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In the midst of a mature, generalized AIDS epidemic and burdened by other communicable and non-communicable diseases, Tanzania’s health and social welfare systems face many challenges. About 1.4 million Tanzanians are living with HIV and there is an average adult HIV prevalence estimated at 4.7 percent, according to UNAIDS. Strengthening the health system to better respond to public health challenges, as well as the country’s HIV epidemic, is impeded by a severe shortage of trained human resources for health, inadequate infrastructure, and overburdened logistics systems and supply chains, among other factors.
The complexity of Tanzania’s HIV/AIDS epidemic requires a comprehensive management system of prevention, care, and treatment services, which encompasses diverse clinical, biomedical, and psycho-social interventions along the cascade of HIV/AIDS care. Sustainable outcomes can only be reached if Tanzania has a healthcare workforce with the necessary skills mix.
With support from PEPFAR and the US team in country, AIHA has been working toward an AIDS Free Generation by building sustainable institutional and human resource capacity for health in Tanzania since 2005.
Click here for a printable overview of our work in Tanzania.
The Tanzania Nursing Initiative
2005 – 2017
With its roots in an institutional twinning partnership linking Muhimbili University College of Health Sciences School of Nursing with a community-based consortium led by World Services of La Crosse in Wisconsin, the Tanzania Nursing Initiative has evolved into a far-reaching technical assistance and support program that is supporting nursing education and professionalism throughout the country.
Nurses constitute the largest healthcare provider workforce in Tanzania. They are frontline caregivers providing specialized treatment and care to people living with HIV (PLHIV), as well as broader clinical services to the entire population. With support from PEPFAR and CDC/Tanzania, AIHA has been working to strengthen the profession and ensure an adequate supply and quality of nurses in the country since 2005 through our dynamic Tanzania Nursing Initiative (TNI).
Over the years, TNI has evolved from an institutional partnership created to strengthen nursing school capacity to equip students with the knowledge and skills they need to provide quality care, to a multi-pillared national project that supports improved recruitment, deployment, and retention for this critical cadre that has long been on the front lines of HIV/AIDS treatment, care, and prevention.
TNI stakeholders have included the Ministry of Health, Community Development, Gender, Elderly and Children’s (MoHCDGEC) Nursing Training Unit and the Directorate of Nurse and Midwifery Services (DNMS), the Tanzania Nurses and Midwives Council (TNMC), the School of Nursing at Muhimbili University of Health and Allied Sciences, the Tanzania National Nurses Association (TANNA), World Services of La Crosse, Inc., Winona State University College of Nursing, and the University of Michigan School of Nursing.
Together, AIHA and these broad-based partners have provided the targeted and ongoing technical assistance needed to build capacity for sustainable, professional nurse training and practice in the country. The project encompasses faculty training and mentoring, development of competency-based curricula, and support for training institutions.
A crucial initial accomplishment of TNI was the development and roll out of an HIV/AIDS care training package, which included creation of a multi-module curriculum, training more than 300 nurse tutors, and implementing the program at 72 nursing schools throughout the country.
AIHA’s Tanzania Nursing Initiative uses a structured and holistic approach focusing on four key areas:
Partners also improved learning environments at targeted schools through the installation of skills labs, International Council of Nursing Mobile Libraries, and a pilot tablet project designed to strengthen nursing education by enhancing
access to up-to-date texts and evidence-based resources.
In January 2017, AIHA graduated TNI partners involved with the education pillar as priorities for technical assistance shifted to the development of regulatory mechanisms to support Tanzania’s new task sharing policy, which empowers nurses, social workers, and allied health cadres to provide HIV/AIDS-related services. This new focus entails revising existing scopes of practice to incorporate HIV counseling and testing services, nurse-initiated and managed ART (NIMART), pharmaceutical dispensing, and adherence counseling, as well as providing training to up-skill these cadres in preparation for their expanded roles in the provision of treatment, care, and support services for PLHIV.
In support of the other three pillars, AIHA has been providing direct technical assistance to Tanzania’s Directorate of Nursing and Midwifery Services to bolster its capacity to oversee the provision of quality nursing and midwifery services throughout the country; helping to strengthen TNMC’s ability to build capacity of nursing supervisory authorities at the regional and district levels; and building TANNA’s capacity to promote nursing excellence, influence health policy, and advocate for its 13,000 members nationwide.
