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Tanzania

Tanzania-mapIn the midst of a mature, generalized AIDS epidemic and burdened by high risk of other communicable diseases, Tanzania’s health and social welfare systems are faced with many challenges.

About 2 million Tanzanians are living with HIV and there is an average adult HIV prevalence estimated at 5.1 percent, according to both the Tanzania Commission for AIDS and UNAIDS.

Strengthening the health system to better respond to the HIV epidemic is impeded by a severe shortage of trained human resources, inadequate infrastructure, and overburdened logistics systems and supply chains, among other factors.

With support from PEPFAR and the United States Government team in country, AIHA has been working toward an AIDS Free Generation by building sustainable institutional capacity and human resources for health in Tanzania since 2005.

Current Projects

The Tanzania Nursing Initiative
2005 – Present

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.

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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 and AIDS treatment, care, and prevention.

TNI stakeholders include the School of Nursing at Muhimbili University of Health and Allied Sciences, the Ministry of Health and Social Welfare’s Nursing Training Unit and Chief Nurses Office, the Tanzania National Nurses Association, the Tanzania Nurses and Midwives Council, World Services of La Crosse, Inc., and Winona State University College of Nursing.

Together, AIHA and these broad-based partners provide ongoing technical assistance needed to build capacity for sustainable and professional nursing training and practice in the country. The project encompasses faculty training and mentoring, development of competency-based curriculum, and support for training institutions.

AIHA’s Tanzania Nursing Initiative uses a structured and holistic approach focusing on four key areas:

  • Education
    curriculum and faculty development, school support
  • Nursing Regulation
    improving the safety of nursing service delivery and public protection through licensure and examinations
  • Association Building
    advocacy, improving the public’s perception of nurses and nursing care
  • National Authorities
    policy development, nursing leadership development

 

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 almost 400 nurse tutors on the material, and implementing the program 72 nursing schools throughout the country.

Partners are also improving learning environments at targeted schools through the installation of skills labs, International Council of Nursing Mobile Libraries, and a pilot tablet project that is strengthening nursing education by enhancing access to texts and evidence-based resources.

Before we got the Mobile Library, the only books I had access to were from the 1980s. These were so outdated there was no material on HIV/AIDS at all. HIV is a huge problem in my community and the new resources have really helped me gain a better understanding of prevention and treatment options.”

— Jacqueline Mgasa, student, Mirembe School of Nursing, Dodoma

 

Nursing leadership capacity is another focus of TNI and partners are working to develop strong national nurse leaders as a way to effectively increase the number of well-trained healthcare workers and integrate these critical caregivers into the health system, while at the same time supporting country ownership and long-term sustainability.

The Tanzania Social Work and OVC Support Initiative
2006 – Present

Partners at the Tanzania Institute of Social Work, Jane Addams College of Social Work, and the Midwest AIDS Training and Education Center at the University of Illinois in Chicago are improving care and support for orphans and vulnerable children by providing in-service social work training to community-based workers, as well as addressing Tanzania’s long-term need for skilled social workers by strengthening pre-service training programs, working with emerging schools of social work throughout the country, and supporting professional social work associations.

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Since 2006, 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 has been working in close collaboration with Tanzania’s Ministry of Health and Social Welfare to strengthen the country’s social work profession.

PSWCoverImageA particular focus has been 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.

The PSW Program in Numbers

In collaboration with the Tanzania Human Resource Capacity Project, AIHA and our partners have fully trained 2,563 certified PSWs; 743 PSW supervisors; and 103 master trainers. In addition, another 2,119 individuals have completed PSW I training. ISW leads all related technical assistance and quality control efforts for implementation of the PSW training.

 

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 field work.

Tanzania’s Ministry of Health and Social Welfare 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 service welfare workforce. The efforts and benefits of a trained social welfare workforce ensure a loss to follow up and a continuity of care across community and clinic-based service providers.

The first SWA class of 35 students graduated in December 2013 from the Kisangara Institute of Social Welfare. To date, 96 SWAs have graduated from Kisangara and have been deployed to work at the ward level providing case management services to OVCs and other vulnerable populations, as well as supportive supervision to PSWs working in their wards.

Another component of this initiative is strengthening the social work profession in Tanzania through support for the Tanzania Association of Social Workers (TASWO). The Association is currently focused on expanding 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. To date, TASWO has opened 10 regional offices and recruited more than 600 association members.

Through the initiative, AIHA and our partner also support the Tanzania Emerging Schools of Social Work Program (TESWEP) to strengthen the country’s capacity to provide quality social work education. This component is focused on building the capacity of 14 schools of social work throughout Tanzania by standardizing curricula and providing a broad range of faculty support, training, and development activities.

TESWEP was recently registered as an autonomous organization under the name of the Association of Schools of Social Work in Tanzania, whose vision is to become the nation’s leader in supporting social work education and educators.

The U.S. Embassy in Tanzania recognized the important impact AIHA-trained Para Social Workers are having at the community level in this PEPFAR success story.

 

Past Projects

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.

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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.

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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.

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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.

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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.