1. 1 AFRICA LOCAL GOVERNMENT FORUM: SERIES IV SESSION 3 TAKING THE LEAD IN COORDINATION AND ACTION : STRATEGY AND PARTNERSHIP DAR ES SALAAM CITY COUNCIL TANZANIA By Lillian Mnzava

2. 2 Africa Africa

3. 3 Introduction: Coordination, Integration and Partnership in Developing HIV/AIDS Strategy It is an important component of National Policy on HIV/AIDS. The national policy call for establishment and strengthening of partnership for an expanded response among all stakeholders: – Government institutions – Development partners – PLHA – Private Sectors – NGOs, CBOs and Faith Based Institutions.

4. 4 Coordination in HIV/AIDS Control Strategy The local government has taken a coordinating role by appointing HIV/AIDS coordinators for each Municipality. The HIV/AIDS coordinators are responsible for networking and bringing together various organizations implementing control/prevention activities.

5. 5 Integration in HIV/AIDS control strategy Dar es Salaam has 3 Municipalities served by 68 Public owned health facilities and over 300 Private facilities. All Municipalities have integrated HIV/AIDS related services and prevention programs into their Public Health delivery system. The services which have been integrated include: 1. IEC/BCC at 68 public health facilities. 2. Treatment of Sexually Transmitted Infections (STI) and other opportunistic infections.

6. 6 Integration in HIV/AIDS - Continue 3. Voluntary Counseling and testing services (VCT). 4. Home based Care operating from 60 public facilities in 73 Wards. 5. Management of opportunistic infection at 3 public hospitals and 5 health centers. 6. Prevention of mother to child transmission (PMTCT). 7. Screening of blood for transfusion at 3 Public Hospitals. 8. Orphan care/support at 3 public hospitals. 9. Legal aid at 3 Public Hospitals.

7. 7 Partnership in HIV/AIDS control strategy The local Government Authority in Dar es Salaam is working in partnership with over 131 NGOs, CBOs & FBOs implementing HIV/AIDS Control activities the major ones are: i. CCBRT – HBC, VCT, Legal aid at hospital & orphan care. ii. AMREF-VCT at two HCs. iii. PATHFINDER-HBC at 9 Public HCF/Wards,youth clinics with AYA at 5 Public HCFs. iv. MUCHS/HAVARD- PMTCT at 17 HCFs.

8. 8 Strategies cont….. v. UNICEF – PMTCT at one HCF. Vi. PASADA – Referral center for VCT, PMTCT, Orphan care/support,HBC & Support i.e. ARVs. vii. MUCHS – TB vaccine for HIV positive.

9. 9 An overview of Local Government NGOs, CBOs and FBOs collaboration Active collaboration between Local government and other stake holders in various shapes and approaches are in Place: Pooling resources together in establishing, promotion and running of services such as: – 12 VCT sites (AMREF,CCBRT etc) – Home based care services in 47 out of 72 Wards (CCBRT,PATHFINDER) – PMTCT in 17 Public Health Facilities(MUCHS,PASADA).

10. 10 Cont.. Creating an enabling environment for smooth operation and implementation of various activities by NGOs and CBOs e.g. providing financial support (NACP,TACAIDS (GoT), UNAIDS, WHO, USAID, BELGIUM AID, UNFPA & ITALIAN GOVERNMENT. Support efforts of NGOs/CBOs conducting promotion campaign by waiving Municipal fees on billboards erected in public places( local Govt and Municipalities).

11. 11 Relationship between the local government and AIDS service Organizations The Council is working together with most of these organizations by: Supporting them to implement their activities by providing: – Financial support – Training/Technical support – IEC/BCC materials – Condoms Working together to deliver services eg Collaboration with: – AMREF (VCT services). – Pathfinder, CCBRT& PASADA (home based care). – PSI (Condom promotion and distribution).

12. 12 Local responses to HIV/AIDS: Gaps discovered Assessment of local response to HIV/AIDS have been incorporated into Local government reform process which consist 17 steps. Lack of effective networking between NGOs/CBOs/FBOs themselves and with the local government. Ineffective communication and coordination. Inadequate resources. Donor dependence Services are concentrated in urbanized areas while peripheral areas are least served. High demand of services in relation to the existing capacity.

13. 13 Cont….. Access to Data/ Information. Forum for all stakeholders. Incomplete mapping of NGOs/ CBOs /FBOs.

14. 14 Some of the Mainstreaming activities implemented by Local Government Collaboration with private investor (Dispostek) on safe disposal of needles and other hospital waste. Waste disposal plant will start operation in January 2004-By Laws in place. Advocacy and awareness campaigns to fight HIV/AIDS stigma/discrimination and high sexual behavior through: – Public meetings and religious gatherings. – Public bus routes and tickets containing messages on HIV/AIDS. – Along highways, Streets and in play grounds. – Distribution of IEC/BCC materials to all stakeholders. Provision for referral system between schools and adolescent sexual and reproductive health services.

15. 15 Partnership between Local Government and AIDS service organizations : Facilitate local response to HIV/AIDS control. Increase coverage and efficiency in service delivery especially at grass root level(i.e. Municipalities 68 HCFs & PASADA 13 HCFs Reduce burden of local government in service delivery. The NGOs,CBOs and FBOs are close to the community (Total of 131).

16. 16 Identified gaps on functional integration Limited access to VCT & referral services especially in rural areas. Inadequate integration between VCT/Care and support services including provision for: – ARVs – Legal aids – Nutritional counseling – Management of opportunistic infections. Coverage is still very low, however we intend to improve through HBC.

17. 17 Addressing gaps on functional integration Incorporating VCT services in all Public health delivery system especially in peripheral areas or through HBC. Establishing outreach counseling services in remote areas through HBC program. Utilizing the exisisting mobile van ( 1/Municipality) to provide ANC and VCT services. Strengthening collaboration with NGOs, CBOs and FBOs in increasing access to Home based care, nutritional counseling and Legal services at community level by introducing a joint forum and Data net working. Introduction of ARV, management and prevention of opportunistic infection at health facility level. Sharing of responsibilities taking on board Ward/Community level HIV/AIDS Committees. Review /complete mapping of all NGOs, CBOs and FBOs.

18. 18 Conclusion Effective and sustainable local response to HIV/AIDS require Coordination, Integration and Partnership with NGOs, CBOs, FBOs and other stake holders. Local Government need to take the lead in identifying, working together and supporting AIDS service organizations.

19. 19 Thank you for your kind attention Acknowledgement City Director-Dar es Salaam Municipal Directors – Ilala, Kinondoni and Temeke Regional Medical Officer – Dar es Salaam Municipal Medical Officers of Health: Ilala, Kinondoni and Temeke.

20. 20 References ALGAF HIV/AIDS Training module: Guidelines for Participants Dar es Salaam City/Regional Report. Local Government Responses to HIV/AIDS: A Handbook Municipal HIV/AIDS Implementation reports – Ilala, Kinondoni and Temeke National Policy on HIV/AIDS 2001