strategic plan 2013-2016 - agpahi tanzania · 2 agpahi strategic plan 2013-2016 contents ......

Strategic Plan 2013-2016

AGPAHI StrAteGIc PlAn 2013-2016 2

Contents

ACKNOWLEGEMENT AND THANKS.............................................................................................. 4

Acronyms................................................................................................................................................... 5

Foreword .................................................................................................................................................... 7

Executive Summary ................................................................................................................................. 8

CHAPTER ONE ....................................................................................................................................... 9

THE INSTITUTION ............................................................................................................................. 10

1.1 OBJECTIVES AND MANDATE ............................................................................................. 10

1.2. IMPLEMENTATION AND ASSOCIATED CHALLENGES ............................................... 11

CHAPTER TWO .................................................................................................................................... 13

SITUATION ANALYSIS ........................................................................................................................ 14

2.1 Global Status of HIV/AIDS ....................................................................................................... 14

2.2 National Status of HIV/AIDS ................................................................................................... 14

2.3 Programs Implemented by AGPAHI ....................................................................................... 16

2.3.1 HIV Care and Treatment Program .......................................................................................... 16

2.3.2 Reproductive Health and Family Planning ............................................................................. 17

2.3.3 The Prevention of Mother to Child Transmission (PMTCT) Program .............................. 18

2.3.4 Integration of Family Planning Services at C&T/VCT .......................................................... 19

2.4 Funding ........................................................................................................................................ 20

2.5 Situation Analysis Framework .................................................................................................. 21

CHAPTER THREE ................................................................................................................................ 23

STRATEGIC DIRECTION: VISION, MISSION AND VALUES .................................................... 24

3.1 Mission ......................................................................................................................................... 24

3.2 Vision ........................................................................................................................................... 24

3.3 Core Values .................................................................................................................................. 24

3.4 Guiding Principles of AGPAHI’S Strategic Plan .................................................................... 24


CHAPTER FOUR................................................................................................................................... 25

IMPLEMENTATION OF THE STRATEGIC PLAN ........................................................................ 26

4.1 DURATION OF PLAN ............................................................................................................ 26

4.2 IMPLEMENTATION ASSUMPTIONS .................................................................................. 26

4.3 RISK ANALYSIS AND MITIGATION STRATEGIES .......................................................... 26

4.4 GOVERNANCE AND EXECUTIVE LEADERSHIP ............................................................ 27

4.4.1 AGPAHI GOVERNANCE ......................................................................................................... 27

4.4.2 EXECUTIVE LEADERSHIP .................................................................................................... 28

4.5 MONITORING AND EVALUATION (M&E) ....................................................................... 28

4.5.1 THE ROLE OF M&E SYSTEM................................................................................................. 28

4.5.2 DATA USE PLAN ....................................................................................................................... 28

4.5.3 PERFORMANCE MANAGEMENT ....................................................................................... 29

4.5.4 PERFORMANCE MEASUREMENT ...................................................................................... 29

4.5.5 REVIEWING AND UPDATING AGPAHI SIP ..................................................................... 29

4.6 FINANCING THE SIP .............................................................................................................. 30

4.6.1 BUDGET KEY DRIVING ELEMENTS .................................................................................. 30

4.7 EXPECTATIONS ........................................................................................................................ 30

4.8 OPERATIONAL PLAN WITH BUDGET .............................................................................. 31

APPENDICES ......................................................................................................................................... 34

Appendix I List of Stakeholders consulted ......................................................................................... 34


ACKnoWLeGeMent AnD tHAnKs

The development of AGPAHI’s three year strategy plan required a lot of effort, dedication, time and energy of various individuals and organizations. In true sense, AGPAHI would not be able to develop such a comprehensive document without the personal and professional commitment and support of many partners, individuals and colleagues.

The following list contains brief but by no means exhaustive list of some key stakeholders, who, in one way or the other, greatly assisted to make this possible. Our thanks and acknowledgement for your leadership, support and commitment go to:

Centers of Diseases Control and Prevention (CDC)

U.S. Agency for International Development (USAID)

Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)

United Nations Population Fund (UNFPA)

The Board of Directors of agPaHi - Dr. Aggrey K. Mlimuka - Dr. Oswald J. Mashindano - Dr. Marina A. Njelekela - Prof. Eleuther A. Mwageni - Dr. Anja Giphart - Ms. Rosemary Mwakitwange - Mr. Ally H. Laay - Ms. Tatu Y. Msangi

The AGPAHI Management Team and partners who contributed – directly or indirectly - towards the development of this Strategic Plan, we recognize your efforts and say AHSANTE SANA. Your input, advice and direction is very well recognized and appreciated.

We look forward for the collaboration in the implementation of this plan.

