In Tanzania, institutional efforts to combat HIV/AIDS started in 1985 by establishing a National Task force within the Ministry of Health. This was so because the HIV/AIDS epidemic was first perceived as a health problem and the initial control efforts were formulated and based within the health sector. Later on in 1988 this task force was transformed into a fully-fledged National AIDS Control Programme which was launched in April 1988. The programme is headed by a Programme Manager and initially had the following Technical Units:
- Management Unit (MGT)
- Epidemiology and Research (EP & RES)
- Laboratory Services (LAB)
- Clinical and STD Unit (STD Unit)
- Information Education and Communication. (IEC)
- Counselling and Social Support Unit (CSSU) – 1991
- Care and Treatment Unit – 2004
From 1989, AIDS Control efforts were decentralised to the regions and districts, and from 1992, control efforts started also to be initiated within non-health sectors. The non health sectors which joined the National AIDS Control Programme included Ministry of Defence and National Service, Education, Community Development, Women Affairs and Children, Labour and Youth Development, Agriculture, Information Services and Non-Government Organisations. By the year 2000 there were 23 other sectors that had joined the National Response to HIV/AIDS, and have developed AIDS action plans including all the districts in the country. During all this time the National AIDS Control Programme, remained the central coordinating unit as a Secretariat to the National AIDS Committee (NAC). In addition to Coordination, the NACP continued to serve as the main implementing agent for Ministry of Health as well as responding to needs of other non-health sectors.
2.0 Broad functions of NACP
Currently the NACP undertakes the following broad functions:
- Implementation of Health sector prevention and care interventions: These interventions include patient care, STD services, blood safety, public health education, voluntary counselling and testing.
- Coordination of internal and external partners (donors, NGOs, sectors.)
- Strategic Planning
- Resource Mobilisation
- Policy formulation.
- Monitoring and Evaluation including overall Programme Reviews
- Secretariat to National Committees
- Research Coordination
- Sharing and Dissemination of Information
- Technical Support to other Sectors
- Intervention development
- Distribution of commodities such as condoms. Health Learning Materials and Supplies.
TABLE 1: SUMMARY OF FUNCTIONS OF THE NACP BY UNIT
|1||Programme Office management and operations||MGT|
|2||Documentation and information storage for use by different partners and stakeholders.||MGT|
|3||Distribution of commodities such as condoms, HIV test kits, and health learning materials and supplies||MGT|
|4||Information dissemination to the general public||IEC|
|5||Design and develop education packages- targeted and non- targeted||IEC|
|6||Design strategies for effective communication to the general public||IEC|
|7||Organize promotional activities for behaviour change campaign||IEC|
|8||Establish and strengthen HIV testing services||LAB|
|9||Ensure provision of HIV free blood (safe blood) for transfusion purposes in the country||LAB|
|10||Establish and promote the counselling, and social support systems in the country||CSSU|
|11||Advocate and establish voluntary counselling and HIV testing services||CSSU|
|12||Promote and advocate for community and Home Based Care (HBC) services for infected and affected individuals including orphans||CSSU|
|13||Develop and promote strategies and guidelines for the prevention and control of STDs||STD|
|14||Promote the management and control of STD cases through the health care system.||STD|
|15||Create opportunities for the negotiation of access to care and drugs for HIV and opportunistic infections.||STD|
|16||Maintain the epidemiological and behavioural surveillance of the HIV/AIDS/STDs epidemic.||EPI & RES|
|17||Support and promote research activities on HIV/AIDS/STDs according to the established priority area in the country.||EPI & RES|
|18||Maintenance of a financial and accounting system to enable efficient management of programme funds||EPI & RES|
|19||Promote utilization of research findings||EPI & RES|
|20||Maintenance of financial and accounting systems to enable efficient management of programme funds||F & A|
|21||Monitor, supervise and evaluate quality implementation of activities for HIV care, treatment and support||C & T|
|22||Coordinate the development training materials and training of health care workers on HIV care and treatment||C & T|
|23||Promote Coordinated HIV care, treatment and support including strengthening links between the health system and implementers of community and Home based care and treatment services||C & T|
STAFFING OF THE NACP
The NACP draws staff mainly from the Ministry of Health. However, over the years, there have been occasional needs for additional staff to implement specific tasks/projects within the programme, which donor organizations have been willing to support on contractual basis.
