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

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The already over-stretched health sector has suffered multiple effects due to HIV and AIDS: increased number of patients due to opportunistic infections, increased demand and sometimes reallocation of resources from other equally important health problems, and decreased number of health workers. Therefore there is serious impact on the health services in terms of quality of care as a result of increased service demand coupled with attrition of the workforce and stigma attached to HIV and AIDS. The average HIV+ adult in Tanzania has an average of 17 illness episodes before death, leading to healthcare costs per patient which can be twice the Tanzanian GDP of US$478 per capita. 1.2 HEALTH SECTOR RESPONSE TO HIV AND AIDS 1.2.1. National Health System Response and Capacity The health system in Tanzania has two major components; the public and the private sector. The public share is 56%, the private share is 44% (which includes Faith Based Organizations (FBOs) 30% and private for profit 14 %). The system works at four levels; the community, the ward where we have a dispensary and a health center at the division level. As we move further we have the district and regional hospitals at district and regional levels. At the zonal and national level are the consultant/ refferal hospitals. Table 2: Levels of Health Service Delivery Level Type of health Service Remarks facility population Country National Hospital 36 million There is only one national hospital, serves 36 million because offers some specialized services not generally available in other consultant hospitals Zone Consultant Hospital 8 million Serve as the referral centre for the hospitals in the surrounding regions in the zone. There are four consultant hospitals in total including the national hospital Region Regional Hospital 1-1.5 million 17 regional hospitals District District Hospital 250-500,000 A number of FBO hospitals function as designated district hospitals (DDH). More than 1 hospital may be available in each district, usually run by FBOs (219 hospitals) Division Health centre 50-100,000 481 health centres Ward Dispensary 5-10,000 More than 1 dispensary may be available in a ward (4679) Village Health post, ADDO 2-5,000 Currently in Tanzania there are a total of 5,379 health facilities geographically distributed so that 70% of the population is within 5 km of a facility and 90% is within 10 km as at the end of 2005. v Administratively, the health system is largely decentralized. The MoHSW has direct responsibility for the referral and regional hospitals, and regulatory power over all health facilities. To accomplish this responsibility, the Ministry’s functions are divided into six directorates which include:Hospital Services, Preventive Services, Human Resource Development, Policy and Panning, Social Welfare, Adminstration and Personnel. These departments are further divided into sections for a more effective implementation as reflected in the organogram. The organisation and management of HIV and AIDS services is undertaken within the parameters of the Preventive Services of MoHSW mandate through NACP. The district facilities are independently run by the PORALG. 16 |FINAL COMBINED-HSHSP 2008-2012: June 24 th 2007
Human resource The country is facing a serious human resource crisis. Between 1994 and 2005 the human resource has declined by 35.4%. The shortages are best shown in Table 3. Table 3: Human resources national requirements Current Shortage Total required staffing level Shortage % of requirement Specialists 171 96 75 43.9 Doctors 2,057 1,483 574 27.9 Trained nurses 14,743 9,093 5,650 38.3 Pharmacists/chemists 328 87 241 73.5 Technicians 1,506 741 765 50.8 Other medical staff 7,780 6,478 1,302 16.7 Support staff 16,737 13,778 2,959 17.7 Administrators/managers 547 196 351 64.2 Total 43,869 31,952 11,917 27.2 SOURCE: “Assessment of the Human and Financial Resources for the Revised HIV and AIDS National Multi-sectoral Strategic Framework” 2007 There are also serious imbalances in existing human resources between rural and urban areas. 1.2.2. HIV and AIDS Control Strategies The National Response to HIV in Tanzania has evolved since 1985. Under the responsibility of the MOHSW and its National AIDS Control Programme (NACP) supported by World Health Organisations’ (WHO) Global Programme on AIDS (GPA) several Short-term (STP) and Medium-Term Plans (MTPs) have been developed and implemented between 1985 and1991. (See Figure 4) 1983 First AIDS cases reported Figure 4: The National Response to HIV/AIDS Epidemic in Tanzania Shortterm plan 1985 AIDS Task Force formed Acceleration through decentralization of IEC activities (RACCs & DACCs appointed) MTP I NACP Established MTP II 17 |FINAL COMBINED-HSHSP 2008-2012: June 24 th 2007 MTP III 1992 1996 1987 1988 1991 1998 TACAIDS 2002 HSS H/A 03-06 NMSF 03-07 During the implementation of the STPs and MTPs a number of achievements were realised including the strengthening of the health sector services to ensure safe blood transfusions, management of STIs, care of the infected and affected, as well as rising public awareness about the disease to over 95%. Despite these efforts, HIV infection rates continued to increase in the country, reaching its peak in the mid 90s. Starting with the MTP II (1992 - 1996) efforts were undertaken, to work towards a broader national response involving sectors like education, labour, and agriculture for the first time, as well as collaborating
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 and 12: Financing the Health sector respons
Page 13 and 14: 1.1.3. Geographic and administrativ
Page 15: 1.1.6.2. Gender and HIV and AIDS It
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
Page 63 and 64: plan for districts. Rather the acti
Page 65 and 66: The Table 14 below shows the trend
Page 67 and 68:
Given the findings discussed above
Page 69 and 70:
Monitoring Depending on the type an
Page 71 and 72:
“Mkukuta Based MDGs Costings for
Page 73 and 74:
ANNEX 2: FRAMEWORK FOR TARGET SETTI
Page 75 and 76:
ANNEX 3: ORGANOGRAM OF MINSTRY OF H
Page 77 and 78:
Strategy 4: Improve programme manag
Page 79 and 80:
Intervention Area 3a: Prevention of
Page 81 and 82:
Intervention Area 4a: Vulnerable Po
Page 83 and 84:
Intervention Area 5: Positive Preve
Page 85 and 86:
Strategy 3: Increase access to and
Page 87 and 88:
Strategy 4: To reduce the burden of
Page 89 and 90:
Intervention area 2: Community base
Page 91 and 92:
Strategy 3: Develop and implement c
Page 93 and 94:
Strategy 3: Develop effective strat
Page 95 and 96:
Strategy 1: To ensure nation-wide a
Page 97 and 98:
Strategy 3: Implement and strengthe
Page 99 and 100:
Strategy 1: Strengthen existing and
Page 101 and 102:
Intervention area 3: Promote BCC pr
Page 103 and 104:
103 |FINAL COMBINED-HSHSP 2008-2012
Page 105 and 106:
Intervention area 3: Human Resource
Page 107 and 108:
Intervention area 4: Strategic info
Page 109 and 110:
Strategic Objectives 3: To strength
Page 111:
ANNEX 5: REFERENCE AND NOTES i TACA
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