The Benjamin Mkapa HIV/AIDS Foundation

“Due to severe shortage of staff in our health facilities, we are obliged to use the 9 Emergency higher professionals not only for HIV/AIDS services but also in assisting deliveries from pregnant mothers. Indeed they are very supportive to us” - ANNA K. LUGANGA, DISTRICT NURSE, MAFINGA DISTRICT COUNCIL

Human Resource for Health (HRH) making in-roads
The Benjamin William Mkapa HIV/AIDS Foundation (BMAF) has for the past three years contributed commendably in strengthening Human Resources for Health (HRH) through its Mkapa Fellows Program jointly supported by the Norwegian government and the Clinton Foundation. The innovative program is anchored on recruitment, trainings and deployment of skilled health personnel to underserved rural districts of Tanzania. Started its implementation in July 2006, the programme has recruited and conducted induction trainings to ninety-nine (99) Mkapa Fellows that have been posted to 33 rural districts, in effort to enhance access to quality and affordable health services particularly HIV & AIDS to needy Tanzanian.

Within two years of operation, encouraging signs of success in scaling up HIV and AIDS care and treatment services, BMAF has been granted a second project in February 2007 – Emergency Hiring Project (EHP), a project of the Ministry of Health and Social Welfare that is financially supported by the Global Fund. The Foundation provides technical and managerial assistance to the project and successfully fast tracked hiring of 176 skilled health workers that had been deployed in 19 rural districts.

Both programmes strive to alleviate the critical shortage of HRH as well as accelerate access to Anti-Retroviral Therapy (ART) through improving quality of care, promoting public education, and strengthening counseling services. Placed on 3-years contract with a defined remuneration package has assured high retention of 82% among the programme recruitees. Notable strong collaboration of programme staff with district health teams, has laid a solid foundation for the district and other stakeholders to focus more intensively in HIV/AIDS care and treatment.

Care and Treatment Services improving
The injection of the 275 trained staff in care and treatment of HIV/AIDS services has relieved the burden of care that health workers experienced in the existing districts. On the other hand the extra pair of skilled hands meant increased daily operating hours from 4 to 8 for five days instead of twice a week. This means clients are assured of timely services, improved health education and counseling on HIV/AIDS, and prompt provision of ARVs, the result of which is improved quality of care in terms of well prescribed drugs and accurate diagnostic check-ups despite limited laboratory facilities. The districts currently benefiting from the Fellows programmes have registered up to three fold increases of clients enrolled in Care and Treatment Centers (CTCs) and those on ARV’s as shown in the two graphs fig 1 and fig 2 below.

The Performance in HIV/AIDS Care and Treatment for 26 months in the 33 districts benefiting from Mkapa Fellows:	A Progressive increment of CTC clients in the 19 EHP districts within 16 months of stay:

Through Mkapa Fellows programme support for conducting outreach/mobile services, HIV/AIDS services have extended to remote communities. Reports from the districts benefiting from the programme show that there has been a progressive increase of sites providing care and treatment from 47 to 170 sites which include stand alone, re-filling centers and mobile clinics. In order to further strengthen the HIV/AIDS outreach and clients referrals, the Foundation supported five districts of Kilindi, Mpanda, Simanjiro, Micheweni and Kilolo, each with one 4WD vehicle Health staff under the two programmes have also been actively involved in collection and transportation of blood samples for clinical monitoring of patients who are using Anti- Retorviral drugs at least twice a month to the regional and district hospitals.

District Health Systems Strengthening initiatives pay off
Both programmes - the Mkapa Fellows and Emergency Hiring (EHP) have scored notable successes in district health management structures and general provision of health services. Ten (10) Medical officers under the Mkapa Fellows Programme have been appointed as District Medical Officers and some of the deployed health personnel have assumed managerial positions in the various Councils Health Management Teams (CHMTs) and in Hospital management teams. Presence of Pharmaceutical and Laboratory specialists have contributed highly in the improvement of the drugs and supplies logistic systems as well as Laboratory services and quality control. Due to the fact that the deployed teams possess varying skills and expertise, their presence additionally contributed to improved obstetrical and child health services particularly provision of Emergency Obstetric Care including surgeries.

Youth and other vulnerable groups were reached through sexual reproductive health services including HIV/AIDS education an experience noted in the districts of Newala, Wete and Tarime. Additionally, the trained teams have provided technical guidance and clinical mentorship on effective planning of district HIV/AIDS interventions and on care and treatment to staff at lower Primary HealthCare units (PHCs), respectively. A unique milestone reached by the Foundation through the Mkapa Fellows Programme is the mainstreaming of Fellows into the public service whereby 27 of them were absorbed during the financial year 2008/09. Additional 93 health staff under the two programmes is in the process of being mainstreamed as well during the FY 2009/10.

Building partnerships and improving data management
A number of bilateral and multilateral partners play a critical role in complimenting the national response to HIV and AIDS, acting at national and local level. These include the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) which has provided training to two Mkapa Fellows to serve as mentors in Urambo and Sikonge districts in Tabora region that have subsequently mentored several other staffs in the newly opened CTCs.

As part of the Mkapa Fellows Package, the availability of computer sets in all beneficiary districts and internet services to 19 districts has attributed to great improvement in HIV/AIDS data management hence contributing to better planning of interventions. Through internet services districts are able to send the collected data to various regional and national bodies in a timely manner. Some of the Mkapa Fellows have also benefited from online trainings on Health and Human Rights and in Effective Project Management. The essence is to encourage more health workers to use the available internet for distance learning.

Promoting policy dialogue for HRH
BMAF is yet another key stakeholder striving to compliment government efforts in addressing HIV and AIDS as well as Health workforce crisis. The Foundation has worked towards building an enabling policy environment through close collaboration and policy dialogue forums on HRH matters with Development Partners and key ministries, the Ministry of Health and Social Welfare, Presidents Office Public Service Management and Prime Ministers Officer Regional Administration and Local Government.

The foundation’s experience in HRH, matters and its membership in the National HRH working group has enabled it to engage with the government in the on-going process of improving production, attraction, recruitment, retention and enhancing productivity of health workers. It has continuously contributed in the process of defining underserved areas as well as in the creation of incentive package for all public workers, including health workers. In collaboration with other stakeholders, the Foundation took the lead in strengthening HRH supervision tool which is to be utilized by the Regional level.
In the same spirit, BMAF’s management actively participated in the development of country proposal for Global Fund Rounds 8 and 9 that focus on HIV/AIDS, Health Systems and HRH strengthening, further underscoring its contribution to national efforts addressing the pandemic.

Despite these achievement, challenges on the ground that are mostly related to health system, limitations and stigma surrounding HIV/AIDS, have been attended by the Districts, respective central government, regionalized HIV/AIDS Partners in close collaboration with Mkapa Foundation. Our Foundation believes in partnership in addressing development challenges within our country.