1. Rombo District Experience 8 th Annual CDC/HRSA Track 1.0 Partners Meeting Dr. Criston Nkya District Medical Officer Rombo District, Kilimanjaro, Tanzania

2. Header  Bullet 1  Bullet 2  Bullet 3

3. Outline Background District Approach Achievements Strengths and challenges Way forward

4. Background Rombo 1 out of 7 districts forming Kilimanjaro region Covering about 1,442 km² of mainly mountainous area Population 305,289; mainly subsistence farmers Growth rate 2.8% 43 health facilities: – 2 Hospitals (FB; 1 acts as designated DH) – 4 Health Centres (all GOT) – 37 Dispensaries (21 GOT; 8 FB; 8 private) HIV prevalence 1.9%* - 2.9%** 6 Health Facilities offer CT services * Tanzania HMIS 2007-08, Kilimanjaro region ** Jan-June 2010 EGPAF PMTCT program data

5. Background (2) First USG support (ICAP) started in Jan. 2004 – Facility approach to the designated DH After regionalization, EGPAF support from Oct. 2006 onwards – District Approach – Sub-grants for PMTCT (USAID) and C&T (CDC) – District-wide support including LLHF C&T (CDC) support includes – Ped HIV, TB/HIV, LAB, EID, SCM, CL, TCB, M&E, QI

6. District Approach Sub-grants with mainly District Authorities: Council Health Management Teams (CHMT) Annual contract renewal workshops – Workplan and budget development – U.S. Govt. rules and regulations District Executive Director signs the sub-grant DMO oversees program In line with MOHSW policies of decentralization Builds capacity of existing local systems and stakeholders Increases ownership and sustainability Allows rapid expansion of high quality patient services up to LLHF

7. Achievements Established 6 CTC centres (and 32 PMTCT centres) Renovated 2 CTC facilities Procured 1 vehicle and 2 motorcycles Improved specimen transportation (CD4 / DBS PCR) Procured FACS Count, Haematology and Biochemistry machines and their reagents Increased availability of drugs for opportunistic infections and test kits District-owned and -organized trainings Community sensitization on HIV and related programs

8. Achievements (2) Care – Cumulative 3,187 patients; 472 children (15%) – Current 1,927 patients; 309 children (16%) ART – Cumulative 1,618 patients; 201 children (12%) – Current 1,172 patients; 165 children (14%) HCW’s trained for C&T (CDC funded) – 21 HIV and ART (including pediatrics) – 3 District Mentors – 28 IMAI – 42 HCW’s in EID, plus 3 TOT’s – 34 Lay Counsellors

9. Achievements (3)

10. Strengths Involvement and capacity building of all district managers Training of trainers and ownership of trainings at District Level Improves regular supportive supervision and on-site mentorship Strengthens capacity to monitor both U.S. Govt. and MOHSW funds Strengthens logistical and SCM capacity Contributes to sustainable health systems strengthening

11. Challenges Nation-wide challenges - Human resources shortages and high turn-over - Inadequate physical infrastructures - Lack of equipment Delays in program implementation due to bureaucracy at District level – But procedures are necessary to follow rules and regulations Challenges in the National SCM systems

12. Way Forward Further strengthening of CHMTs – Financial and managerial capacity – Technical expertise Through – Initiatives to increase the workforce – On the job and classroom training of DMO, District AIDS Control Coordinators, Health Care Providers, and other key stakeholders

13. Asanteni sana!