Jhpiego in Tanzania

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					                                                                                                  Tanzania
                                                                                             Country Profile




Jhpiego in Tanzania
                                        Background
Quick Facts                             The United Republic of Tanzania has the largest land area of any East African
Estimated total                         country. More than 70% of the population lives in rural areas, and about half the
population:1
                                        population lives below the poverty line. With high infant and maternal mortality,
47.7 million
                                        and high HIV and malaria prevalence, the government is striving to strengthen
Maternal mortality ratio:2              quality and access of health services for the population. This goal is greatly
454 per 100,000 live births             challenged by the vast size of the country, as well as inadequate human resources
                                        for health. The country faces a mature, generalized HIV epidemic, with an
Neonatal mortality rate:2               estimated 6% of Tanzanians currently living with HIV/AIDS. Furthermore, an
26 per 1,000 live births                estimated 8,000 women die in childbirth every year in Tanzania.

Under-five mortality rate:2             Jhpiego began working in Tanzania in 1999, initially with funding from the
81 per 1,000 live births                U.S. Agency for International Development (USAID) to provide technical
                                        assistance to develop Essential Maternal and Neonatal Health Guidelines.
Total fertility rate:2                  Subsequently, under the Maternal and Neonatal Health (MNH) Program,
5.4
                                        Jhpiego worked to improve antenatal care in two districts (Arusha and Iringa) as
                                        a part of a larger, multi-organizational performance improvement initiative. In
Contraceptive prevalence:2
27% (modern methods)                    2005, Jhpiego’s role in Tanzania expanded into the area of community
                                        mobilization for malaria prevention and control, with funding from the U.S.
HIV prevalence:3                        Centers for Disease Control and Prevention (CDC). Currently, Jhpiego is
6%                                      implementing a variety of programs as described in more detail below.

Births with skilled                     Program Highlights
provider:2                              Mothers and Infants, Safe, Healthy, and Alive
51%
                                        With USAID funding, Jhpiego is collaborating with the Tanzanian and
Sources:                                Zanzibari Ministries of Health and Social Welfare (MOHSW) to strengthen
1
  Population Reference Bureau 2012      antenatal care, basic emergency obstetric and newborn care, and community-
World Population Data Sheet;            level services to reduce maternal and neonatal morbidity and mortality. The
2
  2010 Demographic and Health Survey;
3
  2007–2008 Tanzania HIV and Malaria
                                        MAISHA Program also incorporates infection prevention and control, pre-
Indicator Survey.                       service education in medical and nursing schools, cervical cancer prevention
                                        services and prevention of mother-to-child transmission of HIV. The project
                                        aims to reduce: 1) maternal deaths associated with the major direct causes of
                                        mortality, including postpartum hemorrhage; 2) newborn mortality due to
                                        infection; 3) the prevalence of low birth weight babies, stillbirths and newborn
                                        mortality due to malaria and congenital syphilis; and 4) the number of HIV
                                        infections transmitted from mother to child. MAISHA is active in every region
                                        of the country, as well as in Zanzibar.




                                                                                                                            i_l
                                 Universal HIV/AIDS Counseling and Testing (UHAI-CT)
                                       Knowing one’s HIV status is critical for preventing the spread of the disease and for
                                           receiving life-extending treatment. With funding from USAID, Jhpiego is:
                                                 1) providing innovative, high-quality, community-based HIV counseling and
                                                        testing services for women and their families in Tanzania; and
                                                          2) working with hospitals and clinics to help them implement the
                                                          Tanzanian government’s new provider-initiated counseling and testing
                                                          (PICT) strategy. Under the former strategy, Jhpiego is supporting and
                                                           mentoring local nongovernmental organizations to scale up counseling
                                                           and testing and bring the services to the high-risk populations they
                                                           represent. For the latter strategy, health care providers offer counseling
                                                           and testing for HIV to all patients who come to health facilities,
                                                            especially those coming for diseases associated with HIV, such as
                                                            tuberculosis. UHAI-CT is active in nine regions of Tanzania.

