The TUNAJALI HBC/OVC Program

Community Care for People Living with HIV/AIDS and Orphans/Vulnerable Children

The TUNAJALI Program

Cooperative Agreement No. 621-A-00-07-00002-00 Submitted to: Susan Monaghan, PhD United States Agency for International Development Approved: ______Date: ______For further information, please contact: Gottlieb Mpangile, MD Chief of Party [email protected]

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

TUNAJALI VISION, MISSION AND CORE VALUES

Our Vision

Communities provide sustainable quality care & support to PLWHA and OVC.

Our Mission

To empower community-based organizations and communities to mitigate the impact of HIV/AIDS and provide quality comprehensive care for PLWHA & OVC as part of a continuum of care.

Our Values

 Commitment to high quality care  Establishment of effective networks, partnerships and referral mechanisms for comprehensive care  Accountability and results-focus  Enhancement of community ownership and drive  Maintenance of client dignity, confidentiality and rights  Ensure sustainability

ABBREVIATIONS AND ACRONYMS 2

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

AIDS Acquired Immune Deficiency Syndrome APCA African Palliative Care Association ART Anti Retroviral Therapy ARV Antiretroviral CHMT Council Health Management Team CMAC Council Multisectoral AIDS Committees COP Chief of Party COUNSENUTH Centre for Counseling, Nutrition, and Health Care CRS Catholic Relief Services CSO Civil Society Organization CTC Care and Treatment Clinic DCoCCC TUNAJALI District Continuum of Care Coordinating Committee DMS Data Management System DSW Department of Social Welfare DSWO Department of Social Welfare Officer FD Finance Director FHI Family Health International GC Grants Coordinator GOT Government of Tanzania HBC Home Based Care HIV Human Immunodeficiency Virus IEC Information, Education, and Communication IGA Income Generating Activities M&E Monitoring and Evaluation MUCHS Muhimbili University College of Health Sciences MVC Most Vulnerable Children MVCC Most Vulnerable Children Committee NACP National AIDS Control Program NETWO+ National Network of Tanzanian Women with HIV/AIDS OVC Orphans and Vulnerable Children PD Program Director PLHA/PLWHA Person Living with HIV/AIDS PMP Performance Monitoring Plan QA Quality Assurance REPSSI Regional Psychosocial Support Initiative RT Regional Teams STI Sexually Transmitted Infection STO Senior Technical Officer TA Technical Assistance TAWLA Tanzanian Women Lawyers Association TOR Terms of Reference TOT Training of Trainers TPCA Tanzania Palliative Care Association USAID United States Agency for International Development

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

USG United States Government VHW Village Health Worker ZACP Zanzibar AIDS Control Program

Table of Contents

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

I PROGRAM OVERVIEW 6 II OBJECTIVES and Activities A. Expected Result 1...... 9 Objective 1.1 9

B. Expected Result 2...... 21 Objective 2.1 21 Objective 2.2 23

C. Expected Result 3...... 24 Objective 3.1 24 Objective 3.2 26

D. Expected Result 4...... 27 Objective 4.1 27 Objective 4.2 29 Objective 4.3 29

IV Performance Monitoring Plan 33 V Management and Staffing 39 VI Grants and Financial Management41

Appendices :

Appendix 1: Implémentation Plan

Appendix 2: Budget

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

I PROGRAM OVERVIEW The goal of TUNAJALI is to deliver core palliative care and support packages, which provide services along the prevention-treatment-care continuum, to HIV and AIDS-affected households in Tanzania. Our activities aim to: increase the accessibility and availability of care and support services; strengthen the capacity of civil society organizations (CSOs) to deliver palliative care and OVC support services in collaboration with communities and government health and social welfare systems; establish effective linkages and supply systems; ensure the application of national policies and guidelines; and advocating that TUNAJALI lessons learned enhance the national HIV and AIDS response.

The TUNAJALI teams have been instrumental in creating community networks offering integrated, comprehensive, high-quality, and accessible care and support services for PLHIV and OVC. Anchored at the district-level, these networks facilitate the scale-up of existing activities to reach an increasing number of HIV affected households. In year four, TUNAJALI will not expand to new districts rather we will make marginal expansion within the existing 34 districts in the six mainland regions—Coast, Dodoma, Iringa, Morogoro, Mwanza, Singida and Zanzibar.

Scaling-up of the TUNAJALI community networks involves building local capacity to provide comprehensive services. TUNAJALI supports CSOs to provide a core package of palliation and assistance to PLHIV as well as provide vulnerable children with an age-specific core package of support services approved by the Department of Social Welfare (DSW). To ensure provision of quality health care, the TUNAJALI program builds the capacity of both the CSOs and the health care facilities to integrate and internalize the concepts and functions of palliative and comprehensive care by strengthening referral and supportive supervision systems. Formal partnerships with multi-sectoral public and private institutions established at the district level have been transformed into Continuum of Care Coordinating Committee (DCoCCC) with the role of ensuring effective linkages among various agencies to maximize support and ensure the provision of comprehensive services across a continuum of care.

TUNAJALI activities will be ultimately supported at district and community levels by existing coordinating structures: Council Multisectoral AIDS Committees (CMAC) and Council Health Management Teams (CHMT). TUNAJALI continues to strive to build the planning, coordination, monitoring and supportive supervision capacity of these local government bodies. Also, the program is facilitating the integration of CSO activities in district plans. We will continue with these efforts in year four.

TUNAJALI program intends to contribute to scaling-up of the national HIV/AIDS program through the application of national policies, guidelines and evidence-based HBC and OVC standard approaches and assists in enhancing the national response by informing national systems of effective TUNAJALI approaches. The lessons learnt from pilot testing of home based counseling and testing informed the national scaling up on the same. We have participated in the development of national HBC data management system, review of national HBC guidelines and development of national guidelines for improving quality of OVC care. We will adopt these guidelines and data system in all our operational areas.

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

This submission provides our plan of action for the period October 01, 2009 to September 30, Budget 2010. The proposed budget for the plan period is USD 10,773,647. In FY 2010 TUNAJALI plans to reach the following targets:

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 TABLE 1: TUNAJALI Targets for FY 2010 Indicator Target The TUNAJALI HBC/OVC Program PROGRAM AREA: PALLIATIVE CARE (HOME-BASED CARE) Number of individuals served 73,000 Number of organizations provided with 31 technical assistance Number of service outlets 550 wards Number of people trained 3,700 volunteers 120 supervisors

108,000 care givers

PROGRAM AREA: ORPHANS AND VULNERABLE CHILDREN Number of individuals served (Primary + 85,000 Supplementary Support) Number of OVC served by an OVC program, 21,250 PRIMARY SUPPORT Number of OVC served by an OVC program, SUPPLEMENTARY SUPPORT Number of people trained in caring for OVC 55 supervisors 3,700 5,167 elderly caregivers10,500 district & MVCC members

PROGRAM AREA: HBC COUNSELING AND TESTING Number of individuals who received 95,145 counseling and testing for HIV and received their test results Number of service outlets providing 140 wards counseling and testing according to national and international standards Number of individuals trained in counseling 952 volunteers and testing according to national and 68 HBC focal persons international standards 64facility-based counselors

PROGRAM AREA: OTHER POLICY ANALYSIS AND SYSTEMS STRENGTHENING: POLICY DEVELOPMENT

Number of organizations provided with 34 TUNAJALI DCoCCCs technical assistance for HIV-related policy development

PROGRAM AREA: OTHER POLICY ANALYSIS AND SYSTEMS STRENGTHENING: INSTITUTIONAL CAPACITY BUILDING Number of organizations provided with 31 TUNAJALI sub- technical assistance for HIV-related grantees institutional capacity building Number of districts provided with technical 34 districts in mainland 8 assistance in data management on HBC NumberCooperative of Agreement individuals No. 621-A-00-07-00002-00 trained in HIV-related 64 institutionalOctober 1, 2009 capacity building PROGRAM AREA: OTHER POLICY ANALYSIS AND SYSTEMS STRENGTHENING: STIGMA AND DISCRIMINATION REDUCTION Number of individuals trained in HIV-related 3,700 volunteers The TUNAJALI HBC/OVC Program

II. Objectives and Activities

A. Expected Result 1: Civil society partners deliver a core package of community care support services for PLHA and OVC

Objective 1.1: Increased accessibility and availability of comprehensive community care and support services to PLHA and OVC

1.1.1 Select and provide grants to CSOs to deliver core package of services.  Develop work plan and budget for 31 current sub-grantees for year 4 activities. The TUNAJALI team will facilitate the sub-grantees to develop their work plans and budgets for year 2010. Soon after the approval of the work plans and budgets, funds will be disbursed to the sub grantees.

1.1.2. Assist CSOs to identify and enroll PLHIV and OVC into the TUNAJALI Community Network.  Orient CSOs on PLHIV enrollment process. TUNAJALI program has continuously oriented the sub grantees on the criteria for identifying PLHIV and emphasized on the need for complete involvement of the communities. In year four, TUNAJALI does not intend to make a remarkable clientele expansion as we will focus more on quality of our services. However, the program will continue to work with the established linkages with counseling and testing sites, CTCs and PMTCTs, and like in previous years, the newly diagnosed HIV+ individuals referred to our program will be enrolled and our volunteers will provide further counseling and follow-up. This coupled with the self referral to HBC program resulting from increasingly high visibility of TUNAJALI is expected to raise the number of cumulative PLHIV in program to 73,000. Where CTCs provide our program with details of ART defaulters, we will track them and convince them to resume services at their respective CTCs. In year three, we managed to track 1,520 patients lost to follow up within our operational areas.