______

laurean rugambwa Bwanakunu

executive Director


ACronyMs

AIDS Acquired Immune Deficiency Syndrome

AGPAHI Ariel Glaser Pediatric AIDS Healthcare Initiative

ART Antiretroviral Treatment

ARV Antiretroviral

CCHP Comprehensive Council Health Plan

CDC Center for Disease Control and Prevention

C&T Care and Treatment

CTC Care and Treatment Centre

CHMT Council Health Management Team

CSS Comprehensive Supportive Supervision

DAW Data Analysis Week

DED District Executive Director

DMO District Medical Officer

ED Executive Director

EGPAF Elizabeth Glaser Pediatric AIDS Foundation

ERP Enterprise Resources Planning

FO Funding Opportunities

FOA Funding Opportunity Announcement

FP Family Planning

HBC Home Based Care

HEART Help Expand Anti-Retroviral Treatment

HIV Human Immunodeficiency Virus

HR Human Resources

IRHFP Innovations for Reproductive Health and Planning

LIFE Linking Initiatives for the Elimination of Pediatric HIV

LMIS Logistics Management Information System

M&E Monitoring and Evaluation

MDAs Ministries, Departments and Agencies

MOHSW Ministry of Health and Social Welfare

NACP National AIDS Control Programme


NGO Non-Governmental Organization

NIMR National Institute of Medical Research

NMSF National Multi-Sectoral Strategic Framework

NSGPR National Strategy for Growth and Reduction of Poverty

PMO-RALG Prime Minister’s Office-Regional Administration and Local Government

PMTCT Prevention of Mother to Child Transmission of HIV

PO Program Officer

PO M&E Program Officer Monitoring and Evaluation

RCH Reproductive and Child Health

RHMT Regional Health Management Team

SIP Strategic Implementation Plan

TACAIDS Tanzania Commission for AIDS

TD Technical Director

TDHS Tanzania Demographic and Health Survey

THMIS Tanzania HIV/AIDS and Malaria Indicator Survey

RFA Request for Applications

RM Resources Mobilization

UNAIDS United Nations Organization for AIDS

USG United States Government

VCT Voluntary Counseling and Testing


ForeWorD

Registered in early 2011 as a Non-Governmental Institution, The Ariel Glaser Pediatric AIDS Healthcare Initiative (AGPAHI) was established with the key aim of improving children and families’ health as a whole by eliminating pediatric HIV/AIDS in Tanzania.

AGPAHI was formed as a result of changes in the USG system of managing international organizations that led to the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) supporting the establishment of AGPAHI of which the two independent organizations are affiliated. Both organizations’ mission is to bring hope to children with HIV and AIDS. Both mother and daughter from whom the two organizations are named lost their lives to HIV and AIDS.

This Strategic Implementation Plan is building on the wins and losses, highs and lows, failures and successes that it has experienced since its inception. By having its objectives grouped under Key Strategic and Institutional areas and for a closely monitored period of only three (3) years, the Plan acts as a comprehensive guide that not only addresses the needs of the people it is serving and its stakeholders, but also synchronizes the demands and needs of these two sides.

This Plan is driven by three (3) key strategic areas which together aim to provide a disciplined approach to the management of AGPAHI programs. The Plan aims to continue strengthening the capacity of Institutions as they continue striving to prevent pediatric HIV/AIDS. Further, the Plan aims to allow women and children to access to quality HIV and AIDS services together with fostering partnerships among stakeholders that will ensure the provision of such services.

It is through the key pillars of capacity building, advocacy, research, prevention and treatment that AGPAHI will be able to attain its goals. Working in partnership to create and implement innovative solutions for improved healthcare is also key to achieving the goals.

The path that AGPAHI has chosen is in line with the footsteps being laid down and taken by its founding principles and other affiliated associates in various countries, as well as the Government of Tanzania, fellow Non-Governmental Institutions, private and public persons, all of whom count as key stakeholders central to AGPAHI cause.

__________________

Dr. aggrey K. Mlimuka

chairman


exeCutive suMMAry

The Ariel Glaser Pediatric AIDS Healthcare Initiative (AGPAHI) was founded in February 2011 as a Non-Governmental Organization under the affiliation of the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) with the main aim of curbing HIV and AIDS in children. It is with such aim that this Strategic Implementation Plan (SIP) is derived, taking into consideration the efforts undertaken by the Government through the Ministry of Health and Social Welfare and other key stakeholders to prevent mother to child transmission of HIV.

This Strategic Implementation Plan is the result of key participatory meetings of the Organization’s Board of Directors, Management, Staff, External Stakeholders (Both Government and Non-Governmental), Volunteers and Development Partners. The Strategic Implementation Plan also provides the strategic direction for the AGPAHI and its stakeholders for the next three (3) calendar years of 2013 – 2016, setting out a clear goals and focus in terms of its vision, mission and guiding principles (core values).

There are four chapters in this Plan. Chapter one provides a review of AGPAHI’s mandate, objectives and program areas. Chapter Two of the Strategic Implementation Plan analyses the current situation by looking at the cause(s), analyzing AGPAHI’s Strengths, Weaknesses, Opportunities and Challenges and the existing gap. Chapter Three lays down AGPAHI’s strategic direction, which stems from the organization’s mission, vision and values. Chapter four covers the Implementation Arrangement proposed through sorting out the risk posed, existing leadership and governance, how the program will be monitored and evaluated and performance managed and measured without also forgetting the need for a systematic review system and lastly how the Strategic Implementation Plan will be financed.

It is worth noting that the AGPAHI’s Strategic Implementation Plan is focused on attaining Three (3) key objectives of strengthening the capacity of Institutions as they continue striving to prevent pediatric HIV and AIDS, increasing the awareness of the rights of children and women to access quality HIV and AIDS services and fostering partnerships among stakeholders that will ensure the provision of such sustainable services.

The Organization hopes to achieve all these mentioned objectives through continued close collaboration with the Government of the United Republic of Tanzania, fellow NGOs, International Organizations, Development Partners, those affected by HIV and AIDS, Researchers, Professionals and the community as a whole.