                                                            The Communication and Malaria Initiative in Tanzania
                                               Jhpiego is a partner in the USAID-funded COMMIT (the Communication and
                                               Malaria Initiative in Tanzania) program. Led by The Johns Hopkins Center for
                                               Communication Programs (JHU-CCP), COMMIT is implementing a
                                               comprehensive strategy for behavior change and communication in the
                                               prevention and case management of malaria in Tanzania. The program includes
                                               promotion of insecticide-treated nets, use of artemisinin-based combination
                                               therapies for malaria treatment, intermittent preventive treatment of malaria for
                                               pregnant women and indoor residual spraying. Under this program, Jhpiego is
                                               working with health care providers at different levels of the health system to
                                               improve their interpersonal communication skills to counsel clients on malaria
                                               prevention and prompt case management.

                                               Maternal and Child Health Integrated Program
                                               Jhpiego/Tanzania has received USAID funds under MCHIP to scale up voluntary
                                               medical male circumcision services (VMMC) for HIV prevention. As the lead for
                                               VMMC activities in Tanzania, Jhpiego is responsible for developing and adapting
                                               VMMC training and supervision materials, orienting and preparing VMMC scale-
                                               up sites, and establishing a pilot program at Iringa Regional Hospital, which is
                                               located in the region with both the highest prevalence of HIV and the lowest
                                               prevalence of male circumcision in all of Tanzania. In 2010, Jhpiego-Tanzania
                                               implemented sub-Saharan Africa’s first high-volume VMMC campaign using
                                               Models for Optimizing Volume and Efficiency (MOVE) techniques, circumcising
                                               10,352 clients at just five sites in 36 days. As of July 2012, Jhpiego has supported
                                               the MOHSW to circumcise a total of more than 100,000 men in Iringa and
                                               Tabora regions of Tanzania.

                                               Infection Prevention and Control in Tanzanian Hospitals
                                               With funding from CDC, Jhpiego is building the capacity of the MOHSW to
                                               address infection prevention and control in hospitals across Tanzania. Using a
                                               whole-site quality improvement approach, Jhpiego and the MOHSW work with
                                               teams in each hospital to address infection control and develop targeted
                                               interventions for provider and patient safety, health care waste management,
A mother brings her baby to a health           injection safety and the provision of post-exposure prophylaxis for HIV/AIDS.
facility for immunizations, Morogoro
region, Tanzania.                              Building on past efforts in this area, Jhpiego is supporting the government to
develop and disseminate guidelines and standards, train health care workers,
provide essential supplies, and promote behavior change and communication.
The goal of the program is to reduce the toll of health care-associated infections
in Tanzania.

Wazazi na Mwana
Under a subaward with Plan International, Jhpiego is working to improve
maternal, newborn and child health for underserved populations, particularly
women of childbearing age, in four districts in Tanzania (two each in Mwanza and
Rukwa regions). Under this initiative, Jhpiego is leading efforts to strengthen all
201 health centers and dispensaries in the four districts to provide quality services
for basic emergency obstetric and newborn care, and for integrated management of
childhood illness. In addition, Jhpiego is building the capacity of four health
centers to provide comprehensive emergency obstetric and newborn care services.
Anticipated project results are to increase the number of: 1) frontline health
workers trained, equipped and retained to deliver essential preventive and curative     Health care provider at Mugolele Health
                                                                                        Center, Morogoro region, Tanzania.
services for pregnant women, new mothers and newborns; 2) pregnant women
accessing health services during the pre- and postnatal period; 3) pregnant women
exclusively breastfeeding infants up to six months of age; 4) women assisted during
childbirth by skilled birth attendants; and 5) effectively treated cases of common
childhood illnesses in children under five years of age.