 Scale-up of MVC identification in five (5) districts: In year three scale up of the Most Vulnerable Children identification process to cover all wards in each of five districts of Mvomero (Morogoro), Kilombero (Morogoro), Misungwi (Mwanza), Njombe (Iringa), and Mkuranga (Coast) was accomplished. Also, the program expanded the MVC identification process to additional five districts for which scale up will be done in year four. These are Ukerewe, Kwimba and Sengerema (Mwanza); Kilolo (Iringa); and Ulanga (Morogoro). Using the national guidelines, the respective district facilitator teams created and trained in year three will conduct the identification process at ward level. The process will eventually end with selection and training of members of the village MVCCs. TUNAJALI volunteers will be involved in the identification process and it is expected that most of them will ultimately become members of MVCC. At the end of year three 572 (18% of current in program) volunteers were already members of MVCCs.

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

 Expand MVC identification process in 8 to districts in Unguja and Pemba. In year three the plan was to expand MVC identification 15 districts in the Mainland and 10 districts in Zanzibar. However, the expansion was carried out in 2 districts in Zanzibar and 5 districts in the Mainland. The remaining 10 districts in the Mainland were covered by UNICEF and Global Fund while in Zanzibar, delayed completion of the identification guidelines by the Department of Social Welfare contributed to the low coverage. In year four TUNAJALI will expand to the remaining 8 districts in Zanzibar. Three teams based at regional levels will be trained and these in turn will conduct training for their respective shehias.

In year four, the MVC identification scale up and expansion processes are expected to establish a total of 500 new MVCCs in the Mainland and Zanzibar. In year three 399 new MVCCs were formed bringing the cumulative number of MVCCs to 716.

As for the PLHIV, in year four no remarkable increase is planned on OVC in program, hence not all newly identified vulnerable children under the MVC identification process will be enrolled. This fact was emphasized to the relevant district authorities during the advocacy meeting, and we will repeat the message as well as encourage them to serve the remaining children through some other sources. The plan is to reach 85,000 by end of September 2010.

1.1.4. Provide PLHIV and OVC core packages through the TUNAJALI Community Network of volunteers.

 Continue identifying and selecting new volunteers. In year three, TUNAJALI identified and trained 156 community volunteers on home based care and OVC care taking skills, bringing the number of trained volunteers to date to 3,475. The identification was done through the support of the respective communities while the training was facilitated by national trainers from the National AIDS Control Program (NACP); Department of Social Welfare (DSW); and COUNSENUTH and MUHAS our technical partners in nutrition and stigma respectively. In year four, we plan to identify and train 300 new community volunteers to fill the gap resulting from attrition as well as serve the new PLHIV to be enrolled. As in the previous years, the identification and training of these new volunteers will be done as per national HBC guidelines.

 Scale-up the provision of care in six regions—Coast, Dodoma, Iringa, Morogoro, Mwanza, Singida and Zanzibar. The cumulative number of PLHIV and OVC registered under TUNAJALI program stood at 68,017 and over 79,465 respectively by the end of June, 2009. In year four, TUNAJALI will continue to serve these beneficiaries and will scale-up slightly to reach 73,000 PLHIV and 85,000 OVC. The scale up is aimed at covering more wards/shehias within the current 34 districts in the Mainland and 10 in Zanzibar – we plan to cover a total of 550 wards/shehias.

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

 Continue providing working tools to all volunteers. In year three, TUNAJALI developed, printed and distributed a Job Aid to guide volunteers during home visits. The provision of HBC kits to volunteers was not done due to changes in the procurement procedures / process by the donor. In year four, we plan to provide 3 kits to each volunteer – one every four months. A tool containing a list of drugs in the kit and the explanation on dosage and administration will be developed, printed and distributed to all volunteers. Also, the Job Aid will be provided to all new volunteers. Bicycles will be provided to new volunteers and those whose bicycles are worn out.

 Increase children accessibility to VCT, CTC and other care and support services. Efforts to enroll more HIV+ children into TUNAJALI program resulted into minimal improvement – from 12% in year two to 13%. Training of Home Based Counseling and Testing (HBCT) counselors on child counseling skills was postponed to year four In addition as part of our strategy to reach more children TUNAJALI will strengthen linkages with PMTC, pediatric wards, and CTC. Volunteers will follow up with pregnant women in index patient households to test and provide follow up services to exposed children. Child counseling and testing in index patient and OVC households will also be done. Those testing positive will be enrolled in the program.

1.1.4.5 Scaling up home-based HIV counseling and testing in index patient households. In year three TUNAJALI implemented the following activities: scaled up counseling and testing through trained volunteers in eight districts by targeting high transmission areas. Expanded home-based counseling and testing to 8 other districts; trained 34 HBC supervisors and 30 facility based health workers as counselors in voluntary counseling and testing and 377 volunteers in home-based counseling and communication skills;. As of June 2009, approximately 31,399 people in the index households, OVC households and other willing community members were counseled and tested. The demand for testing was very high due to the sensitization and mobilization done by community volunteers and good support of local government and community leaders. However, the target set for year three was not reached due to inconsistent supply of test kits from the District Medical Officers (DMOs). In order to ensure an adequate number of test kits are available in year four, TUNAJALI will request to be included in the list of agencies to receive test kits from the Medical Stores Department through the District Medical Officers. Also, to supplement the consignment from the DMOs, we will purchase additional test kits. In year four, we plan to reach a total cumulative number of 95,145 people counseled and tested. To move towards this target, the following activities will also be undertaken: o Train 34 HBC supervisors focal persons and 34 health facility staff on voluntary counseling and testing; and child counseling o Train 175 community volunteers on basic communication skills and counseling o Conduct a retreat for 68 counselors as part of psychosocial support to them to address the emotional stress that they undergo in the course of performing their work.

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

o Conduct quarterly joint supportive supervision with the district counseling and testing supervisors to ensure quality HBHCT services o Continue to work with local and influential leaders on preventing HIV transmission and stigma reduction o Continue to sensitize community members to increase demand for home counseling and testing

Facilitate the formation of new PLHIV support groups and strengthen the existing ones. In year 3, TUNAJALI continued to strengthen the existing support groups and facilitated the formation of new ones to reach a total of 409 groups with 10,783 members. 67 sub grantee project coordinators and HBC supervisors were oriented on TUNAJALI developed guideline on establishing and maintaining PLHIV support groups. In year four these will train volunteers on the same. Utilizing the knowledge gained from the training, some PLHIV have restructured their groups for better performance while others have dropped non active members. Also, efforts were made to link the groups with income generating activities (IGA) see section 2.1.2 second bullet. In year four we shall: o Facilitate the formation of 300 new PLHIV support groups with 9,000 members. o Continue to strengthen the 409 existing support groups o Orient additional 30 HBC focal persons and volunteers on the PLHIV guidelines for establishing and maintaining PLHIV support groups o Continue to link PLHIV groups to IGA

 Scale up permaculture initiative in 10 districts. To address the most basic needs of PLHIV, i.e. food and nutrition, in year three, TUNAJALI provided training on Permaculture in 10 districts whereby 30 sub-grantee supervisors and 10 district agriculture officers were trained as trainers (ToTs) in Permaculture. The ten districts are Kibaha, Kongwa, Mufindi, Njombe, Kilosa, Dodoma Urban, Kilolo, Mvomero, Makete and Zanzibar Urban West. The ToTs trained 162 volunteers and the latter trained 875 clients and their household members. A total of 316 gardens were established. In year four under the supportive supervision of the ToTs, the trained volunteers will monitor and support households trained in year 3 as well as scale up the initiative within their catchment areas by training additional 600 PLHIV/OVC households.

 Integration of positive prevention package for PLHIV TUNAJALI pilot-tested positive prevention package for PLHIV in 4 districts (Kilolo, Mufindi (Iringa), Mvomero and Morogoro Urban (Morogoro). 5 HBC supervisors, 75 volunteers and 75 PLHIV were trained and a total of 1,522 PLHIV were served. In year four, the planned activities are: o Conduct 3 day training to 145 HBC supervisors, who will then train volunteers and PLHIV support group members during monthly meetings o In collaboration with T- MARC and PSI provide condoms and water purifiers within TUNAJALI areas. o Procure and distribute ITNs and soap o Print and distribute IEC materials on positive prevention 12

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o Provide water storage vessels to 10,000 PLHIV households o Sensitize communities in general about safe water system Through our volunteers, and collaboration and networking with other stakeholders, notably T-MARC, FHI, PSI, USAID, we will integrate positive prevention activities within TUNAJALI operational areas. The services will be provided as per package below;

Table 2: Minimum Positive Prevention Content for HBC Prevent HIV Transmission Prevent Disease Promote Healthy Living Partner disclosure facilitated Cotrimoxazole prophylaxis Regular clinic visits promoted adherence supported Safer sex discussed (abstain, For ART client: Avoidance of alcohol, drug limit to 1 partner, use ARV adherence supported use, smoking discussed condoms properly and consistently) Condoms provided Referral for STI assessment Good nutrition promoted provided HIV testing for partner and Referral for anti-malarial Good hygiene promoted and children promoted and referral PT/treatment provided soap provided provided RH/Family planning referral Referral for diarrheal Safe food and water discussed provided prevention/treatment (e.g., and water purifier provided de-worming) provided Referral for PMTCT provided Insecticide-treated bed nets provided and use encouraged

 Scale up the supply of ARV through volunteers. In year 3, TUNAJALI worked with volunteers to collect and report use of ARV for patients whose conditions have stabilized and who live in remote areas that are far away from CTC. Negotiation with CTCs was done and we started with 7 CTCs of Mkuranga district hospital (Coast); St Francis and St Kizito Hospitals (Morogoro); Mvumi Hospital (Dodoma); Mafinga, Ilula, Kibena and Bulongwa hospitals (Iringa). A total of 531 PLHIV were served. In year 4 we will scale up to cover 15 more CTCs.