CHAPTER ONEtHe institution


CHAPter one

tHe institution

1.1 oBJeCtives AnD MAnDAte

The Ariel Glaser Pediatric AIDS Healthcare Initiative (AGPAHI) was founded in February 2011 as a Non-Governmental Organization with the main aim of curbing HIV and AIDS in children and also in response to PEPFAR goal that focuses on transition of HIV/AIDS programs to local entities to support sustainability of programs within its host country.

AGPAHI is associated with the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) and the two organizations created a formal affiliation structure aiming to establish mutual beneficial areas of technical collaboration, opportunities to participate in a network of organizations, and a mechanism to promote high standards of management and program implementation.

The transition nature of work and the affiliation arrangement between the two organizations creates a synergy whereby AGPAHI and EGPAF continue to work together towards strengthening capacity and accelerating efforts to eliminate pediatric AIDS, while providing high-quality HIV care, support and treatment services in Tanzania.


AGPAHI’s strategic objectives are:

• To strengthen the capacity of health institutions to prevent and eliminate pediatric HIV and AIDS;

• To create demand for high quality and comprehensive HIV and AIDS, Reproductive and Child Health services;

• To foster partnerships among stakeholders in order to ensure quality comprehensive and sustainable health care services;

1.2 iMPLeMentAtion AnD AssoCiAteD CHALLenGes

1 Strategic Objective 01: to strengthen the capacity of health institutions to prevent and eliminate pediatric HiV and aiDS

Strategies challenges

Enhance knowledge and capacity of Regions, Dis-tricts and Health Facilities in providing high quality HIV comprehensive pedi-atric services.

• Inadequate implementation of health policies

• Weak health infrastructure and lack of equip-ment and supplies

• Limited access to quality health services

• Inadequate human resources, shortage of skilled health providers

• Weak referral systems

• Low utilization of modern family planning services

• Weak health management at all levels and inad-equate coordination between public and private facilities

• Attitude of Health providers influence on patient care (positively or negatively)

• Lack of an age-appropriate comprehensive HIV care package


Promote Evidence Based Decision Making in imple-menting HIV and AIDS Services

• Data use, especially at sub-national level is inadequate

• Mismatch between recording and reporting requirements

• Lack of needed skills mix for M&E as well as capacity building strategies for M&E, especially at sub-national levels

• Inadequate investment in M&E infrastructure, especially electronic data management equip-ment and information and communication technology (ICT) at all levels

• Lack of sustainable strategies for data quality improvement applicable and acceptable to local setting

2 Strategic Objective 02: to create demand for high quality and comprehensive HiV/aiDS, reproductive and child Health services.Increase community awareness of RCH services, including adolescents and men; and ensure that they access quality FP and HIV care services

• Long distance to health facilities

• Unfriendly services to adolescents

• Gender inequalities in decision-making and ac-cess to resources at household level

• Low acceptance of modern FP methods

• Limited spousal communication

• Misconceptions about modern family planning methods

• Traditional and religious beliefs

• Low Male involvement3 Strategic Objective 03: to foster partnerships among stakeholders for ensuring

quality comprehensive and sustainable health care services Improve donor portfolio • Inadequate funding for HIV and AIDS programsStrengthen partnership with the MoHSW and other stakeholders

• Inadequate planning, implementation, monitor-ing and evaluation of health services


CHAPTER TWOsituAtion AnALysis


cHaPter tWO

SitUatiOn analYSiS

2.1 global Status of HiV/aiDS

HIV is among the most common causes of mortality and morbidity worldwide. Sub-Saharan Africa is the most affected part, accounting for 69% of those affected worldwide and with nearly 1 in every 20 adults (4.9%) said to be living with HIV/AIDS.

By the end of 2010 about 34 million people were living with HIV worldwide and among them approximately 3.4 million were children under 15 years (UNAIDS 2011).

Sub-Saharan Africa is the most affected region, with over 68% of the patients and over 76% of all the deaths. Further, almost 90% of all children living with HIV reside in the continent (UNAIDS 2011).

According to the report, new HIV infections were 1.9 million, out of which 390,000 were children under 15 years. Total Deaths were 2.1 million, out of which 250,000 were children (UNAIDS 2011).

The burden of HIV infection is thus still very high despite the decrease in prevalence by an average of 25% between 2001 to 2009 in many Sub Saharan countries (UNAIDS 2011).

2.2 national Status of HiV/aiDS

With a population of 48 million people (2012 census), Tanzania has been hit hard by the AIDS pandemic, notwithstanding the current estimates which are beginning to show decline in prevalence. According to the Tanzania HIV/AIDS and Malaria Indicator Survey (THMIS 2011-2012), the prevalence rate dropped from 7% in 2008 to the current 5.1%. It is further estimated that of the 1.6 million people living with HIV, 10% are children below the age of 15 years. The cumulative number of clients on anti-retroviral treatment (ART) was 384,816, of which 29,457 were children (MoHSW, 2011).