Key recent accomplishments of this dynamic initiative include identifying HIV/AIDS competency gaps and working with the Ministry of Health to upgrade training in prevention of mother-to-child transmission (PMTCT), gender based violence (GBV), violence against children (VAC), family planning, voluntary medical male circumcision (VMMC), and services for key populations for both certificate and diploma-level curricula.
Partners also conducted PMTCT Option B+ trainings for 100 nurse tutors from high-burden districts across Tanzania and AIHA provided technical support to the Ministry’s Directorate of Nurse and Midwifery Services on the development of the national nursing scheme of service, updates to the scope of practice for nurses and midwives, and revised job descriptions for nurses and midwives based on the task sharing policy. In addition, AIHA helped to develop Respectful and Compassionate Care Guidelines for Nurses and Midwives, which will help nurses improve quality of and retention in care for PLHIV.
In response to Tanzania’s new task sharing policy, TANNA developed an advocacy plan that is guiding the association’s advocacy efforts to strengthen and promote the professional development of nurses, advance their economic and
general welfare, and increase and strengthen the positive image of nurses in Tanzania.
Under the aegis of TNI, the Directorate of Nurse and Midwifery Services completed a baseline assessment to determine how implementation of the task sharing policy and Test and Start by nurses can effectively position Tanzania to attain the global 90-90-90 targets by 2020.
TNI partners selected 12 priority districts in six ministerial zones for data collection on identified NIMART indicators — key national HIV/AIDS and PEPFAR indicators that can demonstrate the role of nurses in the continuum of HIV-related services. The results of the baseline assessment provide a unique opportunity not only to gain a clear picture of where real needs are and where investments can make a significant difference, but also a means to implement the NIMART intervention systematically while scientifically gauging impact.
In February 2018, AIHA and its nursing partners developed a NIMART Handbook, which is being distributed to nurses working in the 12 pilot districts. The handbook provides guidance on who will practice NIMART, when, and under which circumstances. Following finalization and approval of the NIMART Handbook, we developed a NIMART training package consisting of a Facilitator Guide and Participant Manual in advance of the in-service training launch in May 2018. In
addition, AIHA and DNMS developed the National NIMART M&E Framework to guide data collection, analysis, and utilization and to provide a means to measure the contribution of NIMART toward epidemic control by 2030.
AIHA supported TNMC’s efforts to develop a national continuing professional development (CPD) mechanism and accreditation guidelines and is currently developing 10 CPD modules on HIV/AIDS. AIHA recognizes that life-long learning is one-way Tanzanian nurses and midwives can demonstrate their knowledge and clinical skills to the public thereby positively influence attitudes and perceptions about these medical professions. We are committed to developing and supporting a CPD system for these critical frontline health worker cadres to ensure they are constantly updating their knowledge and skills and maintaining professional standards of care. Additionally, TNMC, with AIHA support, finalized the scope of practice addendum for nursing and midwives incorporating expanded HIV/AIDS roles per the task sharing policy. Example tasks include ART prescribing, ART adherences, and VMMC were added to the scope of practice. The scope of practice encompasses the full range of roles, responsibilities, activities, and functions that nurses are educated, legally authorized and competent to inform.
The Tanzania Social Work and OVC Support Initiative
2006 – 2016
From 2006 to 2016, AIHA’s twinning partnership linking the Tanzania
Institute of Social Work (ISW) with Jane Addams College of Social Work and the Midwest AIDS Training and Education Center (MATEC) at the University of Illinois in Chicago worked in close collaboration with Tanzania’s Ministry of Health and Social Welfare to strengthen the country’s social work profession.
A particular focus was on training a new community-level social service
cadre called Para Social Workers (PSWs) in key social work, case management, psychosocial support, and child development skills, so they are better able to address the needs of most vulnerable populations, including orphans living with or affected by HIV/AIDS and PLHIV.
The comprehensive, multi-stage training program arms PSWs with the knowledge and skills they need to identify children and households most at risk for HIV infection then provide necessary care or referrals to other organizations for needed services. The case management approach PSWs employ helps ensure vulnerable children and their caregivers have access to a holistic support continuum that includes health and allied care, education, nutrition, legal, and other needed services. In 2016, the US and Tanzanian partners updated the PSW curriculum, including enhanced HIV/AIDS competencies to support global 90-90-90 targets and an expanded focus on linkages and referrals to HIV counseling and testing services.
Under the partnership, AIHA and our partners supported the June 2012 launch of a companion social welfare workforce strengthening program representing the next step on a career ladder to enhance the country’s social support system. The Tanzania Social Welfare Assistant Program is year-long certificate program that prepares PSWs or others with similar backgrounds for employment in ward-level social welfare roles. The Social Welfare Assistant (SWA) course includes seven months of classroom work and two months of supervised fieldwork.