3.0 FORMATION OF TANZANIA COMMISSION FOR AIDS (TACAIDS)
On 1st December 2000, the President of the United Republic of Tanzania announced the formation of a Commission to be known as Tanzania COMMISSION FOR AIDS (TACAIDS) to co-ordinate and provide policy guidance to the national response to HIV/AIDS. The Commission will co-ordinate the multisectoral response to HIV/AIDS. In order to create a smooth working relationship between the Commission and the various sectors which are all involved in implementation of activities in their areas of comparative advantage, it is proposed that the Commission undertake the following functions:
- Policy Formation
- Strategic Planning
- Resources Mobilisation
- Monitoring and Evaluation
- Information Sharing and
- Best Practice Promotion.
All the other function mentioned under section 1.0. should continue to be undertaken by Ministry of Health. Table 2 shows the allocation of roles of NACP between Ministry of Health and Prime Ministers’ Office:TABLE 2: ALLOCATION OF ROLES OF NACP, MOH AND PMO
|Ministry of Health||Prime Ministers’ Office|
|1||Support the implementation of prevention and care interventions: These include patient care (hospital based and home based), STD services, blood safety, voluntary counselling and testing.||Ö|
|2||Coordination of internal and external partners (donors, NGOs, sectors including Districts, etc)||Ö|
|4||Resource Mobilisation and Utilisation||Ö|
|7||Monitoring and Evaluation including overall Programme Reviews||Ö|
|8||Secretariat to National Committees||Ö|
|10||Sharing and Dissemination of Information||Ö|
|11||Technical Support to other Sectors||Ö|
|14||Distribution of commodities such as condoms. Health Learning Materials and Supplies.||Ö|
|15||Promotion of best practice||Ö|
1.0 Program Management Unit
The Programme Management Unit was established in order to have an efficient functioning of the NACP. The unit supports the other Programme Units to implement their technical roles by ensuring availability of necessary requirements to execute their normal official duties
- Providing administrative support to the programme
- Providing logistical support (transport, communication, water, electricity, security etc).
- Managing human resources and personnel
- Providing Public Relations services.
- Ensuring that Government guidelines are observed during implementation
- Preparing plans and budgets
- Co-ordinate the implementation of the plans
- Provide monitoring and evaluation support
- Mobilise resources required to various sectors
- Prepare annual reports
- Prepare contracts with various partners including NGOs and consultant teams.
- Ensure Programme assets and equipment are cared for
- Stores management, including procurement, storage and distribution.
- Convene meetings with various partners and arrange for the meeting logistics
- Administer the logistics of various workshops involving different partners and ensure that reports are produced.
- Ensure that national events are coordinated.
- Solicit for training opportunities in and outside the country for NACP staff and partners working on HIV/AIDS.
1.1 Finance & Accounts
Under Programme Management Unit, this section supports other technical units in the area of financial management, budgeting and reporting according to financial regulations and procedures.
The following are the major functions that the unit offers to ensure the Programme is meeting its objectives: –
- To identify resource requirements and gaps and initiate resource mobilization processes.
- Make follow up of pledges from different sources.
- Establish a manageable systematic inventory of financial resources received by the Programme.
- Establish and maintain computerized financial/accounts management system that enables the Programme to record and track utilization of financial resources in a most transparent manner.
- Make timely payment of Programme bills when they become due for payment.
- Maintain books of accounts as per government financial regulations and donor requirements.
- Ensure that all local and foreign transactions are recorded and related accounts are kept in order with proper management of receipts and expenditure.
- Prepare monthly bank reconciliation.
- Liaise with local Banks on the operationalization and management of Programme’s accounts.
- Prepare and submit consolidated financial reports on quarterly, semi-annual and annual basis.
- Provide periodic accounts/statements and reports to various donors and developmental partners on the status of their financial assistance.
- Collaborate with internal and external Auditors as and when required.
- Provide guidelines to other technical units, Sectors, Districts and NGOs on financial regulations and procedures for spending HIV/AIDS/STI funds as well as retirement and reporting their expenditure.
