PEPFAR/TANZANIA: CDC, AID, State, DOD & Peace

UNCLAS SECTION 01 OF 04 DAR ES SALAAM 000110 SIPDIS AF/E FOR JLIDDLE STATE PASS USAID & Peace Corps DOD FOR WRAIR HHS FOR CDC E.O. 12958: N/A TAGS: EAID KHIV TZ SUBJECT: PEPFAR/TANZANIA: CDC, AID, State, DOD & Peace Corps Partner with the GoT (and one another) to Save Lives REF: 2008 Dar es Salaam 727 ¶1. Summary & Introduction: The U.S. Mission to Tanzania is assistance-driven, with the largest part of that assistance devoted to the health sector. The Secretary cited our success in combating malaria and HIV/AIDS during her confirmation hearings. This message reviews our strategies and progress to date in the treatment, care and prevention of HIV/AIDS. The Tanzanian public is well aware of the role of the American people in fighting this disease. The goodwill engendered by our partnership with the Tanzanian government and public contributes greatly to our influence on a range of diplomatic issues outside the health sphere. PEPFAR discussions with the Tanzanian government on a formal Compact will further expand this synergy. ¶2. At the inception of PEPFAR/Tanzania in 2004, adult prevalence was estimated at 7 percent. It is now estimated at 5.7 percent. Other key statistics include 1.4 million people living with HIV/AIDS; an estimated 440,000 individuals clinically eligible for antiretroviral treatment; and an estimated 1 million orphans and vulnerable children (OVC) in need. ¶3. As of September 2008, PEPFAR/Tanzania has achieved the following: -- 138,000 individuals receiving antiretroviral treatment; -- 352,000 individuals receiving palliative care; -- 290,000 orphans and vulnerable children (OVC) directly served; -- 34,000 HIV-positive pregnant women receiving antiretroviral prophylaxis; -- 2,650,000 annual counseling and testing encounters; and -- 2,800,000 individuals reached with outreach HIV/AIDS prevention programs. The USG supports every medical and nursing institution in Tanzania and works with the GoT on strategies for sustainable health service delivery. The collaborative, mutually supportive modus operandi of the PEPFAR agencies contributes greatly to setting a "one government" tone throughout this Mission. End Summary & Introduction. The Scope of the Epidemic -------------- ¶4. Adult (15-49 year old) HIV prevalence in Tanzania is estimated at 5.7 percent. An estimated 1,400,000 Tanzanians are living with HIV/AIDS with 96,000 Tanzanians dying each year from AIDS-related causes, resulting in further increases to the population of HIV orphans and vulnerable children (OVC),currently estimated at about one million. There is wide regional variation in prevalence, from 15.7 percent in Iringa (Southern Highlands) to 0.8 percent in Unguja, the main island of Zanzibar (Source: 2007-08 THMIS). Our Team: Who Does What -------------- ¶5. The PEPFAR agencies accomplish their goals through close collaboration with the Tanzania Commission for AIDS (TACAIDS) and the Ministry of Health and Social Welfare (MOHSW) on the mainland and Zanzibar AIDS Commission (ZAC) and MOHSW/Zanzibar in Zanzibar (both the islands of Unguja and Pemba),regional officials and a large number of Tanzanian and international non-governmental organizations. The Chief of Mission (currently the Charge d?affaires) is responsible for the overall leadership of the PEPFAR/Tanzania program. He is supported by a Country Coordinator. The four agency heads (CDC, USAID, DoD/Walter Reed, & Peace Corps) along with the Coordinator comprise the Interagency HIV Coordinating Committee (IHCC),which provides overall program direction and strategy guidance. The IHCC is chaired by the Chief of Mission. The Coordinator chairs DAR ES SAL 00000110 002 OF 004 the management and operations group which addresses program implementation and interagency coordination and collaboration. ¶6. The PEPFAR agencies are active members of the Public Outreach Working Group, which coordinates our messages to the Tanzanian public. These messages emphasize the close USG-GoT-civil society partnership and that the work is funded by the generosity of the American people. We emphasize one brand, ?the American People,? to the Tanzanian public, while communicating to Washington the accomplishments of individual agencies on the PEPFAR team. ¶7. PEPFAR partner agencies have the following broad roles: Department of State: Provides overall in-country strategic planning and coordination through the Chief of Mission; Leads public diplomacy efforts and leverages the impact of PEPFAR as a public diplomacy tool; Houses the PEPFAR Tanzania Coordination Office; Serves as the public affairs and communications support arm of PEPFAR Tanzania. CDC: Provides direct technical assistance to the Government of Tanzania, particularly the Ministry of Health and Social Welfare and contributes credible scientific and technical advice and assistance in public health response, surveillance, epidemiology, laboratory strengthening, disease prevention and control and implementation of care and treatment; Undertakes and provides technical assistance in the development and implementation of public health evaluations. USAID: Supports expanded and strengthened non- governmental engagement; Provides a range of acquisition and assistance instruments for implementation flexibility across the PEPFAR program; Contributes expertise in care, health systems strengthening, prevention, primary care, TB and malaria; Provides expertise in community-based strategies and long-term development; Leverages non- PEPFAR funding in ?wrap-around? areas including maternal and child health, economic growth, water and sanitation, and democracy and governance. DoD/Walter Reed: Administers care, treatment and prevention programs to the general public. Conducts HIV vaccine research; Serves as the lead PEPFAR liaison to the military, the