Tanzania’s Ministry of Health, Community Development, Gender, Elderly and Children has set a goal of training 6,000 individuals through the SWA program as a means to bridge the human resource gap and strengthen the country’s overstretched health and social welfare workforce. The efforts and benefits of a trained social welfare workforce ensure fewer patients are lost to follow up and support continuity of care across the community and clinic-based service providers. A total of 140 SWAs have completed training at the Kisangara Institute of Social Welfare and were deployed at the ward level, where they provide case management services to vulnerable populations and supportive supervision to PSWs.
Another important component of this initiative is strengthening the social work profession in Tanzania through support for the Tanzania Association of Social Workers (TASWO). AIHA is supporting TASWO’s efforts to expand opportunities for social work
professional development and continuing education, as well as working with partners to help establish a National Social Work Council to regulate the profession.
In response to Tanzania’s new task sharing policy and the expanded roles of social workers, TASWO conducted a baseline assessment to determine how social welfare cadres can effectively meet national indicators for social welfare services and HIV/AIDS care and treatment services. An assessment was conducted in 18 PEPFAR priority districts across six zones, and data analysis is currently underway. TASWO also supported the revision of the scheme of service for social workers to better align with task sharing.
Through the project, AIHA and our partners also supported the Tanzania Emerging Schools of Social Work Program (TESWEP) to strengthen the country’s capacity to provide quality social work education. This component focused on building the capacity of 14 schools of social work throughout Tanzania by standardizing curricula and providing a broad
Tanzania Ministry of Health and Social Welfare / Boulder Community Hospital
(2006 – 2015)
AIHA and the Boulder partners successfully strengthen capacity to provide high quality HIV diagnostic services at 23 regional laboratories throughout the country.
Medical labs in Tanzania are faced with a severe shortage of qualified staff who are capable of supporting care and treatment services.
AIHA began working with the Ministry of Health and Social Welfare’s Diagnostic Services Section in 2006, linking them with experts at Boulder Community Hospital (BCH) in Colorado to strengthen the capacity of regional labs, with a particular focus on improving the quality of HIV diagnosis and treatment monitoring services.
A key component of this partnership, which graduated in March 2015, was providing ongoing mentorship to ensure proper implementation of standard operational procedures and quality standards.
AIHA supported placement of some 40 lab mentors at 23 regional sites where they provided technical assistance, monitoring, and quality control. Additionally, we provided more than 50 lab workers with professional development opportunities while BCH experts trained Tanzanian lab mentors in quality systems essentials, which is in turn enabling them to support the efforts of regional labs to attain 3-star accreditation through the Strengthening Laboratory Management through Accreditation (SLMTA) Program.
SLMTA aims to strengthen lab management, achieve immediate lab improvement, and accelerate the process toward accreditation based on international standards. By the completion of the project, three participating labs had attained a one-star rating on WHO’s SLIPTA scale and Temeke Hospital Lab earned the country’s first 3-star rating.
Temeke Hospital Lab was highlighted as a PEPFAR success story in late 2014.
Evangelical Lutheran Church of Tanzania / Empower Tanzania
2007 – 2015
Partners are improving treatment and care services for PLWH in Tanzania’s Pare Diocese by training medical and non-medical workers in palliative care.
Home-based care (HBC) is a crucial component of the holistic approach
necessary to care for PLHIV and other life-limiting illnesses, yet both hospital and home-based palliative services are extremely limited in Tanzania.
From 2007 to 2015, AIHA partners at the Evangelical Lutheran Church in Tanzania’s Pare Diocese and an Iowa-based consortium led by Empower Tanzania worked to change that by training both medical and non-medical workers to provide high quality care and support to adults and children living with HIV.
Upon completion of the project, they trained more than 300 community health workers at 21 target sites in the Same and Mwanga districts. These HBC workers routinely conducted home visits with patients, providing much-needed care to more than 3,973 patients. In addition, partners trained 10 sustaining trainers/clinical supervisors, who provide complementary services and oversight for the community health workers affiliated with their respective sites.
Partners also established a Patient Support and Care Center that assists in centralizing information and resources. It also provides continuous, sustainable training opportunities for community health workers.
To gain more buy-in from the local government to better ensure long-term sustainability of the program, AIHA and our HBC program partners established a successful collaboration with Community Health Management Teams and local government officials.
