the united republic of tanzania health sector hiv and aids strategic plan

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STRATEGY FRAMEWORK 1.1. COUNTRY BACKGROUND AND HISTORY 1.1.1 Introduction 1.0. SECTION ONE: The Health Sector Strategy for HIV and AIDS 2008-2012 has been developed taking into account the following developments in Tanzania: Firstly Tanzania AIDS Commission (TACAIDS) who has the accountability for developing and adjusting the national multi sector HIV and AIDS strategy has developed a National HIV and AIDS Multi-sectoral Strategic Framework (NMSF 2008-2012). This framework lays out clearly the areas for concentration for the various sectors and provides guidance on the formulation of the sectoral plans for HIV/AIDS according to their comparative advantage o By addressing HIV/AIDS in a comprehensive and multi sectoral manner, the NMSF contributes to MDGs, universal access to HIV services, overall national development, poverty reduction and thus to the attainment of the aspiration laid out in the Vision 2025. Secondly, Ministry of Health and Social Welfare (MOHSW) has the overall Health Sector Strategic Plan (HSSP-2008) which is expected to end soon. The development of a new health sector strategy will include the HIV and AIDS health sector component and will be done later. Thirdly, this new Health Sector Strategy on HIV and AIDS, spearheaded by MOHSW through the National AIDS Control Programme (NACP), is a continuation of the previous strategy which concluded at end of 2006. Therefore, this HSHSP 2008-2012 is a systematic approach of contributing to the Operationalisation of the TACAIDS NMSF 2008-2012. Operationalisation of the current Ministry of Health Strategic Plan (HSSP-2008) and serve as an input into the anticipated new overall health sector strategy. Guidance of various implementers of Health sector strategy for HIV and AIDS at different levels The management intent of the HSHSP 2008-12 is not to replace the need for Partners, Regions and Districts to have their own plans, but rather to: Support coordinated, prioritised and knowledge-based scale up of the response Facilitate broad ownership of the response by all partners and practical partnerships for the implementation of the response Represent joint strategic direction of all Partners, Sectors, Regions and Districts Enable the involvement of key sectors and decentralised levels in all stages of the process Guide resource management at the strategic level 1.1.2. The Strategic Planning Process and Structure The HSHSP 2008-2012 has been built on the process of joint annual reviews of the progress with the current 2003-2006 Health Sector Strategic Plan for HIV and AIDS and a broad consultative process with the Partners, Sectors, Regions and districts. The approach used included data collection, review of literature, thematic group works, stakeholders’ consensus building workshops, field visits to Regions and districts and consolidation of the plan. The draft HSHSP was also presented and discussed at the stakeholder meetings of MOHSW and other fora and was subjected to external reviews. 12 |FINAL COMBINED-HSHSP 2008-2012: June 24 th 2007
1.1.3. Geographic and administrative Tanzania mainland has 21 regions and about 121 districts. Each district is divided into divisions, which in turn are composed, of 3-4 wards (5-7 villages form a ward). The district is the most important administrative and implementation unit for public services. For this reason the Ministry of Health and Social Welfare (MOHSW) in collaboration with the Prime Minister’s Office Regional Administration and Local Government (PORALG) through the Health Sector and Local Government reforms are currently strengthening the district health services, making the districts the focus for health development. 1.1.4. Demographic and Socio-economic The Tanzania Mainland has an estimated 2007 population of 38,710,723 million projected from the 2002 population Census . It has an annual population growth rate of 2.9%. Crude birth rate is 42.5 per 1,000 populations and life expectancy at birth is 47 years for men and 49 years for women. Thirty three percent (33%) of the population resides in urban areas whereas the majority (77%) of population is rural dwellers. Table1. Demographic and socioeconomic parameters Parameter 2006 2007 2008 2009 2010 2011 2012 Total population 37,452,378 38,710,723 40,005,918 41,338,695 42,709,649 43,484,118 44,523,388 Above 15 21,024,544 21,710,169 22,436,576 23,218,500 24,030,512 24,466,266 25,051010 Growth rate 2.11% 2.39% 2.39% 2.39% 2.39% 2.39 2.39 0 – 11 Months 1,570,943 1,606,401 1,642,882 1,680,580 1,719,334 1,758,088 1,798,088 Under 5 Years 7,012,134 7,215,011 7,418,446 7,612,290 7,801,587 7,990,884 8,180,884 Under 15 Years 16,427,834 17,000,554 17,569,342 18,120,195 18,679,137 19,679,137 19,472,378 CBAW(15-49 yrs) 8,003,907 9,114,964 9,424,784 9,750,742 10,459,146 11,167,550 11,875,954 Crude birth rate 39.2 39.7 39.7 39.7 39.7 39.7 39.7 Source – National Bureau of Statistics – Population Census results (2002) and National projections (2006) 1.1.5. General health and nutrition status According to TDHS 2004-2005 report, the current infant mortality and under five-year are 68 and 112 per 1,000 live births respectively whilst the maternal mortality is estimated at 578 deaths per 100,000 live births. The nutritional status shows a slight improvement , for instance stunting changed from 44% (2000) to 38% (2004/5) while wasting changed from 5% to 3% over the same period. The underweight improved from 29% to 22%. 