The TUNAJALI HBC/OVC Program
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
© 2007 Deloitte Consulting
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
Þ Commitment to high quality care
Þ Establishment of effective networks, partnerships and referral mechanisms for comprehensive care
Þ Accountability and results-focus
Þ Enhancement of community ownership and drive
Þ Maintenance of client dignity, confidentiality and rights
Þ Ensure sustainability
ABBREVIATIONS AND ACRONYMS
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
USG United States Government
VHW Village Health Worker
ZACP Zanzibar AIDS Control Program
Table of Contents
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
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.
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:
TABLE 1: TUNAJALI Targets for FY 2010Indicator / Target
Program Area: Palliative Care (Home-Based Care)
Number of individuals served / 73,000
Number of organizations provided with technical assistance / 31
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 + Supplementary Support) / 85,000
Number of OVC served by an OVC program, PRIMARY SUPPORT / 21,250
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 counseling and testing for HIV and received their test results / 95,145
Number of service outlets providing counseling and testing according to national and international standards / 140 wards
Number of individuals trained in counseling and testing according to national and international standards / 952 volunteers
68 HBC focal persons
64facility-based counselors
Program Area: Other Policy Analysis and Systems Strengthening:
Policy Development
Number of organizations provided with technical assistance for HIV-related policy development / 34 TUNAJALI DCoCCCs
Program Area: Other Policy Analysis and Systems Strengthening:
Institutional Capacity Building
Number of organizations provided with technical assistance for HIV-related institutional capacity building / 31 TUNAJALI sub-grantees
Number of districts provided with technical assistance in data management on HBC / 34 districts in mainland
Number of individuals trained in HIV-related institutional capacity building / 64
Program Area: Other Policy Analysis and Systems Strengthening:
Stigma and Discrimination Reduction
Number of individuals trained in HIV-related stigma and discrimination / 3,700 volunteers
5,700 PLHIV
Program Area: Other Policy Analysis and Systems Strengthening:
Community Mobilization for Prevention, Care and Treatment
Number of individuals trained in HIV-related community mobilization for prevention, care and/or treatment / 3,700 volunteers
5,700 PLHIV
Number of individuals reached with community outreach that promotes HIV/AIDS prevention / 34 districts in 6 mainland
regions and Zanzibar
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.
· 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.
· 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.