Global epidemiology records show that 90% of all HIV infections in children are acquired from their mothers. Nearly all such infections can be prevented by PMTCT programs providing highly effective ART and ARV prophylaxis interventions (WHO 2010). The MoHSW PMTCT Report of December 2011 shows that in Tanzania more than 95% of pregnant women attended ANC at least once and 81% received HIV testing. Of those who were found to be HIV positive, 93% received ARV prophylaxis and 73% HIV-exposed babies received ARV prophylaxis. Furthermore, the ARV coverage across the country ranged from 50-79% as of December 2012 (UNAIDS, 2013). This low coverage is attributed to the lack of knowledge of the benefits of ARVs in preventing HIV transmission to children. Stigma, Discrimination, Lack of Disclosure, Inadequate Healthcare Workers, Low male involvement and Lack of community involvement also contribute to the problem. These challenges have thus denied HIV-infected children the right to care and treatment


services.

According to the THMIS, Njombe region has the highest HIV prevalence rate of 14.8%. Shinyanga region (new) has a prevalence rate of 7.4%, while the prevalence rates in Geita and Simiyu regions are 4.7% and 3.6% respectively. This is AGPAHI’s focus area (the former Shinyanga region), which comprised of the three areas.

This area has a highly dispersed population, a result of which is limited healthcare coverage with 348 health facilities (9 hospitals, 29 health centers and 310 dispensaries) serving over 10,000 people per facility in comparison to the national average of about 5,500 people per facility. The number of people living with HIV/AIDS in the region stands at over 304,000, with only about 45,544 people using ARVs.


2.3 Programs implemented by AGPAHi

AGPAHI currently implements the following programs:

1. The HIV Care and Treatment Program;

2. The Innovations in Reproductive Health and Family Planning Program;

3. The Prevention of Mother to Child Transmission Program which is part of Linking Initiatives for the Elimination of Pediatric AIDS;

4. The Integration of Family Planning Services at C&T/VCT

2.3.1 Hiv Care and treatment Program

This program ensures that people infected with HIV receive quality comprehensive HIV care. The implementation is through innovative strategies to combat the AIDS epidemic and ensure access to sustainable health services for children, women and families.

AGPAHI started implementing care and treatment services in Shinyanga region (old borders) through a sub-grant from EGPAF under project HEART in May 2011 until January 2012. AGPAHI continued to use EGPAF’s resources under the HEART project until April 2012 when the full transition of care and treatment activities from EGPAF to AGPAHI was completed.

In September 2011, AGPAHI won an Independent Cooperative Agreement from CDC titled ‘Provision of HIV/AIDS Treatment Services by Local Indigenous Entities in the United Republic of Tanzania (PHTSLIE)’ to initially cover two districts in Shinyanga region. The Cooperative Agreement was numbered 1U2GGH000436-01.

Under this award, AGPAHI works to increase access to and enrollment in a comprehensive package of sustainable, high quality, cost-effective care and treatment services for HIV-infected families in the Shinyanga Region. Further, it provides technical assistance to and acts as a capacity building partner to the Government of Tanzania, specifically to build the capacity of health teams at the district level and to improve the health facilities.

AGPAHI works in collaboration with the Tanzania Ministry of Health and Social Welfare (MOHSW) to support Care and Treatment service in 41 sites in Shinyanga region. AGPAHI provides sub grants to all eight local authorities (municipal and district councils) in Shinyanga region, one private parastatal hospital (Mwadui), one faith based hospital (Kolandoto) and the Shinyanga Regional hospital.

Through this sub grant, AGPAHI supports infrastructure improvement through renovations, extensions or repairs and conducts supportive supervision and mentorship to lower level health facilities. AGPAHI also supports capacity building of Regional Health Management Teams (RHMT) and Council Health Management Teams (CHMT) to improve and enhance services.


2.3.2 reproductive Health and Family Planning

Reproductive Health

Reproductive health plays a crucial role in the social and economic development of Tanzania, a country that continues to have one of the fastest growing populations in the world. Much of this rapid growth is a result of Tanzania’s high Fertility Rate (TFR), the average number of children a woman has during her lifetime is 5.4. The TFR among rural women on the mainland 6.1 births while in urban 3.7 birth.

There are some regions in Tanzania with above national average TFR (i.e. Shinyanga 6.3%) due to lack of friendly reproductive health services for adolescents, malfunctioning referral system, lack of skilled attendants, commodities and socio-cultural aspects affecting pregnant woman, gender inequalities in decision making and access to resources at household level are among the challenges in accessing quality of care.

Family Planning

In Tanzania, family planning services continue to face challenges in meeting clients’ expectations and needs. Despite having high knowledge of contraceptives (90%), only 26 % of married women use any method of contraception, with only 20% using a modern method. Current usage of any modern method is higher among sexually active unmarried women than among married women (41% and 26%, respectively).

The known challenges on scaling up family planning services are low acceptance of modern family planning methods, erratic supplies of contraceptives with limited range of choices, limited spouse communication, lack of adolescent-friendly health services, inadequate male involvement, limited knowledge and bias of providers affecting informed choice as well as misconception about modern family planning methods.

Regions with low family planning usages in Tanzania include: Shinyanga region with only 15.1%, Mwanza 15.2%, Mara 11.9%, Tabora 24.5% and Kigoma 25% (TDHS 2010).

With support from USAID, AGPAHI implements the Innovations in Reproductive Health and Family Planning (IRHFP) project.

The project has two major components, the integrated family planning services and Skills Laboratory (skills lab) for midwifery students. Integrated Family Planning services are implemented in four districts of Bukombe, Kishapu, Meatu and Shinyanga. The program aims to increase access and utilization of FP services. This is done through integration of FP services in the existing services, including immunization outreach.

