1. AFRICAN LOCAL GOVERNMENT ACTION FORUM (ALGAF) PHASE IV SESSION V:LOCAL GOVERNMENT RESPONSES TO HIV/AIDS DAR ES SALAAM TANZANIA DR. Koku Kazaura, Betty Muze, Lilian Mzava FEBRUARY, 2004

2. INTRODUCTION:  Dar es Salaam City is one of the areas in Tanzania that has been heavily affected by HIV/AIDS with a population 3,000,000 it is estimated to have 16,237 AIDS cases in 2001. (NACP surveillance report)  NACP estimates that only one out of 5 AIDS cases is reported and so these figures are a gross under estimation.

3. INTRODUCTION (cont.)  Statistics show the age distribution of HIV/AIDS cases is between the age of 15 – 49 years, with the highest prevalence in the age groups 25 – 34 and 30 – 39 years for males and females respectively.  The City has a high percentage of young adults between the ages of 19 – 25 infected with HIV/AIDS.

4. INTRODUCTION (cont.)  The rapid spread of the infection is attributed to relatively low impact of the interventions adopted and the element of behaviour change being a complex issue to achieve among people.  The GoT has formulated National Multi-sectoral strategic framework (NMSF, 2003 – 2007) and the Health Sector Strategy (HSS, 2003 – 2006).  These strategies have contributed significantly in intensifying and strengthening the interventions of mitigating the impact of HIV/AIDS.

5. INTRODUCTION (cont.)  The NMSF and HSS have translated the National Policy on HIV/AIDS by providing strategic guidance to the planning of programmes, projects and interventions.  These strategies stress on four thematic areas. - Prevention - Care, treatment and support - Impact mitigation - Cross cutting issues and enabling environment

6. STRATEGIES FOR LGAs RESPONSE TO HIV/AIDS 1.Strengthen and expand advocacy activities 2.Expand and strengthen voluntary counseling and testing services testing services 3.Expand and strengthen home based care services 4.Strengthen workplace interventions 5.ARVs accessibility and opportunistic infections management management 6.Strengthen prevention of Mother to Child transmission services transmission services

7. IMPLEMENTATION PLAN STRATEGIC OBJECTIVE 1: STRENGTHEN AND EXPAND ADVOCACY ACTIVITIES ACTIVITY KEY ACTOR COLLABOR ATOR INDICATOR MEANS OF VERIFICATI ON TIME FRAME2004 Q1 Q2 Q3 Q4 1.1. Sensitize all LGAs leaders from the 3 Municipalities on the NMSF and the National Policy on HIV/AIDS. LGAs,TACAIDS,CMTs,DAC National and International NGOs % of Local Leaders sensitizes. % of Wards with available and accessible policies and NMSF. Review of report and attendant listsNational policy and NMSF in pace in 73 wards Q2 1.2. Print/procure and distribute enough NMSF/policy documents for 73 wards. LGA,TACAIDSPORALG % Number of copies printed and distributed LedgerCopie s in place at ward level Q2

8. THEMATIC AREA PREVENTION STRATEGIC OBJECTIVE 2: VOLUNTARY COUNSELLING AND TESTING ACTIVITY KEY ACTOR COLLABOR ATOR INDICATOR MEANS OF VERIFICATI ON TIME FRAME2004 Q1Q2Q3Q4 2.1. To establish and VCT centers at least 1 in 2 health facilities for each Municipality. LGA,MoHMoH Site established Report of planned sites Q3 & Q4 2.2. Train staff for VCT Counselling for the established sites. LGAs,MoHNACP Number of staff trained List of staff Report on training Q3 & Q4 2.3. Advocate for VCT services and mobilize clients LGAs,TACAI DS NACP Number of advocacy meetings held Reports of advocacy meetings held per ward. Q3 & Q4

9. 2.4. Design and develop IEC materials with VCT message. LGANACP Number of IEC materials developed Reports of distribution of IEC materials Q4

10. THEMATIC AREA: CARE AND SUPPORT STRATEGIC OBJECTIVE 3: TO EXPAND AND STRENGTHEN HOME BASED CARE SERVICES ACTIVITY KEY ACTOR COLLABOR ATOR INDICATOR MEANS OF VERIFICATI ON TIME FRAME 2004 Q1Q2Q3Q4 3.1. Identify and train community care givers on HBC services. LGAsMoH Number of care givers identified and trained Training report Q2 3.2. Expand home based care in the remaining 26 wards. LGAsNACP Number of wards with HBC services Progress report Q4 3.3. Collaborate with NGOs/CBOs/FBO s providing HBC services. LGAsNGOsNACPNGOs Meetings conducted Minutes/repo rt of the meetings Q1Q2Q3Q4 3.4. Strengthening referral system for clients. In need to access a continuum of care. LGAsNACPNGOs Number of clients referred to and from the community to health facilities Register bocks Q4

