Issue #6 USAID Boresha Afya - Southern Zone September 2019 Newsletter

Content Foreword Program highlights Success stories Page 02 As our Program moves On 9 July 2019, the Charge According to the past the half way stage of d’affaires (CDA) of the HIV Impact Survey (2016 – implementation, there are United States Embassy in 2017), region has a low plenty...... Tanzania...... HIV......

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Achieving our vision USAID Boresha Afya Southern Zone Newsletter | Issue 06 | September 2019 USAID Boresha Afya Southern Zone Newsletter | Issue 06 | September 2019

Contents

14 Jan - Feb 19 Index Cascade

12 12 11 11 10

8 7 6 6 6

4

2 2 1 0 Jan - 19 Feb - 19

Index clients No of sexual partner elicited Tested pos 04 06 10 14 Foreword Program highlights Program highlights Success Stories

––Collaboration of Partners Impresses ––Program Collaborates with Media to ––Optimization of Positive Case CDA upon Visit to Ifakara Health Document Progress in Malaria Identification through Index Testing Institute at Hospital – Lindi Region

16 18 20 22 Success Stories Success Stories Success Stories Success Stories

––Changing Roles: Data Clerks Fostering ––How the SMS Reminder System is –– Health Centre, a Beacon of ––Testimonials Data Quality and Data Use for Decision Reshaping HIV/AIDS Services in Tanzania: Excellence in Index Testing. Making A Case Study of USAID Boresha Afya – Southern Zone, .

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Foreword

Dear Friends of USAID Boresha Afya – Southern Zone

As our Program moves past the half I would be remiss if I did not take way stage of implementation, there a moment to acknowledge that are plenty of achievements to write all Program achievements owe a about. Amongst these and most great deal to our prime partner, the notably, new clients initiated on Anti- Government through the Ministry Retroviral Therapy (ART) during the of Health Community Development past quarter were 11,021, directly Gender Elderly and Children contributing to the Program reaching (MOHCDGEC) and the Ministry of a total 189,149 clients currently on the President’s Office Regional ART in the five supported regions Administration and Local Government since Program inception. This (PO-RALG), other partners as well as achievement comes on the back of my staff. sustained efforts in Index Testing amongst others. I hope you will enjoy reading through the pages as much as we have Owing to the aforementioned, cherished every minute in service of this sixth issue of the newsletter our benefactors! details successes in Index Testing in and Lindi. Similarly, it also grants the reader accounts of how an SMS reminder system in Dr. Marina Njelekela – Chief of Njombe is assisting to retain clients Party, USAID Boresha Afya – in HIV care and treatment, how data Southern Zone Program. clerks have been empowered to use data correctly in Mtwara, Malaria successes in Lindi and Mtwara and also briefly narrates a recent visit to Ifakara Health Institute by a prominent US Government official.

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Program highlights Collaboration of Partners Impresses CDA upon Visit to Ifakara Health Institute

On 9 July 2019, the Charge behaviour in the fight against d’affaires (CDA) of the United different mosquito borne States Embassy in Tanzania, infections. In particular, she Dr. Inmi Patterson made a also had the opportunity to familiarization visit to Ifakara learn about the Mozzie sandals Health Institute (IHI) in Ifakara, research and their potential Morogoro. scalability among Tanzanians; zoonoses surveillance activity Her visit commenced with a and its impact on prevention tour of the vector house where of Rift Valley Fever; and the she was oriented on various great research opportunities studies involving mosquito inherent in the viral load testing Ifakara Health Institute, , – The Charge d’affaires (CDA) of the United States Embassy in Tanzania, Dr. Inmi Patterson chats with staff at the laboratory during her visit to the IHI. ©IHI

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activities at the facility laboratory. opportunity to interact with laboratory At the laboratory where both clinic scientists and interns working at the and laboratory teams were stationed, HVL testing laboratory. When touring the teams were able to showcase the the Biobank section of the laboratory, great work performed by heath care she was pleased to note that there workers under the leadership and were more than 100,000 HIV samples collaboration of the R/CHMTs as well as stored at the centre, which could be USAID Boresha Afya – Southern Zone used by various scientists, and visiting technical staff on the ground. researchers.