Skills lab for midwifery students is implemented in collaboration with Kolandoto College of


Health and Allied Sciences which is a faith-based private college in association with five other hospitals (Kahama, Maswa, Misungwi, Nzega District Hospital and Shinyanga District Hospital) whereby students are attached for practical midwifery rotations. midwifery rotations.

2.3.3 The Prevention of Mother to Child transmission (PMtCt) Program

Tanzania is among ten countries with the highest number of maternal and newborn deaths. These countries account for 61% and 66% of the global number of maternal and newborn deaths, respectively. The high maternal and newborn deaths may partly be contributed to the level of fertility which has remained high for the past ten years and currently stands at 5.4 children per woman. However, the number varies across the country with urban-rural disparities, whereby women from rural areas have higher fertility rate than women residing in urban areas (TDHS, 2010).

According to TDHS 2010, maternal mortality ratio in Tanzania is 454 deaths per 100,000 live births and the child mortality rate is 32 per 1000 live births (infant mortality rate is 51 per 1000 live births, under 5 Child mortality rate is 81 per 1000 live births).

To achieve Millennium Development Goals (MDGs) 4 and 5, the Government of Tanzania agreed to reduce the under-five mortality rate by two-thirds and the maternal mortality ration by three-quarters, by the year 2015. Despite the efforts which have been made so far, Tanzania still faces a


number of challenges in reducing maternal, newborn and child morbidity and mortality across the country. These include poor health infrastructure; limited access to quality health services; inadequate human resources and shortage of skilled health providers; inadequate skilled service providers related to inadequate incorporation of neonatal content in pre and in-service training curricula; weak referral system especially referrals for neonates and lack of equipment and supplies. Community involvement and participation in planning, implementation, monitoring and evaluation of health services, as well as health seeking behavior are also serious challenges.

In an attempt to mitigate maternal death, emergency obstetric care services are crucial for handling complicated deliveries. WHO recommends that 5- 15 % of all deliveries should be by caesarean section. However, findings from TDHS 2004/05 indicate that only 3% of all babies were delivered by caesarean section which is below the recommended standard. This has been so because of delay of referrals, lack of skilled birth attendants and lack of functioning blood banks at most facilities. This is further complicated by the fact that the inadequate coverage of emergency obstetric care.

AGPAHI is implementing the ‘Linking Initiatives for the Elimination of Pediatric HIV’ (LIFE) program in collaboration with EGPAF. The goal of this program is to increase the quality efficiency and cost-effectiveness of comprehensive HIV/AIDS services in the program’s focus regions of Tanzania and to ensure a sustainable and locally-owned response.

The program implementation started prior to the reconsideration of Shinyanga administrative borders and currently falls in the three regions of Shinyanga, Simiyu and Geita. It is implemented in thirteen (13) districts of Shinyanga District Council, Shinyanga Municipal Council, Kahama Town Council, Msalala District Council, Ushetu District Council, Kishapu District Council, Bukombe District Council, Mbogwe District Council, Bariadi District Council, Bariadi Town Council, Itilima District Council, Maswa District Council and Meatu District Council.

LIFE’s strategic objectives include:

• Increasing access to integrated, quality and comprehensive PMTCT, RHC and community-based HIV/AIDS services;

• Strengthening linkages and referral networks across service delivery points, and facility and community-based services to improve services and ensure a continuum of care;

• Ensuring sustainability through strengthened health systems and through the transfer of capacity, management and oversight of activities to the local government and other local institutions.

2.3.4 integration of Family Planning services at C&t/vCt

This program is also being implemented in Shinyanga region and is funded by the UNFPA. Its goal is to support specifically people living with HIV and the community in general in Shinyanga


region to meet their family planning needs through integration of family planning services in existing HIV services.

The objectives of the project include:

• To create awareness of CHMT and community members on integration approach of FP to VCT and CTC.

• To build capacity of service providers on FP provision at CTC and VCT.

• To increase uptake of family planning among community members.

Currently the project is being implemented at 8 facilities in two councils of Kahama town and Shinyanga Municipal .

2.4 Funding

AGPAHI currently depends on the support of the following agencies for the implementation of the four programs:

1. U.S. Centers for Disease Control and Prevention (CDC) provides funding for HIV care and Treatment programs from September 2011 till September 2016.

2. The United States Agency for International Development (USAID) provides a sub-award


funding through EGPAF for the Prevention of Mother to Child Transmission program. Funding period is from January 2012 to December 2016.

3. The United States Agency for International Development (USAID) provides funding for the Innovations in Reproductive Health and Family Planning program from July 2012 to July 2014.

4. The UNFPA provides funding for the Integration of Family Planning Services at C&T/VCT Project from July, 2013 to June 2014.

2.5 situation Analysis Framework

2.5.1 Casual Analysis

In Tanzania the gaps on curbing the HIV/AIDS prevalence can be grouped as summarized in the following key aspects such as Program Management and Quality Improvement, Supplies and Procurement, Human resources and Financial resources.

2.5.2 SWOC Analysis

• Strength: Locally managed, well trained staff, location of our Head Office

• Weaknesses: Lack of research and Advocacy Unit

• Opportunities: Emerging global pediatric elimination agenda, affiliation with EGPAF

• Challenges: Donor dependency, stereotype about local NGOs, changes of administrative region Shinyanga.

