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This report comprehensively summarizes the FHI/AIDSCAP program in Tanzania (1991-1997). The report includes a background and country context for the program, as well as an overview of the Tanzania AIDS Project, and a discussion of work undertaken to mobilize communities and strengthen capacity; support interventions and create an enabling environment; and conduct research and evaluation. Lessons learned from the program are also listed.
Table of Contents Executive Summary (See Below) II. Background and Country Context III. The Tanzania AIDS Project: An Overview V. Supporting Interventions and Creating an Enabling Environment VII. Important Lessons Learned From TAP's Experience VIII. Subproject Highlights A. NGO Cluster Projects Executive Summary AIDS in Tanzania spread rapidly since the first cases were reported in 1983. In 1995, the National AIDS Control Programme of Tanzania reported that 1.2 million Tanzanians were infected with HIV and that approximately 82,000 AIDS cases had been reported to the Ministry of Health. Sentinel data from women seeking ante-natal care is indicative of the extent of the epidemic. According to the most recent available data, HIV prevalence among these women is frequently over 10 percent and in one rural site 32.5 percent. Studies from blood donors and population-based studies confirm this data. The National AIDS Control Programme of Tanzania was founded in 1987 and launched intervention and control activities in 1988. The primary objectives of the program were to reduce spread of HIV, screen blood supplies, enhance clinical services for HIV/AIDS patients and improve STI treatment, and conduct epidemiologic surveillance and other research. By 1989 regional and district AIDS committees had been formed, educational materials developed and laboratory services established. A second medium-term plan for 1992-1996 focused on decentralizing planning, decision making and activities in order to improve responsiveness and regional appropriateness of the national program. The MTP II strongly advocates a horizontal implementation structure to engage institutions both within and outside the Ministry of Health, including the full involvement of non-governmental organizations. USAID provided technical and financial assistance for prevention and control projects in Tanzania since 1988, initially via FHI/AIDSTECH and AIDSCOM projects and beginning in 1991 through FHI/AIDSCAP. In 1993 USAID/Tanzania initiated the Tanzania AIDS Project (TAP), which, by emphasizing development and support of NGO activities, responds to the NACP's second medium-term plan's accent on decentralization and on horizontal, multisectorial program implementation. While TAP ends in 1998, AIDSCAP ended in 1997. This report covers the period of AIDSCAP/TAP activities through July 1997. TAP is consistent with AIDSCAP's overall strategic approach that focuses on behavior change communication for reducing sexual risk, condom distribution and promotion, and upgrading professional STI services. It builds on previously funded USAID initiatives in Tanzania, but reshaped the direction and scope of the activities to better respond to the expanding dimensions of the epidemic. First, compared to an earlier strategic emphasis on prevention interventions with key "high risk" groups, TAP target populations are more broadly defined and explicitly inclusive of at risk adults and youth generally. Second, in addition to prevention, TAP aims to reduce the serious and growing health and social consequences of AIDS in Tanzania by delivering services to people living with HIV/AIDS, their families, and orphans. And third, to accommodate these expanded goals, TAP instituted a new implementation structure that is conducive to achieving broad-based community mobilization. While the structure of supporting separate interventions with specific target audiences was phased out, a system of providing support to regional NGO coalitions (TAP's "NGO cluster" projects) has been phased in. Other worksite and community interventions that were launched prior to TAP continue to receive support, but these are also being absorbed into TAP's new organizational structure of NGO clusters. The aims of the NGO cluster approach are to rationalize resource utilization, improve projects' complementarily while reducing intervention overlap, extend target population reach by supporting activities of multiple community-based NGOs, and ultimately, achieve long-term sustainability by "anchoring" interventions firmly in Tanzanian communities. During this reporting period, TAP helped nine regional NGO cluster projects to form, which altogether have a combined participation of over 180 community-based organizations. While the coalition projects have unique program strategies and organizational strengths, all of the clusters conduct a full range of STI/AIDS interventions. Their programmatic emphases include activities aimed at: strengthening NGOs' technical and management capacity; sensitizing community leaders and government authorities about STI/AIDS and engaging their active support for cluster activities; conducting comprehensive and integrated behavior change interventions (behavior change communication, referral to upgraded STI clinics, and promotion and distribution of condoms); and providing care, counseling, and support to persons living with AIDS, their families, and orphans. Although to varying degrees for individual regional projects, the cluster initiative has proven to be effective for conducting STI/AIDS interventions and specifically for engaging local populations in the effort. Overall, the TAP experience suggests that supporting NGO coalitions holds significant promise for achieving technically, institutionally, and, to some extent, financially sustainable projects in the long term. To reinforce these community-based behavior change interventions, TAP conducts and supports several activities at the national level. The TAP project support unit oversees an extensive training program. As a key aspect of indigenous capacity building, hundreds of NGO partner staff have been trained in project design, management, various technical areas, and in income generation during this project period. The TAP central office also supported community-based efforts through the production and wide distribution of printed materials, educational videos, and TV and radio programs. Finally, TAP's national-level policy and advocacy initiatives further help to create an enabling environment to support behavior change projects. To ensure widespread availability of affordable condoms, TAP supported a national social marketing (CSM) project, which also works collaboratively with TAP's community-based partners in establishing locally viable condom distribution mechanisms. Its condom promotion efforts further ensure that the CSM brand is highly visible and thus easily recognized by target consumers. With regard to STI care, TAP supported three training projects that upgraded the clinical skills of hundreds of health care providers to diagnose, treat, and educate STI patients. To date, these training courses have focused on training providers from the private and NGO sectors from regions where TAP NGO clusters have been formed. Another important TAP project, AMREF's high risk transmission area intervention, also trained health care providers in STI case management. Upgraded STI services are linked to community-based education via cluster project and AMREF's peer and community educators who refer suspected STI patients for care to facilities where clinicians have been trained in STI case management. Finally, AIDSCAP/TAP supported a variety of research projects. These range from focused studies intended to inform program design and decision making (e.g., a study of the business community's perceptions about and receptivity to AIDS interventions at worksites), and various behavioral studies that used ethnographic and survey methods, and studies to examine the outcomes of specific TAP funded services (e.g., home-based care and the impact of testing and counseling for prevention). Overall, evaluation data suggest improvements in knowledge about STIs and reduction in some high risk sexual behavior. |
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