Tanzania Peoples Defense Forces; Leverages vaccine research assets to provide lab quality assurance/quality control technical assistance to DoD and other USG treatment partners. Peace Corps: Accesses target groups who implement programs in local communities. Encourages Peace Corps Volunteers (PCVs) to implement prevention, care and nutrition wrap-around programs, including through permaculture and community gardening concepts. Provides small grants for project implementation to communities hosting PCVs. Results to Date -------------- ¶8. Care: Care activities in Tanzania include adult and pediatric care and support, support for TB and HIV program integration, and support to OVC. By September 2010, TB clinics in 132 districts will provide TB/HIV services with 49,680 TB patients expected to be served. The program is focusing on improving the quality and comprehensiveness of OVC services, which cover the full spectrum of child development needs from birth to age 18. ¶9. Treatment: Treatment activities include the provision of free ARV drugs, adult and pediatric services, and laboratory support. The USG is improving broad geographic coverage, operating efficiencies, and enhancing service linkages between facilities and DAR ES SAL 00000110 003 OF 004 communities while improving the quality and comprehensiveness of services. Pediatric treatment activities identify HIV-positive infants and children and provide pediatric treatment services. Our ART program is on track to provide direct treatment support to at least 180,000 adults and children by December 2010. ¶10. Systems Strengthening: One of our highest priorities in FY 2009 is to address the shortage of health care workers in Tanzania. Funding has prioritized support for the training of new health care workers and enhanced quality of pre-service training. To address retention issues, we will develop interventions that address key reasons workers leave the health sector. We support information systems, capacity building for monitoring and evaluation, and direct assistance for disease surveillance activities. We also engage with the GoT to ensure the provision of drugs and commodities required for effective prevention, care and treatment, providing capacity building in logistics management functions. We collaborate with the Health Ministry to strengthen national and point-of-service laboratory capacity, including HIV diagnosis, and therapeutic monitoring. ¶11. Prevention: We will continue to support the scale up of quality prevention of mother-to-child transmission (PMTCT) services and promote the use of more efficacious regimens. In sexual prevention, we focus on the key geographic areas, populations, and behaviors which are driving the Tanzanian epidemic: in particular, adults and high-risk youth within high prevalence regions. With most at-risk populations, including sex workers, our focus includes community-based outreach, access to counseling and testing, condom promotion, and STI services. To prevent medical transmission, we strengthen systems for blood collection, testing, and storage, including support to strengthen the National Blood Transfusion Service. We also support the scale up of the Infection Prevention and Control/Injection Safety programs, with a focus on training, procurement, waste management, and health care worker safety. ¶12. We play key roles in the HIV sector beyond program implementation. We chair the Development Partners? Group-HIV/AIDS. We have strong representation on the Tanzania National Coordinating Mechanism, which monitors the implementation of grants from the Global Fund to fight AIDS Tuberculosis and Malaria. We have developed a model public-private partnership approach to leverage additional resources. The Compact: The Future of the USG/GoT Partnership -------------- -------------- ¶13. Our team has been working closely with the GoT to define six core goals which will serve as the basis for a compact. These areas are: -- service maintenance and scale up; -- prevention; -- leadership and management; -- sustainable and secure HIV drug and commodity supply; -- human resources; and -- evidence-based and strategic decision making. Achievement of these goals will remedy systematic weaknesses that have, to date, prevented the GoT from addressing the HIV epidemic more independently. ¶14. Despite the enormous gains achieved by our PEPFAR team and their Tanzanian partners, well ahead of their projected results, there remains a large unmet need in this country for care, treatment and prevention services. While the compact has the ultimate aim of turning full responsibility for these programs over to the Tanzanian government, it must also ensure that progress is made towards this unmet need. There are two major obstacles that the compact must address: weak health delivery DAR ES SAL 00000110 004 OF 004 structures that need time to absorb the enormous scale-up achieved over the last five years and the fact that 60 percent of health sector jobs are vacant due to lack of capacity to train an adequate number of health care providers and "brain-drain" losses. Our efforts focus on increasing the capacity of Tanzania to cope with the epidemic. ¶15. Despite enormous challenges, PEPFAR/Tanzania has achieved remarkable results, including increasing GoT political support and commitment for HIV/AIDS and strong USG-GoT collaboration. All targets have been met or exceeded, and the PEPFAR team has been noted as a model of Staffing for Results. Through positive, open engagement, public perceptions in Tanzania regarding PEPFAR are very positive. Given the size of PEPFAR/Tanzania relative to the rest of the USG presence in Tanzania, the collaborative, mutually supportive modus operandi of the PEPFAR agencies contributes greatly to setting a "one government" tone throughout this Mission. ANDRE