2.5.3 Stakeholders’ Analysis

AGPAHI conducted a stakeholders’ analysis for the purpose of understanding which stakeholders to engage with and how. Moreover, it helps getting the most effective support for the programs from other stakeholders and reduces any obstacles towards successful implementation as shown below:

• Funding and Collaborative Parties: Tanzanian Government, Development Parties (USAID,UN,EU), International Organization, Private Sectors, Local Organization

• Health Sector: RHMT, CHMT, HMT and HCW

• Community/ Beneficiaries: Local Communities i.e. Regional, Districts, Wards and Villages

• Information and Communications Institutions: Research Institutions, Media and Advocacy groups


2.5.4 Gap Analysis and Potential solutions

The gaps identified to be affecting AGPAHI’s operations since its inception are Financial Sustainability and Program Interventions.

Potential Solutions for the above gap analysis are:

• Increase and diversify private sector funding (unrestricted and temporarily restricted contributions)

• Fully engaged and committed board, staff and paid or and volunteering third parties both willing and able to participate in resource mobilization

• Recruit committed and competent experienced staff

• Set up a broad based programme in more regions to improve outreach and make better impact


CHAPTER THREEstrAteGiC DireCtion: vision, Mission AnD vALues


cHaPter tHree

Strategic DirectiOn: ViSiOn, MiSSiOn anD ValUeS

3.1 Mission

Ariel Glaser Pediatric AIDS Healthcare Initiative envisions a nation-wide NGO that would facilitate Children and Families to have access to quality health services and HIV/AIDS treatment.

3.2 vision

AGPAHI aims to improve health of children and families in Tanzania, including prevention and elimination of pediatric HIV/AIDS by working in partnership with the Ministry responsible for health and other partners to create and implement sustainable healthcare programs.

3.3 Core values

AGPAHI strives to achieve the organization’s mission and vision while being guided by Teamwork, Passion, Innovation, Excellence, Accountability, Honesty, Integrity, Transparency, Ethical Conduct and Diversity.

3.4 Guiding Principles of AGPAHi’s strategic Plan

AGPAHI is a relatively new organization. However, its type of work is critical for the elimination of the HIV/AIDS pandemic which has ravaged Tanzania. A few principles will guide the implementation of this plan.

• Through the implementation of the Reproductive Health and PMTCT programs, not only can maternal deaths be reduced but also the problem of HIV infections for newborns will be addressed. With well-trained personnel and decent facilities are both key in ensuring the improvement.

• Family planning services serve many purposes. Apart from allowing for a manageable family sizes, good advice received from the family planning services will help to cut down new HIV infections and in both adults and newborns.


CHAPTER FOURiMPLeMentAtion oF tHe strAteGiC PLAn


CHAPter Four

iMPLeMentAtion oF tHe strAteGiC PLAn

4.1 DurAtion oF PLAn

This comprehensive but practical plan that aims to provide a disciplined approach to the management of AGPAHI programs (Vision and Mission included) for a period of three (3) years i.e. 2013 – 2016 and will be frequently monitored reviewed on an annual basis.

4.2 iMPLeMentAtion AssuMPtions

While AGPAHI’s mission, vision and values shall be upheld at each stage of the implementation phase, the financial, human and social support and commitment shown by the Government, Development Partners, the Board and all other stakeholders is expected to continue so as to attain the commonly held goal of seeing an overall and sustained improvement in the state and health of Tanzanians.

Given the country’s serene social political atmosphere, AGPAHI remains committed to using highly skilled and qualified individuals to continue carrying out its goals while also continuing the close knit collective and collaborative relationship it has with the communities being served.

4.3 risK AnALysis AnD MitiGAtion strAteGies

To meet organizational goals and objectives, AGPAHI has developed techniques to identify and assess the factors that may jeopardize the success of the projects. These techniques identify preventive measures to reduce the probability of risk factors from occurring and identify countermeasures to successfully deal with these possible constrains as shown below:

1. Fraud, Misuse of Donor Funding and Irresponsible use of Organizational Resources

Risk Mitigation

• Carry out Due Diligence to potential Sub-Awardees before engagement

• Carry out regular compliance reviews to Sub-Awardees during Program Implementation

• Conduct compliance review for the Organization

• Assess organization risk periodically and rectify

2. Decrease of funding from USG to support HIV activities

Risk Mitigation

• Solicitation for other Sources of funding.


• Encourage Sub-Awardees to absorb some of the activities into CCHP budgets

3. Low Knowledge of Donor Rules and Regulations

Risk Mitigation

• Train AGPAHI staff and Sub-Awardees on Donor rules and regulations

• Regular monitoring and giving feedback to relevant partners

4. Low commitment to the project objectives and Goals by the Staff and Sub-Awardees

Risk Mitigation

• Introduce motivational programs to energize staff

• Carry out ongoing training to enhance Staff skills and competencies

4.4 GovernAnCe AnD exeCutive LeADersHiP

4.4.1 AGPAHi GovernAnCe

AGPAHI is steered by experienced Board of Directors who are appointed after every two (2) years. The Board has members with the backgrounds in Medicine, Public Health, Law, Finance, Communications and Management. It holds four (4) regular board meetings per year. The Board is also comprised of three (3) committees, namely the Finance and Administration Committee, The Technical Committee and the Communication and Advocacy Committee.