Upon graduation of the program, both Same and Mwanga district Medical Officers pledged to include funding in their annual budgets for HBC services based on the success of the AIHA-supported program.
In 2015, AIHA will work to further institutionalize quality improvement practices that sustain reductions in morbidity, mortality, and transmission of HIV as we work toward achieving an AIDS-free generation as an HBC technical assistance provider to Tanzania’s National AIDS Control Program.
Tanzania Ministry of Health and Social Welfare (Zanzibar Department of Substance Abuse and Prevention; Non-Communicable Disease, Mental Health, and Substance Abuse Department; Drug Control Commission) / Great Lakes Addiction Transfer and Technology Center
2008 – 2013
Partners collaborated to strengthen ministry and local NGO capacity to implement HIV and substance abuse prevention programs targeting high-risk children and young adults between the ages of 10-24.
Substance abuse and addiction play a critical role in the transmission of HIV, as well as adherence to treatment for people already living with the virus.
From 2008 to 2013, AIHA’s Substance Abuse and HIV Prevention partners at Tanzania Ministry of Health and Social Welfare’s Zanzibar Department of Substance Abuse and Prevention and Mainland Non-Communicable Disease, Mental Health, and Substance Abuse Department and Drug Control Commission worked with the Great Lakes Addiction Transfer and Technology Center to reduce HIV incidence and prevalence rates among substance abusers in Tanzania through a comprehensive, evidence-based approach with a strong focus on a recovery oriented system of care (ROSC).
Partners conducted their first training in Zanzibar in January 2009 for 35 peers in recovery, as well as representatives from the Ministry of Health and Social Welfare’s Department of Substance Abuse and Prevention. Titled “How to Create a Community of Recovery” the workshop focused on the “12 Steps Recovery Model” and the “Islamic Milati,” and was designed to increase capacity to address both HIV and substance abuse in Zanzibar. An early outcome of the training was increased awareness of and attendance at 12-step programs in the community.
Inter-faith dialogue played an important role in collective efforts to understand both HIV and substance abuse within the local community therefore partners and AIHA staff visited the Muslim Education and Welfare Association (MEWA) in Kenya to gain a greater knowledge of the models they have in place for recovery within the East African context, which helped to direct activities as this partnership progressed.
Partners established 10 Sober Houses in Zanzibar, including one for women, and they conducted ongoing family therapy sessions to support people facing addiction-related issues. They also actively collaborated with faith- and community-based organizations to prevent new HIV infections among substance abusers, other vulnerable populations, and the community at large.
Based on the project’s success in Zanzibar, Tanzania’s Ministry of Health and Social Welfare requested its replication on the Mainland, which was accomplished prior to the partnership’s graduation in 2013.
Volunteer Healthcare Corps Tanzania Preceptors Initiative
2007 – 2010
In support of Tanzania’s Ministry of Health and Social Welfare’s goal of expanding ART services at more than 200 care and treatment sites, the VHC actively recruited clinical experts to provide onsite technical assistance through this Initiative.
Currently, AIHA’s VHC supports the efforts of our institutional partnerships and programs by recruiting skilled volunteers to provide technical support and mentoring as requested.
In the mid-2000s, Tanzania’s Ministry of Health and Social Welfare set ambitious goals for national expansion of HIV/AIDS treatment, seeking to expand ART services to 200 sites supporting a total of 100,000 patients on ARV treatment over the next several years. AIHA supported this rapid expansion through our Volunteer Healthcare Corps (VHC).
With the goal of increasing the institutional and human resource capacity of HIV care and treatment centers, the Tanzania Preceptors Initiative placed highly skilled professionals at PEPFAR-supported sites, where they served as onsite technical experts for a period ranging from three months to two years.
During that time, their dual goals were to increase institutional capacity to deliver and expand quality HIV/AIDS treatment and care services and to increase staff competencies in HIV-related treatment, care, and support.
VHC volunteers mentored staff; assisted with the provision of services as needed; and helped with program expansion, quality control, and other support tasks beneficial to the host institution.
As of May 2011, the VHC had placed 18 skilled professionals in volunteer assignments at 14 different sites in Tanzania. The average duration of these assignments — which included placements as an in-service training officer, pediatric clinical preceptor, pediatric nurse, and adherence counselor — was 8.5 months. Collectively, these VHC volunteers contributed more than 156 months toward strengthening health system capacity in Tanzania.
Although the Tanzania Preceptors Initiative officially concluded in late 2010, AIHA continues to field requests for skilled volunteers from our partnership institutions in country.