In year four, according to district and community needs, the following core services will be provided to PLHIVs:

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

Table 3. Core Package of Care for PLHIV Households through HBC COMPONENT SERVICES by Volunteers ASYMPTOMATIC and/or AFFECTED HOUSEHOLD MEMBERS . Refer and assist to counseling and testing services . Refer and assist to services across the continuum, including to CTC, health centre or district hospital . Provide O.I. preventive therapies per NACP standards Health care . Refer PLHIV to RCH clinics for IMCI, pregnancy advice, PMTCT services . Provide health/ prevention-, reproductive health- and nutrition education . Provide psychological and coping support, promote HIV status disclosure . Provide positive living support and education on stigma Psychological and discrimination support . Provide spiritual and bereavement support . Refer to PLHIV support groups for peer education and IGA . Link households to microfinance credit services, livelihood support and IGA (community savings, loans, Socioeconomic vegetable gardens etc.) provided by NGOs support . Link households to programs providing direct food support . Link households to (para)legal or traditional legal services, including planning support for surviving Human children and dependents (e.g. will writing, inheritance rights/legal rights) support . Monitor cases of abuse and discrimination and provide follow-up SYMPTOMATIC Medical care . Assess needs and provide basic palliative care of sick adults and children (e.g. wound care, distressing symptoms-, basic O.I.- and pain management), see Appendix 8 for an example of a pain management tool) . Utilize home care kits of essential drugs and supplies to manage the following: distressing symptoms and pain; prevention needs e.g. condoms, safe water needs and vouchers for ITN . Work with supervisor to provide appropriate prescriptions for pain management . Refer to CTC for worsening symptoms of OI, ART eligibility assessment, drug side effects, distress, adherence issues or pain emergencies . Identify and train family caregivers in care and support

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

Table 3. Core Package of Care for PLHIV Households through HBC . Train a family caregiver to become treatment assistant . Same as those provided during asymptomatic stage Psychological . Provide ART- and OI adherence support support . Monitor and ensure safe storage of drugs (ART) with treatment assistant . Monitoring nutritional status; counseling; promoting balance through local foods; promote vegetable garden Nutrition and reuse of waste water; fermentation and germination of seeds; micronutrients Socioeconomic . Same as those provided during asymptomatic stage support Human rights/legal . Same as those provided during asymptomatic stage support END-OF-LIFE . Provide nursing care (e.g. bathing, wound care). Work Medical care with supervisor to provide end of life care, including prescription pain management (oral opoids) . Provide psychological care and support . Address spiritual support needs Psychological . Provide bereavement counseling and support to family support members . Assist family with support for most vulnerable children Socioeconomic . Same as those provided during asymptomatic stage support and leverage financial support for funeral costs Human rights and legal . Same as those provided during asymptomatic stage support

 Provide core package of care and support services for OVC. In year four, TUNAJALI will continue to provide services to the enrolled OVC. The volunteers will work with MVCCs and the sub grantee OVC supervisors to ensure the needs of OVC are met. Most of their needs will be met through children’s clubs which TUNAJALI has established and will continue to establish and strengthen.

 Form new children/youth clubs and strengthen the existing ones. As at the end of June 2009, TUNAJALI had facilitated the formation of 359 children clubs with a total membership of 13,278 – inclusive of OVC and non OVC. These children clubs are an effective vehicle for provision of services to OVC. In year three, volunteers and their supervisors continued to support regular meetings of these children clubs by ensuring age appropriate education, skills and knowledge (HIV/AIDS prevention, child rights, sexual and reproductive health, and life skills) are imparted to children. Volunteers made home

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

visits to address identified OVC needs. Also, the program provided play materials such as drawing materials, footballs, and netballs. In FY 2010 we will: continue to provide support to these clubs; will facilitate formation of 300 new children clubs; and strengthen the existing ones. The core package for OVC is presented in table 4 below.

 Mobilize community to establish OVC funds: In FY 2009 we planned to establish OVC funds in 50% of our operational districts. Deliberate efforts were made to mobilize communities to establish OVC funds. These resulted into establishment of 194 OVC funds in 15 districts in the Mainland and Zanzibar with a total of TZS 23,533,093 community contributions at the end of June 2009. Most of these funds are established at village/street level, managed by MVCCs and are used to support identified OVC needs. In FY 2010 we will continue with these efforts. It is expected that in year four at least 10 villages per district will establish OVC funds.

. Identify and provide support to OVC with special psychological needs. In year 3, 6 regional OVC coordinators were trained as master trainers on psychosocial support (PSS). In year four they will continue to conduct training for sub grantee OVC supervisors and volunteers in their respective regions. During children clubs and OVC home visits, volunteers will identify children who need extra attention due to emerging psychological and coping problems. Support will be provided to this group of children to address their psychological problems and build their resilience.

. Provide mobile legal aid. In year three the Tanzanian Women Lawyers Association (TAWLA) provided training on legal aid to 20 sub grantee HBC/OVC supervisors and 25 volunteers. In year four, the 45 trained people will train more volunteers and at the same time act as paralegals within their operational areas – assisting PLHIV and OVC on legal issues including will writing, and their rights against discrimination and abuse. In the plan period, in collaboration with TAWLA, TUNAJALI will: provide mobile legal aid services in Morogoro, Mwanza, Dodoma, Coast, Iringa, Njombe, and Zanzibar; distribute Legal Aid materials like leaflets, brochures to the legal aid clients so as to empower them on their legal rights; and provide the trained paralegals with legal aid manual that will guide them in their work.

 Mobilize the community to establish food storage and provide other services through the use of the “journey of life” approach. In year three, TUNAJALI in partnership with REPSSI trained 5 regional OVC technical officers as TOT on the Journey of Life approach. In year four the ToTs will train 20 OVC focal persons and will facilitate communities to identify specific needs of OVC, map out their resources and develop a plan of action to provide care and support to OVC. We will continue to emphasize on establishment of OVC food storage and subsistence farming, regular provision of psychosocial support especially to child headed households, and protection of OVC from abuse.

 Integrate HIV prevention activities into TUNAJALI Program

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

In FY 2010, TUNAJALI in collaboration with UJANA Program will conduct the following HIV Prevention activities: * Youth HIV prevention through participatory theatre and community video shows in Njombe, and Mufindi. Also, the program will promote HIV education through soccer, group educational workshops and interactive theater in Mufindi, Morogoro Urban, and Morogoro Rural

* In Kilosa, Morogoro Urban, Mvomero, Unguja, we will promote Youth-Adult communication on Reproductive health and HIV. We will provide education on HIV prevention to young couples through integrated Reproductive Health services.

* We will reproduce and distribute IEC materials on reproductive health for adolescents.

Table 4. Core Package of Care and Support Services for Orphans and MVC Com Activity Special needs per age group Ponent Health  Promote household hygiene, 0-5year care safe water  Community volunteers  Ensure bed net access and use and MVCC refer MVC to  Refer for HIV counseling and CSO, DSWO for EPI, IMCI testing at age 18 months and to/U5 clinic or CTC if HIV above, to CTC if HIV positive exposed for prophylaxis  Support guardians/family care depending on the givers on treatment problems of an individual administration and adherence child  Provide hygiene materials 14-18years including sanitary for girls  Education on hygiene in household  Refer for serostatus and CTC if positive  Provide basic preventive health information through kids club  Involve community to promote school health program Nutrition  Provide basic nutrition 0-5years education both for caretakers  Education on and OVC complementary feeding to  Refer to institution which caregivers provide food  Refer for food

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 Refer to institution/CSOs supplementation when which have feeding centers necessary  Promote backyard gardening  Advocacy and awareness raising for community for food support Psychoso  Identify and support 12-18years cial guardians who will provide  Facilitate the support support to OVC within the establishment of children community set up clubs to enhance children  Train the caretakers on the involvement and PSS needs of OVC participation  Caretakers to join support clubs for provision of PSS and other services  Support guardians/family to promote disclosure and integrate all OVC into family through memory approach Child  Facilitate birth registration 6-18 years Protectio  Raise community awareness  Address stigma issues n about child rights and protection within households and  Facilitate succession planning schools and protection of OVC properties through memory work approach  Protect children from abuse Educatio  Supply or leverage school kits 6-18years n where needed  Promote and refer for Support  Ensure access of OVC to life skills training school through block grants or  Provide or leverage schools fees vocational training  Promote community awareness on access to school for all especially girls  Monitor school attendance and report absence  Discuss stigma issues at school

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Housing  Ensure vulnerable children are integrated into a family setting and  Ensure access of shelter to OVC Shelter  Advocate for the community to renovate/repair of OVC housing using the available resources  Provide or leverage bedding materials  Provide or leverage casual clothing IGAs  Link households with out of school youth to microfinance programs for business training  Link households to microfinance programs to access financial services, credit, savings Livelihoo  Provide training in home gardening to both OVC and caretakers d  Train OVC through children club in age appropriate life skills Support (decision making, self reliance, conflict resolution, control of own and Life sexuality etc) Skills Preventi  Provide training in sexual and reproductive health on of  Train in negotiation skills and conflict resolution HIV/AIDS  Enable young people to become Volunteers to provide care and among support to PLHIVs and OVC Youth

 Continue to collaborate with other institutions for food support to PLHIV. During year 3 TUNAJALI received food support from Outreach International (OI) . We received 14,400 meals which were used in Kibaha to pilot test provision of supplementary food to 80 PLHIV on ARV with Body Mass Index of less than 18.5. This was monitored and it has been established that the food support is making positive change in the PLHIV health when taken at asymptomatic and early symptoms stages. OI are willing to provide more food consignments from them. If successful, in year four we will scale up provision of supplementary food to identified PLHIV. In year three through networking and collaboration food support was obtained from communities and other entities as detailed under section 2.1.2 bullet one below. Also, in year three through networking with other entities such as CARITAS, TACAIDS, ZACP, CUAMM, and our clients got food support worth more than 100 Million TZS. In the plan period, we will continue to leverage food support from other stakeholders.

