1. PATH Tanzania TB, TB/HIV Project & IPT in the Private Health Sector PATH Tanzania TB, TB/HIV Project & IPT in the Private Health Sector East African Health Care Federation Conference Dar Es Salaam: Diamond Jubilee Hall 28 th February, 2013 Dr. Zahra H. Mkomwa; Project Director

2. Presentation Outline: Overview of PATH Tanzania TB/HIV project Major activities and achievements IPT piloting in the private health sector Challenges Way forward Acknowledgement

3. Project Overview Started in 2005, USAID/PEPFAR funded Signed MoU with MoHSW Tanzania - Mainland & Zanzibar Work closely with MOHSW (NACP, NTLP), Regional and District authorities, APHFTA, IP (ICAP, AIDS Relief, EGPAF, I- TECH) and key collaborators Coverage: Working in Dar Es Salaam (Ilala & Kinondoni), Pwani, Kilimanjaro, Arusha Mwanza and Zanzibar (Plan to expand to Simiyu and Mara) Sub-partners: UCSF, Dartmouth, MSH and Initiative Inc. Staffing: > 70 staff (seconded and central staff)

4. Major activities Lab strengthening Procured 82 LED Microscope (4 placed at Private facilities) 2 Gene Xperts operational  Finalize the national TB lab strategy TB/HIV Supporting 1,042 facilities (197 private health facilities) PITC – 95%, CPT – 98% ART uptake 54% IPT (Hindu Mandal & St. Elizabeth) Pediatric TB National guidelines Training curriculum Trained 273 HCWs  Continue to scale-up, mentor, and monitor results  Community and private sector Involvement  Capacity building for HCP (training, supervision and mentorship MDR TB Develop Guidelines/training material Support cohort review panel 123 patients were initiated treatment as of Dec 2012 Developed decentralization plan - Shift patients in intensive treatment phases to districts facilities

5. PPP activities Type of trainingNo. HCP trained 3I’s46 Pediatric TB49 LED Microscopy4 MDR-TB3 X-ray interpretation 3 TB DOTS36 Total141 Support development of National guidelines: TB work place and TB/Diabetes Conduct supportive supervision and mentorship Capacity building: Trained 141 Health care providers in different focus areas

6. Number of PHFs in PATH supported regions as of Sept 30,2012 RegionNumber of Public facilities Number of Private facilities Total number of facilities Arusha16834202 Dar es salaam593493 Mwanza26739306 Pwani13330163 Zanzibar12818143* Kilimanjaro9344135* TOTAL8451971,042

7. Contribution of PHFs on TB Case Notification April – Sept 2012 RegionTotal TB PatientsContribution from Private Facilities % Contribution of Private Facilities Arusha159958737% Dar es salaam4,6331,06823% Kilimanjaro1,18137031% Mwanza3,08084327% Pwani95628332% Zanzibar2482410% TOTAL11,6973,17527% Private sector can contribute and improve TB case notification if well involved !

8. Isoniazid Preventive Therapy (IPT) Tanzania started piloting IPT in 20 sites in 2012 PATH supports piloting IPT in 2 private hospitals : o St. Elizabeth (Arusha) o Shree Hindu Mandal (Dar) Started in August 2012: Activities conducted: o Training of HCP o distribution of drugs and data collection tools o Supportive supervision and mentorship o The National Policy Guideline for IPT is used in both the public and private sectors.

9. Status of IPT Pilot – Hindu Mandal Hospital, Dar : 31 st Dec 2013

10. Status of IPT Pilot – St. Elizabeth Hospital, Arusha: 31 st December 2013

11. Challenges and way forward SNChallengesWay forward 1.Few clients screened for TB and IPT. Few IPT-eligible clients initiated INH Strengthen services through supervision, mentorship, close monitoring and motivation of HCPs 2.Human resource shortage, capacity, transfers Advocate for Government to second staff to private facilities, Support training for private HCPs 3.Poor infrastructure for some PHF: Inadequate space, equipments Advocate for support from Government, partners/donors) for: renovations/construction and supply of equipments

12. Acknowledgement USAID MOHSW Tanzania Mainland MOH Zanzibar APHFTA Shree Hindu Mandal and St. Elizabeth admin and staff Patients Regional and District coordinators

13. Thank you for listening zmkomwa@path.org +255 655 371 137