- Update the programme on the day-to-day regarding the financial situation of the programme, budget lines, expenditure reviews, financial monitoring and ways to maximise better use of financial resources.
- Provide technical advise and guidance on financial implications on issues relating to procurements, contracts for supplying of goods and services.
2.0 Information Education & Commonucation Unit
The unit was formed in order to coordinate the development of I.E.C. strategies and activities for HIV/AIDS/STD interventions in the country. Different actors and implementers at different levels plan and implement various I.E.C. activities to different target populations.
The reports of the different IEC activities implemented by various actors are shared by the IEC Unit during the planning process, through information exchange mechanisms established in the project write up, and also during consultative meeting with specific organisations and groups.
The coordination activities performed by the IEC unit include the following:
- Meetings and presentation on specific HIV/AIDS/STD issues.
- Conduct workshops to orient / train specific groups e.g. AIDS Coordinators at National, Regional, District or Organisation level
- Conduct seminars to focus a number of target populations.
- Conduct specific training sessions for IEC “experts” in various areas e.g. communications skills or behaviour change methodologies etc.
- Design of IEC materials and / or messages. The materials include; Print materials in the form of books and booklets, newsletters, posters and billboards, leaflets and fliers.
- Conduct sessions on IEC strategic planning
- Collaborate in curriculum development for specific groups – schools/training institutions etc.
- Media personnel involvement – by training and feature article writing, including Radio and TV program development and design.
- Artists – involvement for the development of various artistic materials and programs – including the design of electronic media and materials – such as film or television program script write up.
- Review of draft IEC materials by different agencies including professional advice on these materials for effective communication.
- Review of different IEC performances – by various Artists – focal media groups e.g. cultural and drama group performances.
- Participation into other agencies planning sessions for IEC interventions and activities. Agencies include – Public and Private sector or special group organisations – e.g. women or youth groups.
- Development of specific guidelines – in book form for various actors.
- Supervision and monitoring of IEC activities by different actors.
- Report writing on activities conducted.
- Quarterly and annual progress reports writing.
- Participation into National and International events. Participation here includes:
- Presentation of professional and scientific papers
- Presentation of posters or special topic materials at conferences.
- Conference or meeting and workshop / seminar organisation including modulation /leadership or chairing special sessions – in own (professional) capacity or organisation / country representation.
- Organisation of small groups performances – e.g. NGOs and CBOs, during national events like – Saba Saba and Nane Nane Exhibitions, World AIDS Day and other special campaigns.
- Collaboration with other sectors in the design and development of special IEC materials e.g. Uhuru Torch messages for the youth, women groups and other population groups.
3.1 NACP Library
The National AIDS Control Programme Library is under the IEC UNIT and it maintains all publications published by NACP for reference and future generation. Also it stores a special collection of publications on HIV/AIDS/STIs which include Serial publications, books, articles derived from reputable local and international journals, databases on CD-ROM, newspapers clips, research reports, conference reports, video cassettes, posters, etc. The library’s primary responsibility is to provide services to its MOH staff and all other partners dealing with HIV/AIDS/STDs locally and internationally. Students, researchers, individuals and government officials are also served with the collection.
The main objectives of the Library are:
- To build up a specialised collection on HIV/AIDS and Sexually Transmitted Diseases
- To provide up to date information on HIV/AIDS/STDs
- To support and facilitate consultancy work carried out at NACP.
- To support research work on HIV/AIDS/STDs carried our by various researchers
- To conduct literature search through various documents
- To provide current awareness services for researchers so as to keep abreast with new developments in HIV/AIDS/STDs
- To serve as a Documentation Centre for the HIV/AIDS/STDs collections
- To select, order, acquire process and store publications for library use.
- To solicit book donations from within and outside the country
- To offer Current Awareness Service, Selective Dissemination of Information, and document delivery in form of photocopies.
- Provide supplies and equipment for HIV antibody blood screening/testing
- To provide guidelines to ensure all blood for transfusion is HIV screened.
- To conduct supervisory visits to all laboratories performing HIV antibody testing / screening in Tanzania Mainland.
- Collaborate with research laboratories in order to perform more research on HIV/AIDS/STD.
- Planning and budgeting
- Development of guidelines on safety precaution for laboratory personnel and indicators for blood transfusion.