The responsibility of the Board includes but is not limited to the following:

• Defining the mission, vision, purpose and strategic direction of the orga-nization, which includes oversight of programmatic work implemented by the organization

• Selecting the Executive Director of the organization

• Supporting and evaluating the Executive Director

• Overseeing the finances and exercising their fiduciary duty towards the organization to ensure that activities respect the mission, vision, and core values of AGPAHI

• Developing and reviewing policies and procedures

• Overseeing administrative and financial activities of the organization

• Ensuring legal and ethical integrity and ensuring effective planning


4.4.2 exeCutive LeADersHiP

AGPAHI has strong leadership under the Executive Director, Mr. Laurean Rugambwa Bwanakunu, who holds a Master of Public Management (MPM) degree from Potsdam University in Germany and has over 20 years of experience in leading organizations in Africa and Europe. Mr. Bwanakunu has worked with the International Red Cross Movement from 1994 - 2010 in various countries and in different positions where he was responsible for Country Organization Representation, Disaster Management, Water and Sanitation, Human Resources Management, Logistics, Health and HIV/AIDS Programs, and Resource Mobilization.

Over the past two (2) years he has brought leadership and strong experience to AGPAHI by providing assistance in organizational development, facilitating capacity building in resource mobilization and relationship management, and addressing donor compliance issues. His office is supported by AGPAHI staff located at the Head Office in Dar es Salaam and field offices in Shinyanga.

4.5 MonitorinG AnD evALuAtion (M&e)

4.5.1 tHe roLe oF M&e systeM

A strong M & E system that allows for the identification of objectives, targets, challenges, and problems allows for an effective medical database and strengthens the establishment and utilization of up to date tools.

A good M & E system strengthens all the data management systems and capacity in place, thus ensuring informed decision making, quality assurance and program implementation. This initiative also aims to ensure timely availability of new M&E tools for C&T, PMTCT and other related tools and guidelines at the health facility level, in line with guidelines developed by the government and other development partners.

4.5.2 DAtA use PLAn

AGPAHI has a data use plan in place, which includes the following activities:

• Data Analysis Week (DAW): This is done every quarter and aims at sharing data internally and with sub grantees and donors. Data on specific indicators is compiled, analyzed and shared with all the above-mentioned levels for the purpose of program evaluation.

• Experience Sharing: For PMTCT data, quarterly experience-sharing meetings that involve district coordinators are conducted aiming at sharing the performance in each district and deciding the way forward together. In addition, there are other experience-sharing meetings conducted in relation to quality improvement and monitoring and evaluation.

• Evidence Based Work Plan Preparation: Every quarter, the AGPAHI technical team utilizes the data analysis results and the identified challenges in the planning of program activities in all program areas. The team also utilizes the information from CSS and regional coordination meetings to prepare program work plans.


4.5.3 PerForMAnCe MAnAGeMent

Close and continuous M & E of the SIP will be done in tandem with quarterly, bi annual and annual evaluation exercises so as to allow AGPAHI as an organization to understand the progress of the SIP. Resulting evaluation reports will then provide the base for future action plans.

When the ‘Innovation in Reproductive Health and Family Planning’ Program funding from the cooperative agreement with USAID comes to an end in 2014, and the C&T funding cooperative agreement with CDC ends in 2016, similar exercises will be conducted.

4.5.4 PerForMAnCe MeAsureMent

This will be done through the utilization of modern ICT systems that ensure effective data management. This SIP is expected to be effectively executed as stated but only if the stated above assumptions come to fruition. While AGPAHI will remain focused on attaining its goals, room is made for any unforeseen circumstances that may rise up hence the need to retain its flexibility and ability to adapt appropriate measures that will accommodate such changes.

4.5.5 revieWinG AnD uPDAtinG AGPAHi siP

AGPAHI will conduct a quarterly SIP review by all managers (from field offices, different program areas and operations department) as well as an annual review by the Board, which shall consider;


change in environment; new/change in national policies and guidelines; governing bodies that change the HIV landscape in Tanzania; funding opportunities and gaps, and current progress.

During the review of the SIP, activities in the annual work-plan will be reviewed and those that have been implemented will be documented. Those remaining shall be carried over to the following year. Additional strategies will be considered, including geographic expansion, bringing on additional partners and analysis of program data to inform new directions. The communications and outreach department will have a crucial role in documenting the achievements and sharing with staff the annual report, lessons learned and stories from the field.

4.6 FinAnCinG tHe siP

4.6.1 BuDGet Key DrivinG eLeMents

The following budget elements are expected to make up large portions of the costs:

• Personnel: Personnel costs represent a major cost in most projects at AGPAHI. In any project activities, the organization must budget and bill the necessary staff time to the agreement.

• travel, equipment, and Supplies: These costs vary by proposal and should be directly related to the programmatic deliverables and the operational needs of the project.

• contractual: Sub grantee costs are also high due to the nature of our program implementation activities.

• Other Direct costs: Most ODCs are standard expenses incurred across all projects such as rent, communications, fuel, etc. The types of ODCs which can cause the proportion of ODCs to increase are Training and Workshop costs.

4.7 exPeCtAtions

AGPAHI expects to achieve the following in the course of implementing its SIP:

• Becoming a pioneer in the area of prevention, care and treatment of HIV/AIDS, especially pediatric HIV/AIDS by expanding its geographical coverage and programmatic contents. This includes supporting Family Planning (FP), psychosocial support and Home Based Care (HBC) services.

• To pave the way for other upcoming national NGO to secure funding from donors by setting precedence in making smart investments and implementing quality HIV and AIDS programs that impact the lives of Tanzanians.