Research Studies
In addition to the programs above, Jhpiego is currently implementing the
following three research studies in Tanzania:
   Jhpiego is working with JHU-CCP on the USAID-funded Systemic
    Monitoring of Male Circumcision Scale-Up Program to coordinate and
    implement a study at VMMC sites in Iringa to determine if the adoption of
    higher-efficiency techniques is associated with higher levels of productivity
    of VMMC services while maintaining adequate quality in Kenya, South
    Africa, Tanzania and Zimbabwe.
   With funding from CDC and USAID, Jhpiego is testing two different
    models of PICT in outpatient settings. This multi-country study is being
    conducted in nine sites in Tanga, Tanzania.
   Jhpiego is working with the National Institute for Medical Research on a
    CDC-funded study aimed at increasing uptake of VMMC among men aged
    20 to 49 years of age in the Iringa and Tabora Regions of Tanzania.
   With funding from USAID, Jhpiego is working with the Zanzibar Malaria
    Control Program to examine the prevalence of the malaria parasite in the
    placentas of recently delivered mothers in order to determine the necessity
    of presumptive treatment of malaria in pregnancy.

Key Accomplishments
 The UHAI-CT Program has counseled and tested nearly 650,000 people.
   More than 2,300 health care providers in six implementing regions have
   been trained in PICT, and many of those trained have in turn trained other
   providers.
                                               Under the MAISHA Program, 100% of antenatal care providers in the
                                                country have been trained in focused antenatal care (FANC), and an
                                                estimated 74% of facilities have a provider trained in FANC on staff. Jhpiego
                                                has provided essential medical equipment and clinical supplies for quality
                                                maternity services to over 150 facilities totaling more than $320,000.
                                               In 2010, Jhpiego/Tanzania implemented sub-Saharan Africa’s first high-
                                                volume VMMC campaign—circumcising 10,352 clients at just five sites in
                                                36 days—and provided a model that other countries in the region are now
                                                following. Of those circumcised, 99% were also tested for HIV and learned
                                                their HIV status—the highest acceptance rate in all VMMC programs
                                                internationally. In 2012, the latest campaign served 25,840 clients in two
                                                regions in only six weeks, bringing the total number of men and boys
                                                circumcised under the MCHIP program in Tanzania to over 100,000.
Vaccination day at Kivunge Health Center,
Zanzibar, Tanzania.
                                            Partners and Donors
                                             Jhpiego’s primary donors in Tanzania have been USAID and CDC. The
                                               Canadian International Development Agency (CIDA) is a new donor,
                                               through the partnership with Plan International.
                                             Key local partners include the MOHSW, the White Ribbon Alliance for
                                               Safe Motherhood in Tanzania, T-MARC (a Tanzanian social marketing
                                               organization), nursing, midwifery and medical councils and associations,
                                               and others.
                                             The MAISHA consortium, led by Jhpiego, includes Save the Children, as
                                               well as partnership with JHU-CCP’s Tanzania Capacity and
                                               Communication Project.
                                             Under the UHAI-CT program, Jhpiego’s partners include Africare and
                                               T-MARC.
                                             The COMMIT consortium, led by JHU-CCP, consists of Jhpiego, PSI and
                                               the Research Triangle Institute.
                                             Under the CIDA-funded Wazazi na Mwana, Jhpiego is partnering with
                                               Plan International (as the prime awardee) and Africare.

                                            References
                                            Population Reference Bureau. 2012 World Population Data Sheet. Washington, D.C.
                                            Tanzania Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC),
                                            National Bureau of Statistics (NBS), Office of the Chief Government Statistician
                                            (OCGS), and Macro International Inc. 2008. Tanzania HIV/AIDS and Malaria
                                            Indicator Survey 2007–08. Dar es Salaam, Tanzania: TACAIDS, ZAC, NBS,
                                            OCGS, and Macro International Inc.
                                            Tanzania National Bureau of Statistics and ICF Macro. 2010. Tanzania
                                            Demographic and Health Survey: 2010. Dar es Salaam, Tanzania: National Bureau of
                                            Statistics and ICF Macro.

				
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