1.1.6. HIV and AIDS 1.1.6.1. Burden of disease The Tanzania HIV/AIDS Indicator Survey (THIS) of 2003/4 shows that the predominant mode of transmission has remained heterosexual contact, constituting about 80% of all new infections. Mother to child transmission is estimated to account for about 18% of new infections. About 1.8% of young persons aged 15 to 24 who reported that they never had sex were found to be HIV positive. This suggests that they were infected through blood transfusion, unsafe injections or traditional practices, including male circumcision or female genital cutting i . Recent studies indicate that in some parts of the country, transmission through anal sexual intercourse (heterosexual or among men who have sex with men) as well as HIV infection through drug abuse are occurring and may be important factors for the further spread of HIV. Tanzania is facing a ‘generalized ii ’ epidemic of HIV. The overall prevalence in the sexually active population (age 15 to 49) is 7.0%, with women being more affected than men (7.7% versus 6.3%). This results in a female/male ratio of 1.2 to 1. 13 |FINAL COMBINED-HSHSP 2008-2012: June 24 th 2007
Page 1 and 2: FINAL DRAFT 24 th JUNE 2007 THE UNI
Page 3 and 4: TABLE OF CONTENT Abbreviations and
Page 5 and 6: ACKNOWLEDGEMENTS 5 |FINAL COMBINED-
Page 7 and 8: National HIV and AIDS Priority Inte
Page 9 and 10: 3.3. IEC and BCC and Stigma reducti
Page 11: Financing the Health sector respons
Page 15 and 16: 1.1.6.2. Gender and HIV and AIDS It
Page 17 and 18: Human resource The country is facin
Page 19 and 20: 1.2.3.2. Financial Contributions to
Page 21 and 22: Decentralisation: Devolution of key
Page 23 and 24: Achievements Currently 659 sites (
Page 25 and 26: Indicators Number of health instit
Page 27 and 28: Key implementers Referral, regiona
Page 29 and 30: Indicator % of blood units transfu
Page 31 and 32: etween older males and girls. On th
Page 33 and 34: Challenges Aspects Challenges for p
Page 35 and 36: Aspects Challenges for Facility Bas
Page 37 and 38: Key implementers MoHSW, Private ho
Page 39 and 40: ased care services Establish mecha
Page 41 and 42: Challenges Aspects Challenges for L
Page 43 and 44: Emerging Issues Private for profit
Page 45 and 46: B. Information Education and Commun
Page 47 and 48: Challenges Aspects Challenges in Co
Page 49 and 50: delivery of all health programmes-
Page 51 and 52: o Coordinate partnerships between e
Page 53 and 54: Pharmacovigilance and quality assur
Page 55 and 56: o The tendency of recruitment of st
Page 57 and 58: Availability of annual, midterm and
Page 59 and 60: Key Implementers MoHSW, Academic I
Page 61 and 62: 3.0. SECTION THREE IMPLEMENTATION F
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plan for districts. Rather the acti
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The Table 14 below shows the trend
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Given the findings discussed above
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Monitoring Depending on the type an
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“Mkukuta Based MDGs Costings for
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ANNEX 2: FRAMEWORK FOR TARGET SETTI
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ANNEX 3: ORGANOGRAM OF MINSTRY OF H
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Strategy 4: Improve programme manag
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Intervention Area 3a: Prevention of
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Intervention Area 4a: Vulnerable Po
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Intervention Area 5: Positive Preve
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Strategy 3: Increase access to and
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Strategy 4: To reduce the burden of
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Intervention area 2: Community base
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Strategy 3: Develop and implement c
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Strategy 3: Develop effective strat
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Strategy 1: To ensure nation-wide a
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Strategy 3: Implement and strengthe
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Strategy 1: Strengthen existing and
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Intervention area 3: Promote BCC pr
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103 |FINAL COMBINED-HSHSP 2008-2012
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Intervention area 3: Human Resource
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Intervention area 4: Strategic info
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Strategic Objectives 3: To strength
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ANNEX 5: REFERENCE AND NOTES i TACA
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