4.8 o

PerA

tio

nA

L PLAn

Wit

H Bu

DG

et

No.

Objective and Strategy

Timefram

eTarget

K P I

Respon-

sible D

epart-m

ent 2013

20142015

2016Q

1Q

2Q

3Q

4Q

1Q

2Q

3Q

4Q

1Q

2Q

3Q

4Q

1Q

2Q

3Q

4

1Strategic O

bjective 01: To strengthen the capacity of health institutions to prevent and elim

inate pediatric HIV

and AID

S by 2016Enhance know

ledge and capacity of re-gions, districts and health facilities in providing high quality H

IV

comprehen-

sive pediatric services.

Below

5%R

eduction of m

other to child transm

ission of H

IV.

Elimination

of pediat-ric A

IDS

among H

IV

infected children

Technical depart-m

ent

Promote evi-

dence based decision m

aking in im

plement-

ing HIV

and A

IDS ser-

vices

80% of

councilsC

CH

P plans based on available H

IV and

AID

S data

Technical and com

-pliance depart-m

ents.


No.


Timefram

eTarget

K P I

Respon-

sible D

epart-m

ent 2013

20142015

2016Q

1Q

2Q

3Q

4Q

1Q

2Q

3Q

4Q

1Q

2Q

3Q

4Q

1Q

2Q

3Q

4

2Strategic O

bjective 02: To create demand for high quality and com

prehen-sive H

IV and A

IDS, R

eproductive and Child H

ealth services.Increase com

munity

awareness on

RC

H services

including ado-lescents and m

en; and en-sure that they access quality FP and H

IV

care services.

Under-five

mortality

reduced to 65/1000

Reduction

of maternal

, newborn

and child m

ortality and m

orbid-ity rates

Technical ,com

mu-

nication and com

-m

unity outreach

Maternal

mortality

reduced to 80/100,000

CPR

25%Increased contracep-tion preva-lence rate at supported regions


No.


Timefram

eTarget

K P I

Respon-

sible D

epart-m

ent 2013

20142015

2016Q

1Q

2Q

3Q

4Q

1Q

2Q

3Q

4Q

1Q

2Q

3Q

4Q

1Q

2Q

3Q

4

3Strategic O

bjective 03: To foster partnerships among stakeholders for en-

suring quality comprehensive and sustainable health care services

Improve do-

nor portfolioO

ne new

project each year

Multiple

projects funded by different donors

Technical ,com

mu-

nication and com

-m

unity outreach

Strengthen partner-ship w

ith M

oHSW

and other stake holders

Four ac-tivities per year

Joint activi-ties betw

een A

GPA

HI,

MoH

SW

and other stake hold-ers

Technical, com

mu-

nication and com

-m

unity outreach

Total$4,882,310

$6,835,234$9,569,327

$13,397,058

KPI – K

ey Performance Indicator


APPENDICES

APPenDix i List oF stAKeHoLDers ConsuLteD

no Name Designation Organization

1 Dr. Aggrey K. Mlimuka Board Chairman AGPAHI

2 Dr. Oswald J. Mashindano Board Member AGPAHI

3 Dr. Marina A. Njelekela Board Member AGPAHI

4 Prof. Eleuther A. Mwageni Board Member AGPAHI

5 Dr. Anja Giphart Board Member AGPAHI

6 Ms. Rosemary Mwakitwange Board Member AGPAHI

7 Mr. Ally H. Laay Honorary Treasurer AGPAHI

8 Ms. Tatu Y. Msangi Board Member AGPAHI

9 Dr. Ramadhan B. Kabala Acting Regional Medical Officer Shinyanga

10 Mr. Laurean Rugambwa Bwanakunu Executive Director AGPAHI

11 Ms. Theresa WoltersAssociate Director, Capacity Building and Organizational Development

EGPAF

12 Dr. Amos Nsheha Technical Director AGPAHI

13 Mr. John Busungu Finance & Admin Manager AGPAHI


14 Ms. Suzana Mkanzabi Award & Compliance Manager AGPAHI

15 Ms. Zainab Lesian Senior Human Resources Officer AGPAHI

16 Dr. Gastor Njau Regional Program Manager AGPAHI

17 Dr. Sarah Matemu Clinical Services Manager AGPAHI

18 Dr. Doris Lutkam Program Manager, Strategic Information AGPAHI

19 Ms. Gloria Kaaya Support Services Manager AGPAHI

20 Ms. Jane Shuma Program Coordinator, Communication & Out reach AGPAHI

21 Ms. Dafrosa CharlesProgram Coordinator, Innovative Reproductive Health &Family Planning

AGPAHI

22 Ms. Lydia Masaki Senior Finance Officer AGPAHI

23 Mr. Emilian Program Coordinator, Pharmaceutical Management & Supply Chain

AGPAHI

24 Dr. Peter Maro Technical Director (Former) AGPAHI

25 Dr. Marium Ngaeje M&E Manager (Former) AGPAHI

26 Ms. Naina Vira Executive Assistant AGPAHI

27 Mr. Carl Bosser Organization & Management AdvisorBiz-Logic Solutions Ltd

28 Mr. Victor Mrema Attorney Brevis Attorneys

29 Mr. John Bakilana Consultant Freelance

strategic plan 2013-2016 - agpahi tanzania · 2 agpahi strategic plan 2013-2016 contents ......

Documents