1.1.6 Provide volunteer incentives

 Implement performance-based incentive system: TUNAJALI encourages sub grantees to provide performance based incentives to volunteers. Such incentives include: awarding certificates; material tokens, and sensitizing communities to exempt volunteers from communal work. In FY 2009, the following were achieved: 56 volunteers were awarded certificates for best performance and provided with non

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

monetary gifts; and 556 volunteers were exempted from communal work on the basis of their contribution through their support and care to PLHIV and OVC.

In year four we will continue to facilitate sub grantees to think of other ways of motivating their volunteers and monitor effectiveness of this incentive system as well as raising awareness of the district authorities and communities for further motivation of volunteers.

 Link volunteers to income-generating programs. In year three volunteers were encouraged to establish savings and credit groups. About 279 have joined SILC groups and other IGA groups. These efforts will continue in year four.

 Continue monthly feedback meetings between volunteers and supervisors. TUNAJALI conducts volunteers’ monthly meetings whereby the former meet with their supervisors for feedback on performance, capacity building in areas identified during supportive supervision, and reporting. In year three this was done in clusters of volunteers within a ward while all volunteers per each sub grantees met bi-annually for experience sharing. This will continue in year four.

1.1.7 Continue to implement supportive supervision to improve quality of care

 Develop supportive supervision plan for Year 4 with CSOs and district authorities. In FY 2009 the planned joint supportive supervision with the district were implemented as follows: 45 supervisions with the District HBC coordinators and 37 quarterly supervisions and 15 semi-annual MVCC strengthening sessions with the District social welfare officers. In year four the same activities will be undertaken .as follows: o District HBC Coordinators will visit health centers (two health centers per district) every quarter o District Social Welfare Officers will visit MVCCs in one ward of a district every six months. o The sub grantee HBC and OVC focal persons will regularly supervise volunteers and monitor their respective HBC and OVC activities in a given catchment area. o The sub grantee HBC focal person will liaise with the health center HBC Coordinator to ensure effective use of HBC kits and appropriate implementation of referrals. o The CSO OVC focal person will be liaising at the community level with the MVCC members, CMACs and CHMT. o The District Counseling supervisor will visit two sites HBCT sites in one ward every quarter.

 Provide support to CSOs and district authorities to cover transportation and travel allowances for supportive supervision visits. In year four the program will continue providing transport and upkeep support to the relevant district technical personnel during their supportive supervision to our operational areas.

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

 Advocate with district officials to include the supervision expenditures in their annual budget. In year three we continued to sensitize district councils on the need to incorporate supervision expenditures in their budgets. Commitments were made in 5 districts of Ulanga, Kondoa, Bahi, Chamwino and Kongwa. In year four, we will exert efforts on the same to have commitment from at least 25% of the district councils within our operational areas.

1.1.8 Address stigma in communities In year three community sensitization on stigma reduction was done in TUNAJALI operational areas. Notably in Ukerewe, Kwimba, Misungwi, Geita, Makete and Unguja where in collaboration with churches, mosques, PHIV support groups and other NGOs anti-stigma campaigns were carried out. PLHIV continued to be capacitated on stigma reduction mainly through their support groups and volunteer home visits. At the same time, the ToTs trained by NETWO in year two continued to impart knowledge and skills on disclosure - in Makete, Ludewa, Rufiji and Mafia 2,194 community members were sensitized while in Zanzibar and Mwanza public campaigns on reduction of stigma against PLHIV and OVC were conducted in Urban, West, South, and Kwimba districts respectively. In Kwimba a total of 448 (270 M, 178F) people were counseled and tested as a result of the campaign while in Rufiji 6 PLHIV publicly disclosed their HIV status. In year four, stigma reduction activities will continue. We will orient sub grantee OVC and HBC supervisors on the recently launched National Guide on the Integration of Stigma and Discrimination Reduction in HIV Programs. These will in turn mentor and coach volunteers on effective stigma reduction activities. TUNAJALI will collaborate with MUHAS to distribute to all sub grantees the recently printed IEC materials on stigma.

B. Expected Result 2: Integrated services based on networks and linkages ensure access to a continuum of care and comprehensive services for PLHIV and OVC, including supply chain management of essential commodities for comprehensive care

Objective 2.1 Effective linkages established between CSOs and public institutions to ensure provision of comprehensive services for PLHIV and OVC

2.1.1 Develop effective referral networks  Strengthen District Continuum of Care Coordinating Committees

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

In year three, TUNAJALI continued to work with the established 34 DCoCCC. However, the quarterly meetings in which progress and challenges are discussed were not conducted as per plan due to unavailability of members that oftentimes resulted from unscheduled urgent events of the government leaders. In year four, we will continue to strengthen these committees and at the same time urge the government to take over funding of the DCoCCC activities.

 Expand and improve district referral networks in 34 districts. During year three, TUNAJALI continued to collaborate and network with other entities that provided funds, material resources and technical expertise that included food support, fund for income generating activities, trainings, school fees, scholastic materials, drugs for opportunistic infections and others. In collaboration with COUNSENUTH, we conducted analysis of the acceptability, utilization and effectiveness of supplementary food provided to patients in Kibaha district. The food which was obtained from Outreach International made remarkable improvement in nutritional status of the targeted PLHIV. Also, the food was accepted by the community as manifested by reported constant utilization and demand for the same. We have been exploring possibilities of getting more food consignments from OI or other identified sources. If these efforts are fruitful, in year four, we will scale up provision of supplementary food in identified TUNAJALI areas. In collaboration with CRS, the scale up on Savings and Internal Lending Communities schemes (SILC) was done in 10 districts. See similar details on SILC under section 2.1.2 second bullet.

 Provide and monitor referrals. Referral of clients to other service points continued to be one of priority areas in year three. At the end of June 29,182 PLHIV and 8,320 OVC referral cases were reported, with referral to CTC being the highest – PLHIV enrolled in CTC increased from 34,156 last year to 43,634 in June 2009. However, there was no improvement in the CTC referral of patients to home based care service providers. However, in year four this challenge will be addressed through the Patient Tracking Coordinators recently recruited by Care and Treatment program that among other duties is to facilitate referral of patients from CTC to HBC programs. The program continued to follow up on referral feedback but the improvement was minimal. In year four this challenge will be addressed through implied referral form developed through the National HBC and recording and reporting system to be adopted soon within TUNAJALI operational areas.

2.1.2 Establish partnerships with multisectoral organizations

 Strengthen, nurture and broaden partnerships with multisectoral organizations at district level. In Year 3 TUNAJALI continued to improve coordination and build synergy among the various organizations working to improve the quality of services provided to OVC and PLHIV. CARITAS, TACAIDS, ZACP, CUAMM, PACT, TASAF, REPSSI, Foundation for Civil Society, Nyakato AIDS Relief, Plan International, Mwalimu Nyerere

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

Foundation, Community Volunteers of Mundos, and Allamano Consolata Sisters are among the organizations that provided support in terms of food, school fees, scholastic materials, drugs for opportunistic infections, funds for IGA, campaign on stigma reduction and trainings on psychosocial support and PMTCT. During October 2008 – June 2009, we received support worth more than TZS 527 Million. Under permaculture initiative, 30 TOTs from sub grantees and 10 district agriculture officers in 10 districts of Mkuranga, Kibaha, Mvomero, Kilombero, Njombe, Mpwapwa, Kongwa, Misungwi, Magu, and Mufindi were trained and in turn, 337 volunteers, 893 PLHIV and 58 OVC have been trained on pemaculture resulting into establishment of 509 gardens. In year four, we will promote scale up within the 10 districts; also we will conduct assessment on the acceptability of this initiative for future expansion to other districts. In Makete, OVC Monitoring and Evaluation implementing partners team was formed comprising of TUNAJALI, Catholic Relief Services (CRS), Tanzania Home Economic Association (TAHEA), Southern Highlands Community Development Alliance (SHICODA), District Social Welfare Officer, Council HIV/AIDS Coordinator, Regional Social Welfare Officer and Regional AIDS Coordinator. The team will conduct quarterly field visits to monitor services provided to OVC by district and NGOs. The collaboration and networking efforts will be continued and intensified in year four.

 Support CSOs to organize volunteers, OVC, and PLHIV households into income generating groups. During year three TUNAJALI continued to address the low economic status of its clients and their households. Our focus was more on scale up and strengthening of Savings and Internal Lending Communities (SILC) scheme that provides people with income generating opportunities through access to self-managed savings-led financial services started in year two in four districts of Mkuranga, Kilombero, Morogoro Urban and Iringa Urban. In year three, SILC was scaled up to eleven more districts of Mvomero, Kilosa, Kibaha, Kongwa, Mufindi, Kilolo, Makete, Ludewa, Njombe, Dodoma Urban and Unguja West. At the end of June 2009, a total of 115 SILC groups had been established with a membership of 3,230 and a capital fund of TZS 92,244,900. All these funds are from members’ contributions and they have been taking loans from the same for income generating activities. The membership of 3,230 consists of: 426 PLHIV; 34 OVC; 205 Volunteers; 605 care takers and 1,960 other community members. Some of these groups are showing positive results: In Kilombero, Misungwi, Iringa Urban, Morogoro Urban, and Mkuranga, it is reported that SILC has helped PLHIV, OVC and their households get income to cater for their daily needs such as nutritious food, clothes, medication, fare to CTC and school fees for the OVCs. In year four we will scale up SILC initiative within the existing 14 districts and expand into 5 new ones - Singida urban, Ludewa, Rufiji, Kisarawe and Mpwapwa. We will sensitize more PLHIV to join groups and older OVC in order to enable them establish IGAs as they graduate to adulthood. We will support the SILC trained Community Resource Persons (CRPs) with bicycles to easen mobility as they continue to provide technical support to the increasing number of widely spread SILC groups within their respective communities.