The CDA was particularly impressed by Overall, the CDA was captivated by the the strong collaboration and team work great collaboration of partners she amongst all key partners in Ifakara, i.e. saw on display during her visit and USAID Boresha Afya Southern Zone requested IHI to do more to inform Program, St. Francis Hospital as well as the public on their capacity at various IHI through the Chronic Disease Clinic researches and seek for funding from Ifakara (CDCI) which runs the Care the US Government to undertake more and Treatment Centre at St. Francis research. Hospital in partnership with the hospital. She appreciated the fact that Ifakara Health Institute, Kilombero District, Morogoro Region – The Charge d’affaires (CDA) of the United States Embassy in Tanzania, through USAID Boresha Afya Southern Dr. Inmi Patterson seeks clarification from USAID Boresha Afya Program Senior Laboratory Services Advisor, Mussa Maganga during her Zone, collaboration between CDCI visit to the laboratory at IHI. ©IHI and CHMT as well as other partners including SAUTI and Kizazi Kipya had improved significantly leading to provision of high quality services towards achieving the three 90s.

While at the HVL testing laboratory, the head of laboratory services at IHI, Faraji Abilahi and in charge of CDCI, Dr. Anna Eichenberger and her deputy Dr. Ezekiel Luoga all attested to the support USAID Boresha Afya Southern Zone is providing. In particular they mentioned the support in human resources, i.e. four staff (two laboratory scientists and two data clerks) as well as providing capacity building through mentorship and technical assistance at both the laboratory and clinic. She also had the

Ifakara Health Institute, Kilombero District, Morogoro Region – The Charge d’affaires (CDA) of the United States Embassy in Tanzania, Dr. Inmi Patterson is shown a freezer storing HVL samples by the head of laboratory services at IHI, Faraji Abilahi.© US Embassy in Tanzania.

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Program Collaborates with Media to Document Progress in Malaria

During the past quarter, the Program pregnancy at least one month apart at collaborated with health reporters each scheduled antenatal care (ANC) visit, to highlight success stories and best beginning from the second trimester. practices on Malaria achieved through US Approximately 90 percent of pregnant Government support. women in Lindi and 91 percent of pregnant women in Mtwara have received at least In particular, this documentation focused two doses of SP (IPTp2) therapy against a on the prevention of malaria in pregnancy national target of 80 percent. Similarly, an which, includes the use of long-lasting estimated 78 percent of pregnant women insecticidal nets (LLINs), prompt diagnosis in Lindi and 84 percent of pregnant women and effective treatment of malaria in Mtwara attending antenatal clinics have infections. In areas with moderate to received three or more doses (IPTp3+) of high malaria transmission, intermittent this preventive therapy against a national preventive treatment in pregnancy target of 60 percent. (IPTp) with a drug called sulfadoxine- pyrimethamine (SP) is recommended as These achievements are a result of the part of antenatal care services. The drug is good collaboration amongst the United Town Health Centre, Lindi Municipal, Lindi Region – Nurse in charge, Ms. Semeni Lubeya displays SP tablets as she educates given during pregnancy to reduce maternal States Government through the President’s pregnant women attending antenatal clinic the importance of the drug in protecting them and their unborn babies from malaria episodes, maternal and fetal Malaria Initiative (PMI), USAID, the Malaria. ©USAID Boresha Afya – Southern Zone/S. Mhando anaemia, placental parasitaemia, low birth Government of Tanzania (the Ministry of weight, and neonatal mortality. Health, Community Development, Gender, Elderly and Children (MOHCDGEC) and Tanzania has adopted the World Health Presidents’ Office – Regional Administration Organization (WHO) policy to administer and Local Government (PORALG)), RHMTs, at least three doses of the drug (SP) during CHMTs and people of Tanzania.

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However, there still exist some social barriers in the uptake of sulfadoxine- pyrimethamine (SP) during pregnancy. Amongst others, these include culture, poverty (i.e. inadequate funds to obtain transportation to reach health facilities) and insufficient knowledge about malaria and importance of prevention of malaria in pregnancy.

Here are some accounts from the field;

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Success A significant improvement has been noted in 14 Jan - Feb 19 Index Cascade the HIV testing and positivity yield, from 1% in

12 12 January 2019 to 19% by May 2019. This has been 11 11 attributed to the strategic shift to index testing as Stories 10 the primary model of positive case identification at 8 the facility. Currently, Ruangwa District Hospital is 7 6 6 the leading facility in the identification of positive 6 cases through index testing among all 92 facilities 4 in Lindi region that are supported by the United 2 States Government through the U.S. President’s Optimization of 2 1 Emergency Plan for AIDS Relief (PEPFAR). 0 Jan - 19 Feb - 19 Reasons for Improvement Index clients No of sexual partner elicited Tested pos Positive Case The improvement noted is due to a number of Index Testing Cascade at Ruangwa District Hospital (January-February 2019) initiatives including: •• Improved counselling and health talks to PLHIV on partner elicitation, Identification 80 Mar - May 19 Index Cascade 73 •• Enhanced home based Index testing, 70 63 •• Improved peer councelling of PLHIV expert clients to 60 57 53 newly notified cases on importance of HIV testing to through Index 50 46 their close contacts, 40 36 36 33 34 30 •• Addition of working hours (extended hours) to ensure 30 that HIV testing services are available at late hours and 20 Testing at Ruangwa 20 on non working days, 13 10 •• Strengthened relationship between implementing 0 partner CSOs and facility staff on community partner District Hospital – Jan - 19 Apr - 19 May - 19 notification of PLHIV clients, Index clients No of sexual partner elicited Tested pos •• Continous facility backstopping by program staff, and

