• PO-PSM, PMO-RALG, and the MOHSW intend to support and  implement  the Open Performance Review Appraisal System (OPRAS) at all levels to make staff development, productivity, and position establishment decisions

 

• Tier responsibilities for care and support of patients to make the most effective use of available manpower;  specifically, the URT intends to undertake task shifting

 

• Identify individuals outside the health sector who can serve to enhance the effectiveness of the national HIV response

 

• Enhance and implement a human resource information system at all levels that facilitates effective management and strategic deployment of human resources

• Support the implementation of OPRAS at the district level

 

• Support interventions to measure and improve productivity among health workers

 

• Support task shifting approaches that have been demonstrated to be effective

 

• Support expansion of integrated HRMIS to districts to allow them to manage workforce

• Discuss USG support for OPRAS implementation with respect to other MDAs

• Discuss how USG and URT work with other stakeholders

• Discuss the appropriate and effective use of trained lower cadres of health workers, community health workers, and PLHIV to supplement the health and social workforce

• Further discuss URT intention to optimize use of individuals outside the health sector; how do we create opportunities for individuals across sectors to be engaged in the response?

 

Five-Year Goal (6)

Evidence-based and Strategic Decision Making:  Improve use of relevant and comprehensive evidence provided in a timely manner in HIV-related planning and decision making

Under this goal, the U.S. Government intends to support URT efforts to rationalize data collection and reporting systems, address infrastructure challenges that limit effective and efficient use of data, and assist in-country institutions to develop operational research and evaluation capacity, to more effectively use quality data for decision-making, and to hone implementation practices.

Objectives

Expected Contributions

Other Contributions

Considerations for Development  of Partnership Framework Implementation Plan

 

United Republic of Tanzania intends to…

U.S. Government

intends to…

Strengthen and coordinate multi-sectoral M&E systems to ensure quality vertical and horizontal flow of information and use of data by HIV & AIDS, Health, and Social Service sectors

 

•Strengthen the HMIS and M&E systems for HIV & AIDS data flow from health facility to national levels and feed back

• Systematically link M&E systems of vertical programs to the HMIS system within the MOHSW

• Use the Tanzania Output Monitoring System for HIV & AIDS (TOMSHA and ZHAPMoS) data for program planning and prioritization of budget allocations by all levels of government, MDAs, and CSOs

 

• Strengthen URT capacity in data management and use for planning and decision making, particularly at the district level

• Provide technical assistance for implementation of URT Framework contributions

 

 

• Donor Group on Health Monitoring and Evaluation is leading a multi-donor coordinated response to develop MOHSW’s management information systems infrastructure and use of data

 

• WB and the UNJP are supporting the development of TOMSHA

 

• MoFEA (GF R4 and R8) is supporting capacity strengthening at the national level for data systems and data use

 

 

•Define strengthening

• What needs to be done to ensure a stronger HMIS?

• Reflect Zanzibar M&E situation

• Document use of current data for service planning at all levels

• Consider creating standard reports tailored to various levels of government management and that can be issued to all MDAs, CSOs, and non-state actors

•Ensure that civil society  has appropriate skills

 

Increase national capacity to implement key national and sub-population surveys, studies, and evaluation activities

 

• Provide leadership on quality epidemic surveillance, surveys, and other routine reporting, including the mobilization of funding for such endeavors

• Provide technical assistance  and financial support to strengthen national capacity for the implementation of key national and sub-population surveys, studies, and evaluation activities

 

Improve measures of HIV incidence

• Provide leadership and coordinate various initiatives to improve measures of HIV incidence and enable use of data from ongoing studies

 

• Assist URT to improve measures of incidence

 

Adopt best practices in evidence-based and strategic decision making

• Document and disseminate best practices for purposes of policy development, prioritization, and decision making within Tanzania and internationally

• With URT, mutually identify best practices in evidence-based and strategic decision making

 

V. Plans for Developing the Implementation Plan

The Partnership Framework Implementation Plan offers the URT and U.S. Government the opportunity to operationalize the high-level goals and objectives expressed in this Partnership Framework document. Baseline information regarding Tanzania's country profile, the national response on HIV and AIDS, and relevant policy and financial assessments already exist. Thus development of the Implementation Plan is expected to focus chiefly on prioritization among goals and objectives, strategies for operationalization, quantification of expected inputs and outcomes, and articulation of plans to monitor progress on agreed upon targets. National processes currently underway that should be completed in the final quarter of 2009 include: costing of the NMSF; the Public Expenditure Review; HIV and AIDS Policy Review; and the National HIV Prevention Strategy. These inputs are expected to provide the basis for critical dialogue between the two parties to complete the Implementation Plan. As previously mentioned, the two sides wish to prioritize gender issues, human rights, and GIPA as details of the Implementation Plan are developed.

