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

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Intervention Area 2: HIV Testing and Counselling (HTC) services Preamble The National Guidelines for Voluntary Counselling and Testing (2005) clearly state that HTC provides an opportunity to access accurate and comprehensive information on HIV, AIDS and STIs. It serves as an entry point to prevention, care, support and treatment programs and enables persons to confidently understand their HIV status and learn about supportive behaviours for protecting and preventing further spread of HIV. It has been noted that the demand for counselling is high suggesting a need to provide a wide variety of models of HTC including PITC. The existing public system cannot handle the high demand for this service. However the opportunities for support for HTC service provision from a number of partners exists. Situation analysis Below are the achievements and challenges in implementing HSS 2003-2006: Achievements Trainings have been conducted as follows o 2,739 counsellors, 96 national VCT trainers and 62 regional and district VCT supervisors had been trained. o Sixty members of CHMT were oriented on managerial skills on the supervision of VCT and other HIV and AIDS-related interventions. The National Counsellor Training Curriculum was reviewed to equip counsellor with necessary skills to provide services of recommended quality. National guidelines were developed o VCT o PITC 1,027 VCT sites had been established and some have been accredited. Challenges Aspects Challenges for HIV Testing and Counseling Availability • Irregular supply of HIV test kits • Lack of appropriate infrastructure for HTC Equitable access • 10.5% of people aged 15 to 49 in urban areas had been tested in the past year against 3.4% in rural areas • A few trained counselors are in place compared to need, • Lack of skills to provide counselling to special groups, for example, the deaf and the children, Acceptability • Patients and clients visiting the health facilities might not ask for an HIV test because of fear and stigma • VCT services are often provided in small and poorly furnished rooms, which compromise privacy and confidentiality. • VCT being a part time activity and hospital-based, lack of recognition as a career path (counsellor is not a cadre in the health system) Quality Programme management • VCT services being partially included in the Council Comprehensive Health Plans (CCHPs), • Inadequate coordination of VCT services at all levels, • A weak referral and networking system • Inadequate supervision and support to counsellors, • Existence of different HTC standards Quality improvement (M&E and supportive supervision) • Poor/lack or incomplete and inconsistent reporting • Poor/lack of motivation • Heavy workload (some counsellors attending between 30 and 50 clients a day), 42 |FINAL COMBINED-HSHSP 2008-2012: June 24 th 2007
Emerging Issues Private for profit partners find it uneconomical to conduct HTC-related activities due to factors such as o Reduced costs for laboratory service without adequate compensation, o Transporting samples for quality control without compensation of costs involved, o Perceived additional work to their health care providers without remuneration and o Different reporting systems . Equity, Gender and sustainability considerations Low and skewed coverage affecting rural and vulnerable populations More women are accessing the HTC. There is need to address male involvement. Inadequately negotiated exit plans by implementing agents without involving stakeholders at all levels Strategic objective To improve access to and use of quality HIV testing and counselling (HTC). Strategies Strengthen existing and promote the establishment of HTC including services for children Develop and disseminate appropriate standard operating procedures (SOP) for HTC to all health and non health services. Strengthen and support HTC as an integral component of HIV/AIDS/STI/TB prevention, control and care Develop Guidelines o Comprehensive HTC Guidelines o Standard guidelines for peer educators and counselors Targets Increased utilization of HTC services Indicators % of people counselled and tested Number of HTC services established % of people tested referred to other services Key Implementers MOHSW, PORALG, RHMT, RACC, DACC , CHMT, CACC, ZTC Intervention Area 3: IEC, BCC programming and Stigma Reduction Activities A. Behavioural Change Communication (BCC) 1 Preamble Information and knowledge are necessary but not sufficient conditions for behavior change. Behavior change as a process involves knowledge and attitudes, a favourable social, cultural and physical environment for the expected change to take place. The processes behind what happens are summarised on the figure 5 below. 1 This section heavily borrows from FHI (2002), Behavioural Change and Communication for HIV/AIDS: A 43 |FINAL COMBINED-HSHSP 2008-2012: June 24th Strategic Framework 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 and 12: Financing the Health sector respons
Page 13 and 14: 1.1.3. Geographic and administrativ
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: Challenges Aspects Challenges for L
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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