Index Testing Cascade at Ruangwa District Hospital (March-May 2019) •• Attachment of Expert Client (EC) to Community mentor Lindi Region and service providers.

Way Forward According to the Tanzania HIV Impact Data collected illustrates that there Following the encouraging performance of Ruangwa Survey (2016 – 2017), Lindi region has had been a low yield from index District Hospital, the Program in collaboration with a low HIV prevalence rate of 0.3%. testing at the facility due to limited R/CHMTs has already begun to replicate the same However, this does not imply that the knowledge by Health Care Workers 800 Trend on Positivity Yield 20% 19% strategies in other facilities in order to realize the epidemic spread of AIDS has ended in on the importance of index testing 700 18% first 95 UNAIDS target, i.e. 95% of people living with the region. The identification of HIV as the primary mode for positive 16% 600 HIV knowing their HIV status by 2030. positive cases has been a challenge case identification. Referring to index 14% 500 that necessitated the development testing data of January-February 2019 11% 12% of more focused strategies of client compared to March-May 2019 there 400 10% 8% engagement. Index testing , being the has been a significant increase of Index 300 8% 6% current most effective methodology positive yield amongst sexual partners 200 of optimizing HIV case identification from 16% to 68% respectively. 4% 4% 100 has resulted in a positive yield of case 1% 2% identification at Ruangwa District 0 0% Hospital. Jan Feb Mar Apr May HTS Positive Positive Yield

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Changing Roles: Data Clerks Fostering Data Quality and Data Use for Decision Making

Data quality problems are wide spread In , USAID Boresha In the past, the role of data clerks and have social economic impacts. Afya – Southern Zone works as an was merely data entry and as such was riddled by a number of data In particular, relying on obsolete and implementing partner for HIV/AIDS Mkomaindo Hospital, Masasi TC, Mtwara Region – Program Monitoring and Evaluation Officer, Dorothy Nyoni (centre) conducts errors coupled with under reporting incorrect data or uncertainty regarding with the Regional Council Health mentorship to data clerks and ART nurse on proper documentation of new HIV Testing Counselling (HTS) registers. ©USAID of patients’ data. “It is disconcerting the quality of available data attributes Management Team (RHMT) and nine Boresha Afya – Southern Zone/C. Buberwa to less effective decision making. Council Health Management Teams to inform a client that the database indicates you’re deceased but this was Like many other programs, HIV care (CHMTs). The ultimate goal is to build and graphical presentations. Daily, and supportive supervisions on facilities interms of patients’ linkage a common data error,” shares Dorothy and treatment programs are highly sustainable capacity for councils weekly and monthly reporting through M&E tools and troubleshooting to care and treatment services and Nyoni, a Monitoring and Evaluation informed by patient’s data entered on to collect, analyse and use data the Program’s information system computers. He is currently the data consistency, accuracy and (M&E) Officer based in Mtwara. the patients CTC1 card, CTC2 cards as for decision-making. The Program (proDMIS) became another catalyst for data officer for Tandahimba and completeness. Their data clerks are well as the CTC2 database. through the United States Agency for improving their abilities to track facility Nanyamba District Councils. now working with the Antiretroviral To resolve this, the Program realized International Development (USAID) performance. Dr. Adorati Kapinga, District AIDS Therapy (ART) nurses to ensure all HIV Care and treatment relies on supports employment of data clerks in the need for building the capacity of Coordinator for Mtwara DC also patients referred to the Care and data clerks to work beyond data entry a number of patients information 50 high volume facilities. These data Moses Jongo has worked as a data clerk affirms the significant role of data Treatment Centre are registered on in order to ensure completeness, ranging from patients’ visits, weight, clerks work as a bridge between the in Tandahimba District for over five clerks in improving data quality of time and receive good counselling consistency, relevancy and accuracy clinical stage, CD4 count , TB screening, Program and the CHMTS in ensuring years. “I was employed as a data clerk HIV reports, timely reporting into sessions in order to retain them of data sources. This included a ARV regimen, number of days ARVs data for HIV patients is accurately for Mahuta Health Centre in October the DHIS2 systems and exporting in care. During a USAID visit to the number of indoor trainings and onsite dispensed, ARV adherence, viral load captured from the CTC2 cards and 2014 and was relocated to Tandahimba of data from the CTC2 database to facility in May 2019, the data clerks/ mentorships to familiarize them with testing and results and nutritional entered into the CTC2 database. Their Hospital in 2016. My role was mainly CTC3 macro database on weekly officers were commended for their Patient information Management status. Using obsolete information to work in these health facilities has data entry into the CTC2 database. basis. consistency across all data sources Systems (PMS) and practical sessions make decisions may lead to devastating reduced manual data collection and In my opinion, USAID Boresha Afya verified, a remarkable achievement on making simple analysis using excel consequences in the management of collection of wrong data. Southern Zone has empowered me,” This improvement is evident at for individuals whose previous role HIV patients. he testifies. Jongo now works on a many facilities in Mtwara. Today, was simply and literally data entry. number of assignments ranging from Mkomaindo Hospital is one of data analysis, conducting mentorships the best performing high volume