- Financial mobilisation / purchasing order for Lab materials.
- Prepare training sessions for laboratory staff in all hospitals transfusing blood in Tanzania Mainland and Zanzibar.
- Evaluation of testing materials for HIV (Quality Assurance of HIV testing materials)
- Report writing.
- Coordinate the Counselling and Social Support activities in the country.
- Assisting district/sectors to formulate interventions for implementing VCT, HBC, CHBC
- Collaborate with other relevant sectors / partners to sensitise and mobilise communities to provide psychosocial support to PLHIVs.
- Advocate and promote the multisectoral involvement in counselling and social support activities.
- Design and develop training programmes, for counsellors and HBC providers at different levels.
- Design, develop and disseminate national guidelines and training manuals to support trainers and service providers.
- Facilitate the planning and implementation of integrated counselling and social support interventions.
- Conduct monitoring and evaluation of counselling and social support services in the country.
- Initiate and support needs assessment to strengthen capacity of regions, districts, communities, and other partners to carry out the counselling and social support services.
- Resource mobilization.
- Develop IEC materials for promoting counselling and social support systems.
- Organise and Support operational research in the areas counselling and social support.
- Effective STD case management using the Syndromic approach.
- Integrating STD care into MCH/FP services.
- Targeting interventions to people at risk, including initiating special services for them.
- Prevention and control of congenital syphilis and ophthalmic neonatorum.
- Improving health care seeking behaviour through Health Education and IEC in general.
- Facilitating behavioural change and condom promotion though IEC and Advocacy.
- Integrating STD care into Primary Health Care (PHC) services.
- Conducting Research and Surveys with involvement of consultant hospitals.
- Management strengthening intervention at all levels.
- Monitoring and Evaluation.
- To integrate STD care in the PHC services.
- Training of health workers in providing improved comprehensive case management of STDs by syndromic approach.
- To develop training packages of STD management for service providers.
- To forecast and plan for a detailed list of STD drugs, reagents and other medical supplies required for the management of STDs in the country.
- To organize the procurement, storage and distribution of STD drugs, including laboratory reagents and other supplies through Medical Stores Department (MSD) for districts.
- To monitor drug susceptibility patterns of STD causative agents and updating STD case management.
- To set up sentinel Surveillance systems in order to monitor STD sequelae, HIV, ant microbial patterns and STD aetiologies.
- To collect and analyse data needed for STD monitoring according to laid down indicators.
- To coordinate research activities on STDs
- To conduct social studies in order to promote treatment seeking behaviour
- To ensure that national STD standards and treatment guidelines are observed.
- To mobilise resources.
- Develop and disseminate national STD standard and treatment guidelines
- To monitor and evaluate the implementation of STD activities indicated in MTP-III.
- To elaborate national guidelines for prevention, control and management of STDs/AIDS in order to implement the plan.
- Coordination of other sectors in STD prevention and control.
- Develop and disseminate IEC materials on STDs
- To implement STD health education activities including promotion of early treatment and prevention of STDs.
- To contract out activities to be implemented by other actors involved in the STD prevention and control, coordination, logistic support and supervision of those activities.
- To organize workshops/seminars, etc. to share experiences, information and update knowledge of partners working on STDs prevention and control.
- To provide technical support to partners working on STDs.
- To assist Districts, regions and other stakeholders to plan and implement integrated STD/AIDS prevention and control activities.
- To design, develop and distribute national guidelines on STDs management to all actors and stakeholders in order to create a supportive environment for STDs prevention and control.
- To strengthen the capacity of institutions, communities and individuals to arrest the spread of STDs.
- To promote community involvement in STD/HIV prevention and care
- To initiate efforts for patients access to care and treatment with drugs against HIV and opportunistic infections.
4.0 Clinical/STD Unit
Sexually Transmitted Diseases (STDs) are increasingly recognized as a major public health problem in Tanzania. STDs are not only a major cause of morbidity but are also risk factors for the Sexual transmission of HIV infection. As a result of the AIDS Pandemic, Prevention of STDs has received renewed attention.
The Clinical and STD Unit has been charged with the responsibility of co-ordinating the implementation of a nationwide STD Control Programme.