 Link older OVC to vocational training centers.

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

In Year three 251 older OVC were enrolled in vocational training including carpentry, masonry, and tailoring. This is 50% of the annual target and this low achievement is mainly attributable to unsmooth flow of funding. In FY 2010, we will support 300 OVC to enroll in vocational training. We will encourage OVC who finish vocational training to join SILC groups to engage in income generating activities to support themselves and their families. TUNAJALI will provide working tools such as tailoring machines, carpentry and masonry tools to some of the OVC who successfully complete vocational training so that they can establish IGAs. We will encourage sub grantees to use both formal VTC and informal ones. For the latter, we will contract local business people like tailors, and other artisan to provide tailor made training to a specific number of OVC. On completion, these OVC will be provided with working tools, start business and train other OVC while at the same time serving other customers to generate income.

Objective 2.2 Functional supply chain system established to provide essential commodities

2.2.1 Assist CSOs and government bodies to implement a functional supply chain management system

 Conduct assessment of Supply Chain Management TUNAJALI will engage a consultant to document the system and track use of different drugs so that it can be shared with sub-grantees.

 Procure and distribute HBC kits. The plan to distribute 6,832 HBC kits in year three was not accomplished as no kits were distributed. This is attributable to the change in procurement procedures that requires purchase to be done centrally from suppliers accredited to IDA. In year four, in collaboration with the donor we expect to procure and distribute 10,500 HBC kits and 240 supervisor kits. This will be done after every four months for the former and six monthly for the latter.

 Pilot-test the storage and distribution of home-based care kits by accredited drug dispensing outlets (Duka La Dawa Muhimu). The FY 2009 plan to work with ADDOs in Kilosa for distribution of HBC kits was not implemented as no HBC kits were distributed as already mentioned in the preceding section. In year four, it will be implemented if we get our annual consignment at once. If otherwise, we will continue to distribute directly to volunteers through sub grantees as there will be no stock to store.

C. Expected Result 3: Local organizations with capacity to deliver and sustain quality community care and support services for PLHIV and OVC

Objective 3.1 Increased technical and organizational capacity of CSOs to deliver community care and support services to PLHIV and OVC

3.1.1 Provide technical training to volunteers and supervisors

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

 Scale up of Memory book/boxes and hero books intervention. Subsequent to training on memory approach and hero book earlier in year three, communities in Iringa Urban and Kwimba were reached and educated on importance of writing wills and memory books. 15 male PLHIV and caregivers wrote their wills while 20 developed their memory books; and 29 PLHIV disclosed their HIV status to their children and family members. In year four, TUNAJALI will use trained volunteers, care takers and children to continue imparting knowledge to beneficiaries (PLHIV, OVC, care takers and other community members). Also, all sub grantees will be supported to train their OVC supervisors who in turn will train the parents/caretakers to develop their memory boxes/books as well as for children to develop hero books.

 Conduct training for 300 volunteers To equip volunteers with the necessary skills and knowledge on quality care and support to PLHIV and OVC, in year three 156 .volunteers were trained on home based care and OVC care taking skills. This makes a total of 3,475 volunteers trained to date. In FY 2010, we will train 300 additional volunteers. Also, we will conduct refresher training to 1,200 volunteers who underwent the initial training in 2007. The trainings will include 2 days to cover Positive Prevention aspects meant to equip volunteers with knowledge and skills on the same.

The volunteers were also trained on skills on how to provide training to primary caregivers including the elderly ones for OVC to enable them provide continuous quality care to patients in the households even in the absence of the volunteers. These trainings are normally conducted during visits to PLHIV and OVC households. In year four, this will be continued and we plan to reach 108,000 care givers.

 Conduct 6 day training for new supervisors. The plan to conduct training to 30 newly recruited supervisors in year three was not accomplished due to delayed funding. These and the additional 20 to be recruited will be trained in year four. The training is aimed at improving their supervision skills, standards of care, problem identification and solving, assessing use of the HBC kits, and ensuring effective referrals of patients to health facilities and community-based care and support services.

 Provide on-the-job training through supportive supervision. During year three, the program provided regular supportive supervision maintaining the time spent in the field per quarter by different teams as follows: SMT members 15 days; Senior Technical Officers 20 days; Regional teams 20 days; sub-grantee HBC and OVC focal persons 30 days; HBC and OVC district coordinators 15 days; and sub-grantee project coordinator 15 days. In year four, we will continue with the same.

3.1.2 Provide technical and organizational capacity building support to CSOs

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

In year three, TUNAJALI assessed and mapped the existing stages of organizational development of 28 out of 31 existing sub grantees. The assessment was followed by the development of growth plan and strategies for each category of sub grantees. Initial trainings and support on critical areas were delivered to sub grantees in year three such as report writing to 106 individuals from all 31 sub grantees; and financial management training to 64 individuals from the 31 sub grantees. Developed and disseminated the governance resource pack, which outlines roles and responsibilities of the governing body (sub grantee board of trustees), 26 boards of trustee’s members grantees attended the dissemination workshop.

In year four TUNAJALI will continue to provide support to all 31 sub grantees in identified areas as outlined in the mapping chart, which include: Governance: continue to build the capacity of all sub grantees’ board of governance on organizational operational and financial management. We will continue with provision of mentoring and coaching sessions during supportive supervision throughout the year four to governing body members in areas identified through the assessment exercise. Management: we will provide technical guidance and support to all sub grantees. In areas of development of strategic we will support 15 sub grantees to come up with their organizations strategic plans; all 31 sub grantees will be supported in developing operational policies e.g. personnel, volunteering as well as financial policies. Financial Management: Strengthen 5 sub grantees’capacity to manage their finances from organizational perspective. This will be achieved through conducting financial capacity assessment followed by tailored capacity building interventions. We will continue to provide financial management coaching and mentoring to all sub grantees. Sustainability: The program will continue to design and deliver quality modules of organizational development including: o Proposal writing training to 32 project coordinators and trustees from 16 sub grantees. o Work with a consultant to enhance project management skills by training 62 persons from 31 sub grantees – these are project coordinators and members of trustees. The project management training will also cover modules on external relationship and advocacy skills. The training is expected to enable sub grantees to link in and clarify roles with other CSOs in their areas.

Institution Capacity Growth: TUNAJALI will develop institutions’ monitoring mechanism including indicators and time scale to ensure good practice across TUNAJALI program. The tool will be used to assess and score sub grantees performance quarterly with the focus of monitoring progress and institutional growth. The monitoring tool will also help us identify new areas where sub grantees will need further support; e.g. mentoring and coaching in order for sub grantees to deliver quality service to the beneficiaries. All capacity building plans will be updated accordingly.

Human Resources: During supportive supervision we will encourage, mentor and provide one to one support or coaching to sub grantees to ensure that CSOs employ quality staff and utilize/implement policies and procedures as required.

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

 Provide technical assistance in health and social services. In year three, in collaboration with TAWLA we conducted training of paralegals in Dodoma, Singida and Morogoro regions. NETWO+ train 20 PLHIV and 10 sub grantee staff on stigma and discrimination in Mwanza region while COUNSENUTH spearheaded the monitoring of PLHIV under on supplementary food study, compiled and submitted report

Objective 3.2 Increased capacity of local government to coordinate and monitor the implementation of community care and support to PLHA and OVC

3.2.1 Strengthen capacity of local government to coordinate services

 Enhance working relationship with district authorities. Other activities implemented with the government authorities in year three were: * In Sengerema the local government allocated a budget of TZS 23, 588,950/- for scaling up the MVC identification process; while in Bahi a total of TZS 10,000,000 budget allocation was made to TUNAJALI activities. * TUNAJALI participated in CMAC meeting in Mwanza; the National MVC Costed Plan of Action meeting in Iringa, Mwanza and Morogoro; * Sharing of project reports was done in 10 districts of Morogoro Rural, Kilombero, Ilemela, Nyamagana, Geita, Magu, Ukerewe, Kwimba, Misungwi and Sengerema. * District AIDS Control Coordinators support in anti-stigma campaigns in Mafia and Rufiji; and DSWs, MVCCs and local leaders on the same in Zanzibar. In FY 2010, we will continue to nurture our working relationships with the authorities, exerting extra efforts in the districts where we have not received tangible or meaningful support.

 Provide technical support on data management – see Monitoring and Evaluation section below.

 Facilitate DCoCCC quarterly meetings. In year three TUNAJALI facilitated 42 DCoCCC quarterly meetings. Since it was not possible to hold all the intended 144 meetings, tabling of the challenge to host these meetings in future was not fruitful. We will continue to challenge the districts in this fiscal year.

 Participate in the district-planning and budgeting meetings. In year three TUNAJALI sub-grantees and regional teams participated in key district meetings and discussion forums including districts planning and budgeting meetings, Regional meetings on implementation of National Costed Plan of Action for MVC, Council Multisectoral AIDS Committee meetings, district council meetings and, regional consultative committee meetings. In year four we will do the will continue to lobby for invitation to these important forums.

3.2.2 Expand and strengthen the MVCC to identify and address the needs of OVC

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

 Support districts and village authorities to establish 500 MVCCs in 5 districts in the Mainland and Zanzibar and strengthen the existing 716 MVCC . In year four, TUNAJALI facilitated the establishment of 399 MVCCs bringing the total number to date to 716 MVCCs. The existing MVCCs were strengthened in collaboration with the respective District Social Welfare Officers. This resulted into increased community ownership and participation in OVC care and support. A total of 194 OVC funds were established in 15 districts and Zanzibar. In FY 2010, we will further strengthen the existing MVCCs and establish formation of 500 new ones in the districts of Ukerewe, Kwimba, Kilolo, Sengerema and Ulanga as well as Unguja. (See also 3rd bullet of section 1.1.2).