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and the private sector is considered as “At first it was very hard for me to on time. However, this presents an a precondition for success. In turn, this remember my visit dates. I sometimes opportunity for partners to bridge this How the SMS requires strategic and integrative policy had to ask my children to help me gap. Through the use of SMS reminder decisions at the national level to be defined remember the dates I was required to systems, other needs could also be in action plans as concrete steps. visit the hospital. Now it is much easier addressed. For instance; the health as I receive SMS reminders to attend needs of babies born to mothers Reminder System is By tapping into this technology, USAID my visit three days prior,’’ testifies Ms. with HIV, addressing HIV Viral Load Boresha Afya – Southern Zone Program is Janeth Kirua. She adds, “I now plan (HVL) tests and Mobile Post Exposure working with donors (USAID), the Ministry my activities and transport fees well Prophylaxis (mPEP) to health care of Health Community Development Gender in advance without the need for my workers (HCWs) as well as many other Reshaping HIV/AIDS Elderly and Children (MOHCDGEC) and the children to remind me. I’m thankful to mobile health initiatives to improve President’s Office – Regional Administration the Program for this. I’m also delighted health services in the country. and Local Government (PORALG), as well that it is free of charge.” as other stakeholders in the country, to At present, the MOHCDGEC affect real change in health care (HIV/AIDS) Meanwhile, USAID Boresha Afya – in collaboration with PORALG, Services in Tanzania: coverage, consequently saving lives. Southern Zone is already considering implementing partners and Donors Initially, PLHIV were reluctant to provide other mobile health initiatives such are working to build a new integrated their real mobile numbers due to fear as linking laboratories with health GOTHOMIS. The Program will advocate of exposure and stigma. However, after facilities to receive results in real time. for the SMS reminder system to be one A Case Study of a while most accepted it having noted “When I see how the SMS reminder can of the modules. From FY 4 the Program the benefits. At present, at most health help the public, my motivation is the will engage councils to start budgeting facilities where there is an SMS Reminder impact,” Makunda Kassongo explains. for SMS reminder recurring costs System, clients provide their real mobile There remains a challenge for some, especially data bundles. Similarly, the USAID Boresha Afya numbers. mostly in rural areas who do not Program is in discussions with vendors have access to mobile phones or to make the system free and open where the mobile network is poor source so that it can be replicated at – Southern Zone, as they hardly receive the messages more facilities with zero costs. Njombe Region

Launched in mid-2018 through USAID installed at my computer, sending text More importantly, the system allows the Boresha Afya – Southern Zone, Tanzania’s messages to PLHIV enrolled in the system sender (data clerks in most cases) to see SMS reminder initiative was developed to remind them of their next visit dates the delivered and un-delivered messages with the aim of reducing lost to follow and track their progress and adherence to and as such can decide to resend them and up statistics amongst people living with medication to mention a few.’’ even provides a daily report which shows HIV (PLHIV). The SMS reminder system is the number of clients reached and those headed by the Program mHealth Advisor, This reminder alerts enrolled clients when that did not receive the messages. Makunda Kassongo and supported by they ought to go for HIV/AIDS services Program staff, particularly monitoring and and when to pick up their prescribed The rapid increase in mobile phone use evaluation personnel. Through this system, medication. The system is interactive as and other telecommunication technologies the Program is now providing support clients need not respond to the prompts in health care during the past decade has to thousands of PLHIV in Iringa, Njombe, but rather read and follow up on their paved way for optimism. Mobile health Morogoro, Lindi, and Mtwara. schedules. They receive the messages initiatives need to be integrated into on their mobile phones, and data clerks national health systems and priorities Through the use of the SMS reminder are able to see whether the receiver has and fit into the system that the country mobile system, Norbert Mwalongo, a received the message or not. As such, if a has already invested in. Owing to this, data clerk at Milo Hospital reveals, “The client does not visit a facility for services, partnership between governments, health Ludewa Hospital, Ludewa District, Njombe Region – Maria Kayombo (Data clerk) verifies SMS reminder reports in the process is now automated through a server they can easily follow up. care systems, community health workers system. ©USAID Boresha Afya – Southern Zone/F. Nachenga

