A relatively large and populous country located in East Africa, Tanzania, with a population of more than 56 million, is slightly larger than twice the size of the US state of California. Tanzania’s population includes more than 120 different ethnic groups but it is generally a very cohesive society with few ethnic rivalries and one prominent language, Swahili. Almost one-third of the population lives in urban areas, and more than one-tenth of the urban population resides in Dar es Salaam, the largest city and former capital of the country.
However, the Tanzanian economy is overwhelmingly agrarian and some two-fifths of the country’s population is engaged in agricultural production. Tanzania’s population growth rate is lower than the world average and below that of many of the countries of sub-Saharan Africa and life expectancy, at about 50 years, is above average for the subcontinent.
Over the past decade, Tanzania’s overall health status has improved as measured by increased life expectancy, a declining rate in infant mortality, improved health care, increased availability of clean water, and better nutrition, among other areas.
However, one of the most daunting problems that Tanzania confronts remains the high incidence of HIV/AIDS. About 1.4 million Tanzanians are living with HIV and there is an average adult HIV prevalence rate estimated at 4.7 percent, according to UNAIDS. While HIV/AIDS is a generalized problem, HIV prevalence rates are highest and those receiving ART treatment are lowest among the most vulnerable and marginalized populations.
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. It also requires interventions aimed at civil society groups, particularly those representing and providing services to key populations and vulnerable groups.
Sustainable outcomes can only be reached if Tanzania has a healthcare workforce with the necessary skills mix. 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.
While AIHA has been active for many years in Tanzania, under the Twinning Center project, in 2020, AIHA began assisting Tanzania under the grant CDC1950, with initial interventions aimed at improving the capacity of local civil society organizations comprising and representing vulnerable and marginalized populations to respond to the pandemic in their communities.
Click here for a printable overview of our work in Tanzania.
Targeted Programmatic Support Across Countries (CDC1950)
(2020 – Present)
In September 2019, the U.S. Centers for Disease Control and Prevention (CDC) awarded AIHA a five-year grant, providing a vehicle by which AIHA can assist the CDC at the global and country level, in support of the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.
AIHA initiated activities under the CDC1950 grant in Kenya (October 2019), Tanzania and Zambia, (April 2020), Nigeria (May 2020), Guatemala (July 2020), Haiti (October 2020), the Dominican Republic (October 2020), and the Philippines (2020) the goal of which is to strengthen Key Population (KP) and Civil Society (CSO) led organizations’ capacity to deliver services to vulnerable populations to stem the spread of HIV/AIDS through various prevention, care and treatment initiatives. The project also provides KP-led organization with the skills and abilities to enable them to operate as primary recipients (and sub-grantors) of US/PEPFAR and other donor funding.
AIHA is conducting this work in collaboration with CDC/Atlanta and respective CDC Country Offices and National KP Consortia.
Once KP-led organizations in-country have been identified, the first step in the process is to conduct an assessment of organizational capacity. AIHA has used the Organizational Capacity Assessment (OCA tool), a self-assessment that each KP-led or KP-competent organization interested in participating in this project needs to complete to determine gaps and training needs.
The OCA forms submitted by 30 CSOs were analyzed and then shared along with recommendations with the national KP networks. This helped determine the list of 10 KP-led CSOs to be included in the project and informed the development of an organization-specific training plan. The most common gaps identified were in Project, Finance, Human Resources and Organizational management. Due to COVID19 pandemic, AIHA has been conducting trainings on priority areas via a set of webinars to be followed by one-on-one mentorships. All CSOs are welcome to listen to webinars but one-on-one mentorship is being provided to 10 organizations selected for the project.
In May 2020, AIHA – in collaboration with AVAC and the CDC – arranged stakeholders’ consultations with the KVP Forum of Tanzania to discuss the needs of KP-led organizations and identify priorities for training and mentorship.
Trainings were delivered by local consultants in very close collaboration with the KVP Forum.
In Year 1 AIHA conducted trainings in Project and Finance Management via face-to-face workshops and three on-line trainings on Strategic Planning, Governance and Advocacy that were delivered by AVAC. All trainings were followed by mentorships.
In Project Year 2 AIHA focused on the following:
Objective 1: Strengthen financial resiliency through planning for diversified sources of revenue
In accordance with gaps identified in Year 1, AIHA delivered trainings on Finance and Project Management followed by a two week-long on-line training on Social Enterprise and diversified sources of revenue. All trainings were followed up with in-country based mentorship. Upon completion of the training on Social Enterprise, participants submitted draft business plans that included a social enterprise scheme (e.g. a profit-generating activity).
Objective 2: Build capacity to implement and sustain social enterprise schemes
- Small grants were provided to CSOs to address their capacity development needs followed by implementation of their social enterprise capacity development plans. A local consultant and AVAC supported selected organizations in each country to implement their social-enterprise schemes.
Key results (over two year project period):
Key Results of OCA-informed Training and Mentorship Programs:
- Organizational Capacity Assessment completed. 30 CSOs participated, 10 selected for mentorship;
- AIHA conducted a five-day online training on Finance Management training in June primarily for Kenya and included a small group from Tanzania
- Due to insufficient internet connectivity and the need to provide the trainings in Swahili, the KVP Forum strongly recommended to conduct the workshops using a face-to-face format
- 25 participants attended the 5-days training on Finance Management
- 25 participants attended the 3-days training on Project Management
AVAC provided the above-mentioned trainings online:
- 154 participants from 33 CSOs attended three online trainings
- 116 mentorship hours were delivered by local mentors upon completion of the training
- 30+ CSOs attended Finance Management Part II training
Key Results of Social Enterprise Initiative:
- 50+ CSOs participants attended social enterprise trainings
- 20+ CSOs participated in social enterprise trainings, including 10 of 10 of eligible CSOs.