Expected Result 4: Organizations receiving sub grantees ensure the application of national frameworks, standards, guidelines, curricula, and systems to improve quality of care and improve national systems

Objective 4.1 National policy, standards and guidelines applied in TUNAJALI activities

4.1.1 Apply national standards and guidelines in all TUNAJALI activities

District authorities to utilize data processed for decision making

 Apply national standards. TUNAJALI adhere to national standards and guidelines and has been using the Ministry of Health & Social Welfare guidelines on day to day HBC/OVC activities. This includes using the curricula for HBC and OVC in different trainings for supervisors and community volunteers. To ensure adherence to standards TUNAJALI developed and disseminated HBC job aid for volunteers which followed National HBC guideline. The program will continue to work closely with NACP, ZACP and DSW to get timely information on changes that might come up as a result of revisions of training manuals and reporting tools, and adopt the changes accordingly.

 Perform regular monitoring for compliance to national standards and guidelines. To ensure compliance to the national standards and guidelines, TUNAJALI conducts regular supportive supervision and monitoring visits to all program implementation sites. In particular we will continue using the adopted national supervision checklists to reinforce adherence to the set national standards and practices. During supportive supervision the supervisors would continue assessing the standards through random sampling of volunteers providing the services and the clients receiving the services.

4.1.2 National OVC Data Management System and the national HBC mapping and reporting system utilized

 Support CSOs to contribute to the DMS.

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

In FY 2009 we continued rolling out the national Data Management System (DMS) for OVC to TUNAJALI districts and the plan was to scale up the use of DMS in all districts. The program conducted training on the use OVC data management system in 23 districts. The cadre trained included 23 data clerks, 24 sub grantee OVC supervisors and 26 District Council OVC supervisors. Also, 21 TUNAJALI OVC districts in the mainland were provided with computers for managing OVC data, the remaining 6 districts received computers from other OVC stakeholders. The program also supported Unguja and Pemba with one computer each. In year four, the program will train the remaining 4 districts of Ukerewe, Sengerema, Kwimba and Misungwi and will strive to strengthen the use of OVC DMS for reporting and capacity building will be the focus so as to ensure consistency use and maintaining data quality. Either the district councils will be sensitized to make use of OVC data for decision making and planning. To improve on reporting using this system, the following activities will be undertaken: o Conduct training to 10 data clerks to cover drop outs o Enhance the level of technical backstopping and conduct continuous supportive supervision at all levels. o Sensitize the district councils to support and own the OVC data and make them recognize its value to their own planning and decision making.

 Adopting the national HBC recording and reporting system. In FY 09, FHI continued to work with the Ministry of Health and Social Welfare and other key HBC stakeholders to finalize the national HBC recording and reporting system. TUNAJALI under FHI has fully participated in the process of developing the paper based part of this system and has ensured that the required indicators and all the HBC data elements are included. The paper based and electronic parts of the system have been finalized and in year four we intend to adopt both systems for reporting HBC activities. To adopt this reporting system the following activities will be implemented: o Conduct a 3 day TOT training to 14 TUNAJALI regional coordinators and the M&E technical Officers on both paper and electronic part of the system. o Through the TOTs train 3,400 community volunteers for 4 days on the data collection part of the system. To ensure quality of the training the TOTs will work together with the national TOTs. o Train all 150 sub grantees HBC supervisors for 3 days on the paper and electronic part of the system. o Reprint the national HBC recording and reporting tools for use by the volunteers, sub grantees HBC supervisors and the regional staff. o Provide regular backstopping and supportive supervision to the district councils and the sub grantees to ensure proper utilization and quality of data.

Objective 4.2 Mechanism for mutual learning of effective approaches established

4.2.1 Identify, document and share effective approaches among CSOs

 Develop and disseminate guidelines for identifying best practice models.

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

In year three, TUNAJALI planned to use the services of a consultant to develop guidelines for the identification and documentation of best practices. However, this was not accomplished and steps are in progress to ensure that this takes place in the plan period. The guidelines to be developed will be oriented to all program technical staff and the sub grantees so that they can document the emerging TUNAJALI best practices. The best practices would be shared in different forums within and outside TUNAJALI.  Conduct study tours In year three we planned to identify best performers among sub grantees partners and arrange for the other not so well performing partners to visit and learn from the former. A team of OVC representatives, volunteers, sub grantee OVC supervisors accompanied by the respective TUNAJALI regional OVC coordinators visited HUMULIZA, a community based organization in Kagera region providing psychosocial support to orphans and vulnerable children. A key lesson learnt from this visit was how to conduct self led children activities and the technique used to draw community and community leaders to participate in children activities. The team also set an action plan for implementing some of the lessons learnt from the visit. In year four other thematic areas of the program will conduct the same visits for the purpose of learning.

Objective 4.3 To establish mechanisms to inform and improve national systems based on lessons learned from TUNAJALI

4.3.1 Home Based Counseling and Testing

TUNAJALI initiated a process to pilot home based HIV counseling and testing services initially in three sites (Mlali, Ilula and Chalinze). The pilot progress report showed a great success which were documented and disseminated. TUNAJALI documented this initiative and the recommendation that came out is that a national home based counseling and testing scale up should be carried out.

4.3.2 Participate in national committee meetings and other HIV/AIDS national-level activities In year three, TUNAJALI staff participated actively in different meetings and other important committees / working groups as a way of learning and sharing experiences that would improve program performance and quality of care within TUNAJALI districts and beyond: the senior technical officer for home based care took fore part in the technical working group that reviewed the national home based care guideline; the same staff together with the senior technical officer for monitoring and evaluation participated in the technical working group that developed the national HBC recording and reporting system; the senior technical officer for OVC participated in the task force that developed the national quality standard guideline for OVC services. In year four, key program staff will continue participating in various national committees that provide guidance to care, treatment and support services for PLHIV and OVC services.

4.3.3 Develop recommendations for revising national guidelines according to TUNAJALI lessons learned

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

TUNAJALI has adapted different national systems and guidelines including national HBC guideline, national OVC data management system and starting next financial year the program will also adopt the national HBC data management system for recording and reporting HBC activities. The national guidelines have been followed by TUNAJALI in its program implementation including using the training curricula for training TUNAJALI HBC/OVC program implementers. In year four the program will document the identified lessons learnt emerging from the use of these systems and guidelines and share them with the rest of HBC/OVC stakeholders.

III Performance Monitoring Plan In FY 2009, TUNAJALI program will ensure that all planned activities are continuously monitored according to the set indicators and the targets. The program will ensure that the collected information is of high quality and informs management to make evidence based decisions and take appropriate actions. TUNAJALI will ensure: (a) timely steady flow of information from the service providers to the district, regional and national level program planners; (b) comparability of data obtained from different providers; (c) quality data that meet the reporting requirements of the government of Tanzania and the USG; (d) adequate utilization of results from the monitoring activities; and (e) sustainability of monitoring efforts. The developed detailed performance monitoring plan (PMP) that highlights the program indicators, proposed sources of data, frequency of data reporting and responsible party has been developed to guide our program.

Monitoring and Evaluation Activities Data collection: The program will continue using the adopted national data recording and reporting systems; however with the introduction of the new PEPFAR indicators and the program specific data needs, the specific monitoring tools will be reviewed to incorporate the new indicator variables for PEPFAR and TUNAJALI specific monitoring indicators. TUNAJALI Sub grantees will be trained to routinely collect, analyzes, interpret and disseminate reports of their activities using the standard data recording and reporting tools. In year four the program will ensure that all sub grantees report using the national reporting systems for HBC and OVC. The reporting cadre will be trained and others oriented on recording and reporting using these systems. The training to the reporting cadre will include data entry procedures, data quality assurance, simple data cleaning and data safety which includes data backups and storage.

TUNAJALI will review the tools being used for recording and reporting home based HIV counseling and testing (HBHCT) activities so as to follow the national counseling and testing data collection tool. The tool will be oriented to the CSO counselors conducting the HBHCT activities from which the reports will be compiled and submitted to the regional level for consolidation and further reporting.

M&E Capacity building In FY 2009, TUNAJALI program developed a reporting guideline which will act as a reference point on reporting issues. Among other things this document guides on how to address data

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discrepancies, late reporting, data security, document confidentiality and retention. This guideline will be disseminated to all levels of program reporting for use as a reference guide. Regular technical assistance to the sub grantees and service providers will continue in order to strengthen their capacity to collect good quality data and the resultant sustainability of the M&E system.

Data quality assurance: As per previous years, TUNAJALI will adhere to the standardized training materials, tools, standard operating procedures (SOPs) for different program areas/activities, and ensure consistent use. Data quality will be monitored at every step of data recording and reporting and all cadre involved would be capacitated on how to ensure data quality.

Data quality checks and audits. The data collected and reported will be subjected to quality checks before and after reporting at the head quarter, regional and the CSO level down to the volunteers and beneficiaries.

In year four the program will continue to put efforts to improve the quality of the statistical reports for program monitoring and reporting. In order to achieve this, the program will consider building the capacity of the reporting cadre at all levels, the program will train regional HBC and M&E staff on data quality assessment where the standard data quality assessment guidelines and tools developed by the FHI and Measure Evaluation will be used for the training and for regular data quality assessment exercises. The tools will assist the M&E part of the program to check for data completeness, this is to ensure that the required fields on clients’ characteristics and services reports are complete and information provided is disaggregated as required; data consistency to ensure information recorded in different sections of the reports is consistent with one another; integrity to check if the number reported by the source documents and on activity report align; and reliability to ensure the definitions and measurements of clients’ characteristics and services remain constant over time. Data audits will be conducted after every semi-annual and annual reporting; either the program will plan for one major data audit in each region once in the year. During data audits, the data reported by TUNAJALI HQ will be compared with the data reported by the regions and sub grantees in the same reporting period to assess if they align. The source of the data documents will be retrieved and cross checked to ensure compliance and if match with the reported data. Any data discrepancy observed will be documented for future reference and action plan for follow up will also be set.