11. THEMATIC AREA: PREVENTION STRATEGIC OBJECTIVE 4: STRENGTHEN WORKPLACE INTERVENTIONS ACTIVITY KEY ACTOR COLLABORA TOR INDICATOR MEANS OF VERIFICATIO N TIME FRAME2005 Q1Q2Q3Q4 4.1. Establish policy and organization framework for work place interventions in LGAs. LGAsTACAID S TACAIDS Number of frameworks established in LGAs. Q1 & Q2 4.2. Identify and train 30 ToT for training LGAs staff on issues of HIV/AIDS. LGAAMREF Number of LGAs staff trained Training report Q2 4.3. Conduct trainings for building AIDS competency among LGAs staff. LGAPORALG Number of staff trained for each department Training reports Q2, Q3 & Q4

12. THEMATIC AREA: CARE TREATMENT AND SUPPORT STRATEGIC OBJECTIVE 5: ARV’s ACCESSIBILITY AND OPPORTUNISTIC INFECTIONS MANAGEMENT ACTIVITY KEY ACTOR COLLABORA TOR INDICATOR MEANS OF VERIFICATIO N TIME FRAME2005 Q1Q2Q3Q4 5.1. Establish sites in the three Municipal hospitals and in two-health center in each municipality. LGAMoH Number of sites established Progress report Q1 5.2. Capacity buildings of health workers in ARV’s and Opportunistic infections management LGAMoH Number of staff trained Performance report Q2 5.3. Sensitization of communities on the services available. LGAsTACAIDS Number of clients accessing these services Implementatio n reportClients registers Q2, Q3 & Q4

13. THEMATIC AREA: PREVENTION STRATEGIC OBJECTIVE 6: STRENGTHEN PREVENTION OF MOTHER TO CHILD TRANSMISSION SERVICES ACTIVITY KEY ACT OR COLLABORA TOR INDICATOR MEANS OF VERIFICATION TIME FRAME 2005Q1Q2Q3Q4 6.1. Sensitization of the community in 73 wards in PMTCT Conduct sensitization meeting with 10 cell leader LGA s PORALG Number of sensitization meetingsNumbe r of sensitization meetings with 10 cell leaders. ReportsReport Q2, Q3 & Q4 6.2. Train health care providers in the basic package for PMTCT. LG As Mo H MoH Number of health providers trained Training reports Q1 6.3. Produce/develop IEC materials on the PMTCT for the community LGANACP Number of IEC materials produced LedgersReport Q2 & Q3 6.4. Establish facilities based taskforces to oversee the implementation of PMCT services. LGAMoHNACP Number of taskforces established Reports of taskforce meetings Q1

14. MONITORING AND EVALUATION:  LGAs Monitor the implementation of HIV/AIDS/STIs programmes continuously by using tools and indicators that are stipulated in the NMSF and HSS.  Monitoring of the activities is done through regular reporting that is done monthly, quarterly, biannually and annually. (Blood donors, STIs/Clinical Aids, ANC attendees)  Supportive supervision and follow up partners implementing HIV/AIDS (NGOs/CBOs/FBOs).  Surveillance behaviour change in communities (16 regions in Tanzania, Dar es Salaam being one of the sites)  Evaluation is done mid-term, end of term and long term of HIV/AIDS programs in LGAs.

15. TENTATIVE BUDGET 2004/2005 NO. STRATEGIC AREA/LINE ITEM BUDGETS US DOLLARS 1. Voluntary Counselling & Testing -Expansion of VCT services - Training of counselling -Advocacy on VCT - Design/Develop IEC materials sub total: US$ 150,000 2. Home based care services: -Expand HBC services in 26 wards -Train Community care givers. -Conduct Stakeholders meeting. -Strengthen referral system. sub total: US$ 300,000 3. PMTCT Services: -Sensitizatin Community on PMTCT: -Train health care providers on basic packages

16. TENTATIVE BUDGET 2004/2005 -Establish facility based taskforces to oversee implementaion of PMTCT services. -Design/Develop ICE materials on PMTCT. Sub total US$ 360,000 4. ARV's and Opportunistic Infections management: Sub total US$ 840,000 5. Workplace interventions: Sub total GRAND TOTAL US$ 50,000 US$ 1,700,000