- 6 of 10 eligible CSOs submitted business plans for Social Enterprise mini-grants
- 2 of eligible CSOs were awarded Social Enterprise mini-grants
Tanzanian CSOs will share their experiences, lessons learned and recommendations for follow-up in an on-line Learning Exchange Forum scheduled for November 2021.
Strengthening Community Home-based Care to Improve HIV/AIDS Outcomes
(2017 – 2019)
In 2015, PEPFAR tasked AIHA with providing national technical assistance towards improvement of quality of community-based HIV services in Tanzania. Under AIHA’s Twinning Center Program, one crucial accomplishment was the development of standardized national HIV/AIDS QI guidelines, a training package, and SOPs, which will be used to build capacity of community QI teams to improve quality of services offered at the community level.
Tanzania’s National Community Based Health Care Strategic Plan for 2014-2020 calls for strengthening community involvement and participation to improve health outcomes. In response to the country’s shortages of trained human resources for health, the Government of Tanzania has reiterated its willingness to revive and integrate the Community Health Worker (CHW) cadre into the national health workforce as a way to ensure the reliability, availability, efficacy, and organizational sustainability of this important sub-set of care providers.
AIHA worked with the President’s Office Regional and Local Government Administration and other stakeholders to provide targeted technical assistance, including developing standardized national HIV/AIDS quality improvement guidelines, a comprehensive training package, and standard operating procedures that will be used to build the capacity of community quality improvement teams to effectively support the provision of quality healthcare services offered at the community level.
To read the final closeout report of AIHA’s Twinning Center Program, click here.
The Tanzania Nursing Initiative
(2005 – 2019)
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 evolved into a far-reaching technical assistance and support program that supported 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 worked 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, 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 provided the targeted and ongoing technical assistance needed to build capacity for sustainable, professional nurse training and practice in the country. The project encompassed 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 used a structured and holistic approach focusing on four key areas:
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
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 provided 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 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.
To read the final closeout report of AIHA’s Twinning Center Program, click here.
Developing Local Capacity in Biomedical Engineering and Technology
(2017 – 2018)
In 2017, CDC Tanzania provided the AIHA Twinning Center some funding to support the biomedical engineer cadre with necessary skills to provide maintenance of laboratory equipment, particularly VL machines. In collaboration with the Ministry of Health’s Health Care Technical Services Diagnostic Section, faculty from colleges offering biomedical engineering program, laboratory vendors, and other key stakeholders, AIHA utilized local and regional expertise to equip the cadre with in-service training, supportive supervision and mentorship. Over the course of the project, AIHA built the capacity of biomedical and laboratory personnel on VL machine maintenance at 18 facilities.
In response, AIHA worked with the Ministry of Health’s Health Care Technical Services from 2017-2018 to ensure that biomedical engineers and technicians are adequately trained and deployed to ensure availability of comprehensive, quality HIV diagnostic services in support of the HIV/AIDS care and treatment cascade.
Key accomplishments include the development of a training curriculum on viral load machine maintenance in collaboration with biomedical engineering training institutions and viral load equipment suppliers. The curriculum was used to train 25 biomedical technicians and 36 laboratory personnel, including lab managers, from 18 viral load facilities to provide first-line and preventative maintenance of the machines to ensure availability and quality viral load monitoring services. To ensure sustainability, a TOT was conducted with 10 biomeds to equip them with the knowledge and skills to continue providing viral load training after the close of the project.
The Tanzania Social Work and OVC Support Initiative
(2006 – 2016)
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.
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 field work.
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 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 under way. 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 range of faculty support, training, and development activities. For example, in 2016 a MATEC Consultant worked with field practicum coordinators from three schools that offer Masters of Social Work (MSW) programs to improve learning environments for students during field placements. TESWEP was recently registered as an autonomous organization called the Association of Schools of Social Work in Tanzania (ASSWOT), which is dedicated to becoming the nation’s leader in supporting social work education and educators.
To that end, ASSWOT has formed a strong working relationship with the Ministry and, in 2016, conducted a meeting to share findings from a situational analysis that assessed HIV/AIDS competencies in social work education across the country; collaborated with MoHCDGEC to find ways that the country’s schools of social work can utilize the national system for managing training institutions data; and began installing the Training Institutions Information System (TIIS) at the schools to facilitate integration of their data into the Ministry’s system as a way to enhance HRH planning.
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 from the Twinning Center Program, both Same and Mwanga district Medical Officers pledged to include funding for HBC services in their annual budgets based on the success of the AIHA-supported program. In 2015, AIHA worked to further institutionalize quality improvement practices that sustain reductions in morbidity, mortality, and HIV transmission in support of Tanzania’s efforts to achieve an AIDS-free generation as an HBC technical assistance provider to the President’s Office Local and Regional Government Administration.
To read the final closeout report of AIHA’s Twinning Center Program, click here.
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.
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.
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.
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.
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.