The regional staff trained on data quality assessment will in turn orient the sub grantees and continue mentoring them on conducting periodic data assessment including data verification. The program will also build the capacities of the reporting cadre on conducting data audits through training, orientation, back stopping and supportive supervision to all Sub grantees/Volunteers and TUNAJALI Regional staff. In relation to this actual data quality audits including data verification will be conducted on quarterly basis and action points followed up and appropriate improvements done.

Data use and dissemination: Sub-grantees will continuously be encouraged to use the data they collect for their own decision making and planning and for monitoring program activities

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implementation progress. To build the capacity of the project managers, the program conducted training on reporting and data use to the sub grantees and the regional teams. In year four the program will monitor the impact of the training and will address data quality as a crosscutting issue during all training activities. We will continuously advising sub-grantees to share their quarterly reports with district authorities and give feedback to the care givers and to the communities where they work.

Reporting: Based on the annual and monthly work plans for Sub grantees, the TUNAJALI team will monitor the progress of project implementation at district level, and provide feedback and support. Sub-grantees will be required to submit monthly reports to TUNAJALI regional teams. The regional teams will compile the quarterly reports based on the quarterly reports from sub- grantees. For any discrepancies the regional teams will seek verification from sub-grantees before sending the reports to TUNAJALI head quarters for finalization of the reports and submission to the donor and further decision making and planning. TUNAJALI headquarters will share quarterly reports with other key stakeholders such as NACP, DSW, ZACP and TACAIDS. On an annual basis identified and documented best field practices will be shared in different national forums.

IV. Performance monitoring plan.

Source(s) of Frequency Data/Data Data Objectives and Indicators of Responsible collection Reporting Baseline Target Activities Data Party Method/Recording tool Reporting instrument Expected Result 1: Civil society partners deliver a core package of community care support services for PLHA and OVC Objective 1.1 Number of Sub Activity report Every Progress Sub grantees, 32 31 33

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

Source(s) of Frequency Data/Data Data Objectives and Indicators of Responsible collection Reporting Baseline Target Activities Data Party Method/Recording tool Reporting instrument Increased accessibility and availability of grantees providing comprehensive reports Regional TOs HIV-related form quarter community care STO, M&E palliative care and support services to PLHA and OVC 1.1.1 Select and Number of Sub Quarterly provide grants to Finance grantees provided Financial reports Quarterly progress report 32 31 1 new Sub manger with grants grantees Collected routinely Reported 1.1..2 Assist monthly to 69,000 Sub grantees to RT Progress report Subgrantees PLHIV identify and quarterly to and 73000 PLHA enroll PLHA Number of PLHA TUNAJAL TUNAJALI 80,000 Data collection tools and OVC into and OVC enrolled I HQ Data STO, M&E, OVC 85000 OVC the TUNAJALI Reported management regional M&E community semi system officers network annually and annually to USAID Monthly to TUNAJAL 1.1.4 Provide I RT core packages to 69,000 Number of PLHA Quarterly PLHA and OVC Data collection PLHIV and OVC served to Sub grantees through the forms TBD 73,000 PLHIV with core package TUNAJAL Progress report RTs TUNAJALI Data management 80,000 85,000 OVC I HQ, CoP/PD Community systems OVC USAID Network TBD Semi and volunteers annually to USAID Monthly and quarterly to TUNAJAL Number of I RT, individuals Data collection Sub grantees, Quarterly counseled/sensitize forms Progress report RTs 39,117 119,000 PLHIV to d by volunteers on CoP/PD TUNAJAL HIV testing I HQ, Semi and annually to USAID Number of Data collection Monthly to Progress report Sub grantees 31, 399 95,146 PLHIV individuals forms, Data TUNAJAL RTs TBD counseled and management I RT CoP/PD tested at home and systems Quarterly

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Source(s) of Frequency Data/Data Data Objectives and Indicators of Responsible collection Reporting Baseline Target Activities Data Party Method/Recording tool Reporting instrument to TUNAJAL I HQ, received their test USAID results Semi and annually to USAID Monthly to TUNAJAL I RT Number of Quarterly households Data collection to Sub grantees received water forms TUNAJAL Progress report RTs 0 10,000 PLHIV treatment package I HQ, CoP/PD and storage vessels USAID Semi and annually to USAID Monthly to TUNAJAL I RT Quarterly to Sub grantees Number of PLHIV Progress report Data management TUNAJAL RTs 409 709 groups formed Progress report I HQ, CoP/PD USAID Semi and annually to USAID Number of secondary MVC Services distribution Sub grantees, Annually Progress report 877 supported with form RTs school fees Number of functional Sub grantees, Activity report Annually Progress report 359 children/youth RT, OVC STO 659 groups formed Monthly to Sub grantees 1.1.7 Provide Number of TUNAJAL STO, M&E volunteer volunteers Activity report Progress report 3489 3789 I HQ CoP incentives receiving incentives Number of Sub grantees volunteers linked STO, M&E Activity report Quarterly Progress report 279 800 and benefited with CoP IGA activities 1.1.8 Continue to Number of Progress report 32 sub implement supportive Supportive Quarterly Sub grantees grantees supportive supervision visits to supervision reports to HBC and OVC 128 visits supervision to each level (HQ to TUNAJAL officers, improve quality Sub grantees, Sub I HQ Regional of care grantees to teams Volunteers) 31 TUNAJALI Number of Sub HQ technical grantees receiving officers

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Source(s) of Frequency Data/Data Data Objectives and Indicators of Responsible collection Reporting Baseline Target Activities Data Party Method/Recording tool Reporting instrument supportive supervision once a quarter Percent of respondents saying that they would be 1.1.9 Address willing to care for a STO, M&E stigma in family member Progress report STO, HBC 80% communities who became sick Assessment report Annually STO, OVC with the AIDS virus

Number of stigma Volunteers reduction IEC RT Activity report Progress report 1000 materials printed HBC FP and distributed STO, M&E Objective 2.1 Number of Sub Effective grantees that have linkages formal linkages between Sub (e.g. memorandum grantees and of public understanding ) institutions with the public 31 31 established to health facilities, Annually Annual Sub grantees Activity report ensure other institutions progress report RTs provision of and multisectoral HBC FP comprehensive organizations STO, M&E services for providing services PLHA and to PLHA and their OVC families Reported Number/Percentage monthly of PLHA referred 2.1.1 Develop Data collection RT, Sub grantees and received Quarterly effective referral forms quarterly RTs TBD 75% services progress report networks Feedback referral To STO, M&E disaggregated by forms TUNAJAL sex I HQ Reported Number of OVC monthly referred and Data collection RT, Sub grantees Quarterly received services forms quarterly RTs TBD 20,000 progress report disaggregated by Feedback referral To STO, M&E sex forms TUNAJAL I HQ Number of Sub grantees 2.1.2 Establish Reported accessing/leveragin partnerships with Quarterly quarterly g resources from Quarterly Sub grantees multisectoral networking activity To n/a 31 multi sectoral progress report STO, M&E organizations at report form TUNAJAL organizations district level I HQ outside TUNAJALI program Number of Districts Quarterly Reported Quarterly Sub grantees n/a 36 initiated functional networking activity quarterly progress report STO, M&E DCoCCC report To

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

Source(s) of Frequency Data/Data Data Objectives and Indicators of Responsible collection Reporting Baseline Target Activities Data Party Method/Recording tool Reporting instrument TUNAJAL I HQ Reported Number of older quarterly Sub grantees OVC Supported or Quarterly Quarterly report To Regional TOs 389 689 linked to vocational progress report TUNAJAL STO-M&E training centres I HQ Objective 2.2 Functional supply chain Functional supply Annual system Grant chain system Drugs supply progress report 31 established to Annually coordinator established logbook provide essential commodities 2.2.1 Assist Sub grantees and government Number of Sub Grants bodies to Delivery grantees ordering Semi Coordinator implement a Order/request form report/progress 31 and receiving new annual Procurement functional report stocks on time officer supply chain management system 12,536 Quarterly Procurements 23,036 volunteers Number of HBC Delivery/progress Vol kits Quarterly progress officer kits kits distributed reports 103 Super reports Sub grantees 343 supervisors kits kits Objective 3.1 Increased technical and organizational Number of Sub Annual Sub capacity of Sub Capacity grantees that have grantees Performance grantees to building and moved to a higher organizational and Annually assessment 31 31 deliver Regional TOs, category of technical capacity checklist community care STOs performance assessment report and support services to PLHA and OVC 3.1.1 Provide technical 3489 training to Number of Progress STOs (M&E, volunteers, volunteers and Training reports Annually report HBC, OVC) 3789 Vol 100 HBC supervisors and supervisors trained 120 HBC FP FP regional OVC TOTs Number of 20 facilitators. Volunteer, care Progress 800 volunteers, takers and OVC Training reports Annually reports OVC STO caretakers and trained on Memory children approach 3.1.2 Provide Number of Sub Activity report Quarterly Progress report Capacity 31 technical and grantees provided building STOs organizational technical and (M&E, HBC, 37