The URT and U.S. Government intend that development of the Implementation Plan should be a highly consultative process similar to that adopted for the Framework document, and should be guided by the same principles articulated at the beginning of this document. The design team responsible for the Partnership Framework plans to shepherd the document through the implementation planning phase.

The URT and U.S. Government propose the following timeline for Implementation Plan development:

  • September: Partnership Framework iterative review with PEPFAR Headquarters
  • September/October: Design team assesses inputs to Implementation Plan
  • November: Design team drafts and circulates Implementation Plan for comment
  • December 1: Submit draft Partnership Framework Implementation Plan to OGAC
  • December 18 through January 15: *Negotiations tabled in observance of holidays*
  • January: Submit final Partnership Framework Implementation Plan to OGAC

VI. Management and Communications

The Partnership Framework was developed by a design committee comprised of delegates from the URT and U.S. Government, as well as civil society representatives from faith-based, private sector, and PLHIV organizations. This multidisciplinary group has been an effective vehicle for inter-governmental and inter-sectoral dialogue on how to support national priorities for the HIV and AIDS response in the Partnership Framework. The design team plans to steer the Framework in the implementation planning phase, with participation from relevant technical experts and in collaboration with other relevant bodies such as the Tanzania National Coordinating Mechanism (TNCM), Development Partners Group on HIV and AIDS, and the Joint Technical Working Group on AIDS chaired by the Prime Minister's Office.

Once the Framework and Implementation Plans are signed and complete, the Prime Minister's Office, through the Tanzania National Coordinating Mechanism9, plans to assume responsibility for monitoring implementation of the goals and objectives included in the Framework. The URT and U.S. Government have determined that the Partnership Framework Implementation Plan should be reviewed on a yearly basis to assess progress toward targets. To ensure alignment with existing URT review processes, biannual Framework reviews should be subsumed into the HIV and AIDS Sector Reviews, and during off-years Framework reviews should be convened by the Tanzania National Coordinating Mechanism. In addition, Partnership Framework investment decisions should include a thorough review of contributions to the national response and service systems from sources other than the URT and U.S. Government. These preliminary plans for monitoring and review of the Framework are expected to be reaffirmed and expanded in the Implementation Plan.

In addition, the URT and U.S. Government expect ongoing policy dialogue to ensure successful implementation of the Partnership Framework, creation of an enabling environment, and complementarity with other funding streams, especially the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Designates from the U.S. Government and the Prime Minister's Office intend to meet throughout the life of the Partnership to discuss challenges, good practices, and potential readjustments.


1The U.S. Office of the Global AIDS Coordinator (OGAC) has requested that this principle, reflecting the U.S. Government's legal requirements, be included in all countries' Partnership Frameworks.
2The U.S. Office of the Global AIDS Coordinator (OGAC) has requested that this principle be included in all countries' Partnership Frameworks.
3The U.S. Government-issued Partnership Framework Guidance (p. 17, Financial Accountability) requests that "cost sharing assurances" from the partner government be included in the Partnership Framework Implementation Plan. OGAC also recommends draft Partnership Frameworks include the above language, to highlight that U.S. legislation requires host government cost sharing assurances under all Partnership Framework arrangements.
4Care, treatment, and support services include services for OVC, community and home-based care, and facility-based care (ART, PMTCT, TB/HIV, and Laboratory).
5While funding for existing services is expected to remain stable, the channels for implementing these services are expected to change over time. In particular, the USG hopes to transition some service delivery from international to indigenous partners. Goal 1 is thus closely linked with Goal 3, insofar as capacity building for Tanzanian management and coordination is expected to support this transition to local implementing partners.
6This objective is linked closely with Goal 3's objective to ensure the implementation of prioritized, costed HIV & AIDS plans based on the NMSF and HSSP.
7CMO refers to Chief Minister's Office (Revolutionary Government of Zanzibar).
8The intent of this goal is to include all drugs and commodities related to the HIV & AIDS response.
9The Tanzania National Coordinating Mechanism is responsible for oversight of international and national funding sources allocated for the purpose of massively scaling up responses to HIV and AIDS, Tuberculosis, Malaria, and other major epidemics and health-related programs requiring inter-sectoral interventions.

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