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Drivers for success bicycles to reach clients residing Mlimba Health This is no mean feat. In the previous in distant and hard to reach areas. Fiscal Year (18) the facility only However, their passion manifested managed to identify 31 index clients through a sense of ownership amongst against an index positive identification facility staff and CBHSPs is the Centre, a Beacon target of 54. The progress represents overarching ingredient throughout. significant strides. “The Program empowered us with skills through a “It also helps that there are great workshop on Index Testing. We learned relations between Program and facility about client, contract, provider and staff including the CBHSPs who are of Excellence in dual referrals – each detailing how we mainly index testers. This facility uses were to elicit sexual partners of HIV its data well. Upon discovering new positive clients,” explains Eliza Mbuna HIV clients, their details are shared in (40), a health care worker (HCW) at confidentiality to CBHSPs. Their job Index Testing Mlimba HC. She animatedly goes on is then to ensure that their sexual to demonstrate how she approaches partners are tested,” simplifies Gideon Some 300 kilometres from Morogoro town, of the Program has deployed a team of 15 Testing is concerned. As a result, Mlimba clients. Her passion for her job on Yohana, a Program Monitoring and after a very long drive on rough terrain is Community Based HIV Services Providers HC has surpassed its huge index positive display throughout. Evaluation Officer for Morogoro. the bustling town of Mlimba in Kilombero (CBHSP) in a bid to increase access to identification targets of 245, standing at District. Its residents are mostly rice health services at community level. This is 289 as of 5 August 2019, equating to almost The Program has also supported the More about Mlimba Health Centre farmers. Most of their health care needs also a result area for the Program. 118% of its annual index target, with a CBHSPs with transport allowance Mlimba Health Centre is located are met at Mlimba Health Centre (HC), month still to go. This places Mlimba HC and a stipend for their hard work. Dr. in Morogoro’s Kilombero District which is one amongst 105 health facilities Sebastian Njaku (34) leads this motivated third amongst health facilities with huge Elibariki Muguli, a Program HIV Advisor in Mlimba Ward. The facility was supported by the Program in Morogoro team of CBHSPs. He proudly states, index targets, behind Gairo HC and Kilosa for Morogoro ensures that all the established in February 1976 and region. Some of the supported services “We’re all perceived as doctors.” To some District Hospital amongst all 512 facilities administrative processes empowering serves an estimated population of include HIV, Tuberculosis, Family Planning extent, this is true. Their interventions in including all referral hospitals in all the these community volunteers are 23,192 annually. Its Care and Treatment and Malaria. Additionally under the HIV the communities within which they serve five Program supported regions with HIV undertaken efficiently. Similarly, the Clinic commenced operations in 2008. component, the health centre with support are exceptional, particularly where Index component. Program has equipped them with

Mlimba Health Centre, Kilombero District, Morogoro Region – Gideon Yohana (29), a Program Mlimba Health Centre, Kilombero District, Morogoro Region – Community Based HIV Services Providers (CBHSPs) Monitoring and Evaluation Officer for Morogoro works closely with the team of CBHSPs. ©USAID participate in a group discussion at the facility premises. ©USAID Boresha Afya – Southern Zone/S. Mhando. Boresha Afya – Southern Zone/S. Mhando.

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Testimonials

“The confidentiality in handling index clients has granted me esteem in my community. People see me as trustworthy,” shares Richard Mkuvasa (45).

“Index testing has seen a number of my relatives learn their status and begin medication. This job has touched me on a personal level and I’m now respected in my community,” Maria Mdikula (38), a member of the 15-person CBHSP team reveals. “It brings me joy when we’re invited by ward councillors to meetings to give health talks,” – Msafiri Nduye (36).

22 23 This Program is made possible by the support of the American people through the United States Agency for International Development (USAID).