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

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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

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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

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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