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Objective 3.2 Improved capacity of local Number of district government to that incorporate Progress coordinate and Progress TUNAJALI Sub report, District RTs 34 Mainland and monitor the report/district Annually grantees activities plans Sub grantees 10 Zanzibar implementation annual plans in their annual documents of community plans care and support to PLHA and OVC 3.2.1 Strengthen Number of CHMT RTs of local members reporting Social welfare government on supportive Supportive Quarterly Quarterly officers 140 bodies capacity supervision of supervision reports progress report District HBC to coordinate TUNAJALI coordinator services activities Number of district STOs (M&E with officials Quarterly and OVC), 27 districts Training report Quarterly trained on OVC progress report OVC DMS mainland DMS Data manager 3.2.2 Expand and strengthen Number of Services report Sub grantees the MVCC to OVC/MVC forms Quarterly RTs quarterly 30,000 identify and identified through Data management progress report STOs address the MVCC system Sub grantees needs of OVC Number of MVCC Quarterly RT Activity report Quarterly 716 1216 established progress report Sub grantees Objective 4.1 National policy, Number of Sub standards and grantees using Standards audit Quarterly Sub grantees guidelines Quarterly 31 national standards report progress report RTS applied in and guidelines TUNAJALI activities 4.1.1 Apply national Number of Sub RTS standards and grantees using Standards audit Semi Quarterly STO, M&E 31 guidelines in all national standards report annually progress report STO, HBC TUNAJALI and guidelines STO, OVC activities 4.1.2 Utilize Number of Sub OVC and HBC Data Semi Progress IT 31 national data grantees trained and management annually report manager/sub management using OVC and systems grantees systems for HBC DMS HBC and OVC OVC and Data PLHIV specialists, Data Manager,

Cooperative Agreement No. 621-A-00-07-00002-00 October 1, 2009 The TUNAJALI HBC/OVC Program

Source(s) of Frequency Data/Data Data Objectives and Indicators of Responsible collection Reporting Baseline Target Activities Data Party Method/Recording tool Reporting instrument STOs M&E HBC and OVS IT manager/sub Number of OVC grantees OVC and HBC Data Semi 75,000 OVCs and PLHIV entered Progress report Data specialist, management system annually 67,000 PLHIVs in DMS Data Manager, STOs OVC M&E

Objective 4.2 Mechanism for Number of best Best practice report STOs (M&E, 62 (Two from each mutual learning Annually Progress report practices published HBC, OVC) sub grantee) of effective documented and approaches disseminated established 4.2.1 Identify, document and share effective Number of best Semi STOs (M&E, Activity report Progress report 31 approaches practices annually HBC, OVC) among Sub documented and grantees disseminated Objective 4.3 Mechanisms to inform national Number of systems based meetings where Semi STOs (M&E, Activity report Progress report 62 on lessons TUNAJALI shares annually HBC, OVC) learned from lessons learnt TUNAJALI established 4.3.1 Share Recommended core TUNAJALI core package shared Progress report Semi STO, HBC TBD packages with with NACP and Activity report annually STO, OVC NACP and DSW DSW 4.3.2 Participate in national Number of national committee committee meetings Progress report meetings and Semi 10 attended by Activity report STOs other HIV/AIDS annually TUNAJALI staff at national level activities 4.3.3 Develop recommendation s for revising Recommendations national Progress report STOs (M&E, developed and Semi TBD guidelines Activity report HBC, OVC) shared annually according to TUNAJALI lessons learnt V: Management and Staffing The TUNAJALI team will consolidate the smooth and effective management of program operations including recruitment of new staff; establishment of new offices; and general program administration. These steps are detailed below:

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A. Procure new equipment and supplies. Through an open and transparent tender process, we will procure the necessary equipment and supplies for the offices in the regions and at HQ. We will also submit a request to USAID approval to dispose of the old unusable equipment. The Finance Director will ensure that we meet the procurement regulations of USAID.

B. Consolidate general administrative operations. Under the guidance of the Finance Director, the following administrative tools and protocols developed in our first year of operations will be strictly observed to ensure adherence in accordance to USG and the Government of Tanzania regulations;  Organizational policies and procedures for TUNAJALI  Relevant HR documents/policies (HR Manual, Operations Manual, Staff Handbook)  Relevant finance documents/policies (Finance & Admin Manual, Travel Policy, Allowances Policy)  Management of program accounts in all regions and head office  Management of relevant insurance policies for the program

C. Recruit and orient new staff. Each core partner will be responsible for their staffing requirements and will place advertisements announcing opportunities for technical & administrative support personnel for all sites. After review and selection of suitable candidates; each partner will hire the selected applicants. To enhance program management we intend to hire 4 Regional Program Managers in Iringa, Njombe, Morogoro, and Dodoma. These managers will oversee the smooth operations and implementation of field activities and provide leadership to the technical staff for TUNAJALI home based care and TUNAJALI care and treatment programs.

A five day retreat to review program progress will be conducted in April 2010. Also, a two day team building retreat will be done jointly with Care and Treatment staff.

D. Program Management and Administration. The HQ office will continue to have overall oversight of the program; however, day-to-day management oversight of activities in each of the regions and Zanzibar is the responsibility of the staff based in the field offices under the Regional Program Managers.

Field-level management. Activities in each region and Zanzibar will be managed by Regional Teams (RT). RTs will include a Regional Program Manager, Regional HBC Technical Officer, Regional OVC Technical officer, Regional M&E Officer and a Regional Grants Officer. They will provide day-to-day technical and management support to the sub-grantees and are responsible for monitoring sub-grantee performance. They will also assist districts to coordinate and monitor TUNAJALI activities. RTs will coordinate programmatic and technical support with TUNAJALI HQ staff.

HQ-level management. The Senior Management Team (SMT) under the leadership of the Chief of Party (COP) will provide overall management oversight for the TUNAJALI program.

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The roles and responsibilities of the HQ office will include: overall monitoring of grants to the sub-grantees; coordinating technical assistance provided by TUNAJALI core and technical partners, and consultants; and monitoring and coordinating overall project efforts. The HQ staff will also receive all data and reports, and compile and disseminate project-wide documents.

The key project personnel based in the HQ office are Dr. Gottlieb Mpangile (Chief of Party), Priskila Gobba (Program Director), Patrick Waweru (Finance Director) and Sigfrid Kayombo (Grants Manager). The Chief of Party (COP) will be responsible for overall supervision, administration, and implementation of the cooperative agreement. He will be assisted by the Program Director (PD) in the day-to-day management of the program. The PD will provide programmatic oversight, including overseeing the development of work plan, budget, and reports. She will co-supervise the Regional Program Managers with the Care and Treatment Team. In addition, the COP and the Senior Technical Officers will ensure the use of high-quality, state-of-the-art, evidence -based technical approaches in program interventions, including strengthening TUNAJALI linkages with care and treatment programs. The Finance Director (FD) will have overall responsibility for managing the program’s administrative and financial operations in accordance with donor and institutional guidelines. He will supervise the Grants Manager, who is responsible for coordinating the daily management, monitoring and reporting for the grants. She will supervise the Regional Grants Officers.

At the HQ level, the Home-Based Care Senior Technical Officer (HBC STO), Orphans and Vulnerable Children Senior Technical Officer (OVC STO), Institutional Capacity Building Senior Technical Officer (ICB STO), Home Based Counseling and Testing Technical Officer (HBCT STO) and Monitoring and Evaluation Senior Technical Officer (M&E STO) will provide technical assistance and build capacity of sub-grantees in HBC, OVC, ICB, HBCT and M&E, respectively. The STOs will monitor the quality and technical performance of sub-grantees.

Program Management Board (PMB). The TUNAJALI PMB will be the nexus for program management, monitoring and coordination. The PMB will be comprised of representatives of each core partner organizations and will be chaired by the Deloitte Consulting Country Director. The COP will serve as secretary to the Board. It will be based in the Central Office in Dar es Salaam and will meet quarterly. Functional roles of the PMB will include:  Strategic planning  Program and technical oversight and quality assurance  Coordination among Core Partners  Coordination with a broad range of stakeholders

Under the leadership of the COP, the TUNAJALI HQ team will undertake various program management activities at the national and regional level to ensure smooth operation of the program. These activities will include; conducting TUNAJALI Program Management Board meetings; TUNAJALI all-staff meetings; TUNAJALI core partners meetings (Deloitte, FHI, Africare, CRS); meetings with USAID; designing and producing necessary program business materials; attending annual PEPFAR partners meetings and developing and maintaining a TUNAJALI website.

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E. Program Reporting. The RTs will ensure timely receipt and review of Quarterly Reports from sub-grantees. These reports will feed into the quarterly progress reports to be submitted to the TUNAJALI Board and USAID.

VI. Grants and Financial Management A technically robust grants program depends on transparent and efficient grants management procedures. This program builds on those proven effective in Tanzania by the Deloitte-managed Rapid Funding Envelope for HIV/AIDS. Essential activities will include:

1. Disbursements to sub grantees (see activity 12 below)

2. Monitoring & Evaluation

This step is implemented on a continual basis, and involves conducting technical and financial monitoring of sub-grantee activities under the established parameters of the overall program M&E requirements. Disbursements are handled through our established accounting control structures. All expenditure claims will be co-reviewed by the team and approved before final processing of disbursements.

3. TUNAJALI Board Support

Under the leadership of the Grants Manager, TUNAJALI will provide administrative and logistical support to the Evaluation Committee/TUNAJALI Program Management Board. Tasks involved in this step include convening and recording minutes of meetings, and the preparation and submission of necessary progress reports. This support to the PMB will enable the PMB members to concentrate on decisions related to the overall achievement of the program.

4. Fund Administration & Periodic Reporting

The Financial Director will be responsible for ensuring that we maintain up-to-date books of accounts, as well as prepare and submit relevant financial reports to USAID & TUNAJALI Program Management Board

5. Fund Disbursements

Disbursements will be made according to the schedule defined in the contract and based on reviews of sub grantee financial liquidations. All expenditure claims will be reviewed by the Grants Manager, Field Coordinators, and the relevant Technical Officers and approved by the Finance Director.

6. Financial Review/Liquidations of sub grantees

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All disbursements will be based on successful clearance of financial liquidations to be submitted by the sub grantees on a quarterly basis. Grants officers will ensure timely submission of quality financial reports from the field to the head office

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