USAID – “From the American People”

On Friday May 20^th I was fortunate enough to be invited to attend a very high profile meeting in Stone Town at the ZAC (Zanzibar AIDS Commission) office with representatives from USAID, VSO, ZAC, ZANGOC and ZAPHA+. This meeting was in regards to a call for proposals that was recently sent out by USAID/Tanzania for a 5 year funded program for comprehensive and sustainable clinical and community based HIV services throughout Tanzania. Amongst those eligible to apply for this funding opportunity are Tanzanian, international or US NGOs who are able to form a consortium or partnership with other like minded NGOs to develop and submit applications to USAID for a wide ranging clinical and community based HIV services both at facility and community levels.

Outside the ZAC office in Shangani, Stone Town

 

Zanzibar is eligible to form a consortium and apply for this funding under “Core 2” which will cover community‐based HIV/AIDS care and support programs in Iringa, Dodoma, Morogoro, Singida, Mwanza, Kilimanjaro, Tabora and Zanzibar.

The purpose of the meeting on Friday was to get the ball rolling and to decide how many NGOs in Zanzibar this funding will be directed to and to identify which NGOs these will be. The decision came down to the following NGOs: ZAC, ZANGOC, ZAPHA+, WAMATA and UMATI. It is inevitable that other NGOs in Zanzibar will be involved in the roll out of this program as ZAC is a coordinating NGO and ZANGOC, as we know, is an umbrella organization and will hence distribute funds to its member organizations that have the capacity to take on such a large program.

The next steps for the Zanzibar Consortium:

The representative from VSO is to meet with USAID in Dar es Salaam on Monday May 23rd to see if the first round of concept papers due in February had been obliged. If not then the aforementioned NGOs will form a group and write a concept paper to USAID that will be due on June 24th (something I hope to be involved in, one way or another!)

It is possible that the second round of applications will be canceled if funding has been fully obligated. It is also possible that no Concept Papers for “Core 2” will be accepted in the Second Round if an award for “Core 2” has been made as a result of the First Round.

So, hopefully by Tuesday we will find out if we are able to move forward in writing a concept paper for this amazing opportunity.

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HIV/AIDS in Tanzania

Mainland Tanzania is grappling with a mature, generalized HIV and AIDS epidemic. According to the

2007‐08 Tanzania HIV/AIDS and Malaria Indicator Survey (THMIS), adult HIV prevalence in the country is estimated at 5.8% and an estimated 1.4 million Tanzanians are living with HIV and AIDS, of which approximately 10% are children HIV positive. Prevalence has declined slightly from an estimated 7% in 2004. Despite this documented decline in prevalence, an estimated 217,704 people contracted HIV in Tanzania in 2008, according to national surveillance data (National Prevention Strategy Review, 2009). Over 80% of HIV transmission in Tanzania occurs through heterosexual contact, approximately 18% through mother‐to‐child transmission, and 1.8% through medical transmission or traditional practices. Women in Tanzania make up 56% of the HIV‐infected population. With more than 1.8 million births and 6.8% HIV prevalence at antenatal clinics (ANC), approximately 100,000 HIV‐positive women deliver HIV‐exposed infants annually.

In 2010, the USG and United Republic of Tanzania (URT) signed a Partnership Framework (PF) outlining the two nations' joint commitment (2009‐2013) to a durable and effective response to the HIV and AIDS crisis in Tanzania. The Partnership Framework in Tanzania is representative of the core principles of PEPFAR II and focuses on building capacity for a greater country‐led response, increasing Tanzanian ownership of the HIV/AIDS response, scaling up effective prevention interventions, and laying the foundation for more sustainable country programs. The Partnership Framework is consistent with Tanzania’s National Multi‐Sectoral 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 United Republic of Tanzania (URT) national priorities.

Under the National Multi‐Sectoral HIV/AIDS Framework 2008‐2012 and the Health Sector HIV/AIDS

Strategic Plan III 2009‐2015, the Government of Tanzania (GOT) has laid out an ambitious plan to implement several key HIV/AIDS interventions. This document outlines key clinical HIV/AIDS services program such as Prevention of Mother‐to‐ Child Transmission of HIV (PMTCT), Counseling and

Testing (CT), TB/HIV, Facility and community based HIV/AIDS care and support programs for PLHIV such as Home‐based care and nutritional support services. Other supporting documents include the

National Care and Treatment Plan which aims to provide treatment services to over 440,000 people living with HIV/AIDS (PLWHA), the Pediatric HIV/PMTCT Scale up Plan, the TB and TB/HIV

Collaborative Policy and Implementation Plan and the National Guidelines for Home‐ based Care Services.

The 2010 PEPFAR/Tanzania Annual Progress Report (APR), indicates the USG currently provides care and support services to over 900,000 PLHIV of which over 250,000 HIV positive clients are on treatment (ART) and 150,000 clients receive community based care and support services. Over

1,300,000 pregnant women received HIV testing and over 60,000 HIV‐positive pregnant women received antiretroviral prophylaxis.

Most of the USG‐supported HIV/AIDS services are implemented through grants to international partners who in turn support the URT/ Ministry of Health and Social Welfare (MOHSW) in both the mainland and Zanzibar, as well as local partners to roll‐out interventions at regional, district and community levels.

CHALLENGES

Despite successes in enrolling Tanzanians into care and treatment programs and saving lives, the national HIV/AIDS program faces formidable challenges. Long‐term financing and sustainability are especially problematic as the current program is almost completely donor‐funded. Under PEPFAR Phase One, national HIV/AIDS services and programs were launched as an emergency response, implemented primarily through NGOs and international technical assistance partners with foreign donor funds. Tanzania’s endemic health delivery system weaknesses ‐‐the absence of viable health systems and health information systems; a severe lack of human resources; absence of basic infrastructure, shortages of drugs, and commodities; and inadequate financing – have been temporarily patched through PEPFAR and Global Funds inputs but the health delivery system as a whole remains fragile and overly dependent on donor support. Despite enormous inflows of donor funding and international technical assistance, the national HIV/AIDS program continues to suffer from a lack of patient follow up outside the clinical setting, and inability to enroll target populations into care and treatment programs and a significant loss of retention of HIV positive patients on antiretroviral treatment (ART).