The Clinical and STD Unit works to promote the control of STDs in Tanzania guided through the following strategies:
FUNCTIONS FOR IMPLEMENTING THE STD STRATEGIES
To promote multisectoral involvement in activities aimed at reducing transmission of STDs.
- Coordination of STD prevention and control interventions in Tanzania
- To conduct regular epidemiological surveys to validate notification and sentinel surveillance data.
5.0 Epidemiological and Research Unit
5.1 Epidemiological Unit
3.0 Laboratory Unit
The Laboratory Unit undertakes the following services all over Tanzania Mainland:
4.0 THE COUNSELLING AND SOCIAL SUPPORT UNIT
When the First Medium Term Plan (MTP -I) was formulated, the counselling unit activities were under the Information Education and Communication (IEC) Unit. During the review of MTP -I to strengthen NACP capacity and due to the escalating number of People Living with HIV/AIDS (PLHAs), it was recommended to establish a separate unit for the Counselling and Social Support (CSSU) activities under the MTP-II. The Unit was charged with the responsibility of promoting and coordinating the counselling and social support services in the country, to ensure optimal quality of life of PLHAs and their family members.
The unit was established to provide information regarding the trend of the HIV/AIDS/STD epidemic in the country. To undertake this unit has established an Epidemiological and behavioural surveillance system throughout the country whereby data is collected by using special data collection tools and forwarded to the unit for compilation, analysis, production and utilization.
- Establishing and strengthening sentinel surveillance sites in the country according to needs assessment.
- Capacity building including training of staff.
- Development of data collection tools and dissemination.
- Data compilation, processing and analysis.
- Production and dissemination of surveillance reports annually to stake holders.
- Supervise and monitor data collection system from different sources. Including routine data collection of AIDS and STD patients.
- Organize and conduct surveys and research on specific surveillance issue and area.
- Surveillance and epidemiology
- Social behavioural and communication research
- Health and Social service research
- To develop means of preventing infection with HIV
- To Develop better diagnostic and treatment methods for HIV/AIDS
- To better define risk factors and develop interventions against HIV/AIDS
- To monitor the spread of HIV and to determine the impact of intervention.
- Convene research committee meetings
- Review of research protocols for ethical clearance
- Organize researchers meetings
- Dissemination of research findings
- Monitor research progress
- Conduct Research priority setting workshop
- To coordinate all HIV/AIDS/STD research activities in the country
- To Keep inventory of research activities in the country
- Monitor, supervise and evaluate quality implementation of activities for HIV care, treatment and support
- Conduct short and long term strategic planning activities on HIV care and treatment
- Coordinate the development training materials and training of health care workers on HIV care and treatment
- Develop, formulate and review policy guidelines on HIV care and treatment and drug access for People Living with HIV (PLHIV)
- Monitor supportive supervision and clinical mentoring of HIV care, treatment and support in collaboration with RHMTs and CHMTS
- Coordinate forecasting and quantification of ARVs, Opportunistic infection drugs requirement for PLHIV
- Prepare quarterly and annual implementation reports on HIV care, treatment and support
- Coordinate activities towards scale up of pediatric HIV care, treatment and support
- Promote Coordinated HIV care, treatment and support including strengthening links between the health system and implementers of community and Home based care and treatment services
- Number of trained health care workers on HIV care, treatment and support from health facilities selected to provide HIV care and treatment services
- Number of health facilities providing HIV care and treatment services
- Number of PLHIV enrolled in the HIV care and treatment programme
- Number of PLHIV started on Antiretroviral therapy
- Number of children enrolled and initiated antiretroviral therapy
- Number of supportive supervision and clinical mentoring conducted
The specific functions of the unit include the following:
7.0: CARE AND TREATMENT UNIT
The Unit was established in 2004 following the formulation of the National HIV/AIDS Care and treatment Plan. The Plan became operational in October 2004 and it targets to providing ARVs to eligible PLHIV and other services like treatments of opportunistic infections.
HIV Care and Treatment Unit Output
Coordinates scale up of quality HIV care and treatment services to PLHIV through various activities as mentioned above. Implementation of HIV care and treatment services is done at Referral, regional and district hospitals as well as primary health facilities i.e. health centers and dispensaries.